Madagascar is pursuing financial sustainability for its immunization services through legislation. The Sabin Sustainable Immunization Financing (SIF) Program began its efforts in Madagascar in December 2009.

Immunization Program Structure

Madagascar’s Expanded Program on Immunization (EPI) is located in the Immunization Department, Maternal and Child Health Directorate, General Secretariat, Ministry of Health & Family Planning (MOHFP).

Madagascar’s Progress to Date

Government Spending on Immunization

Expenditure Tracking

Legislation for Sustainability

Budget Advocacy

SIF Program Inputs

Government Spending on Immunization

Over the period 2006-2013, Madagascar’s Gross National Income rose from US$280 to $440 per capita, a 57 percent increase. According to the WHO/UNICEF Joint Reporting Form (JRF), the Malgache government spent $1 on routine immunization per surviving infant in 2006. By 2013, this figure had risen to $3, a 200 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. Since 2010, Madagascar has reported inconsistently on JRF financial indicators. The data nonetheless suggest that Madagascar has progressed towards country ownership of its immunization program.

Madagascar’s JRF Financial Feedback Report, 2006-2014.

Expenditure Tracking

Immunization is a mandatory expense for 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.

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 workers and their families. 

In February 2012, a law drafting committee was established. The committee finalized a draft immunization bill thereafter. Peers from other Francophone African SIF countries proposed amendments to the draft bill in November 2012. The committee incorporated these amendments.

In June 2015, Members of Parliament (MPs) and government officials worked on the bill.

Budget Advocacy

In February 2016, two Malgache MPs attended and signed a Parliamentary Statement in Support of the Ministerial Conference on Immunization in Africa. 

SIF Program Inputs

  • September 2010, November 2012, December 2014, June 2016: Cameroonian counterparts join DRC, Congo, Malgache, Malian, and Senegalese peers in Sabin-sponsored peer review workshops
  • August 2015: Sabin Senior Program officer convenes NAHC Chairman, Senatorial Secretary’s Cabinet Chief, and seven Committee Members to track progress towards establishment of an advocacy committee
  • June 2015: Sabin Senior Program Officer co-organizes third legislative workshop
  • June 2012: Malgache counterparts share draft immunization bill with DRC officials in Sabin-sponsored study tour
  • November 2011: Sabin Senior Program Officer organizes national advocacy and legislative workshop
  • June 2011: Sabin Senior Program Officer and SIF Program Director organize MP briefing
  • February 2011: Sabin Senior Program Officer organizes MP briefing
  • December 2009: Sabin Senior Program Officer and SIF Program Director introduce SIF program to Malgache government

Last Updated July 11, 2016