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

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% 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% increase. While increasing in absolute terms, the government share of total routine immunization expenditures dropped from 13% to 6% 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 their beneficiaries (workers and their families). 

In February 2012, a law drafting committee was established. The committee finalized a draft immunization bill thereafter. African counterparts proposed amendments to the draft bill in November 2012. The committee incorporated these amendments.

In June 2015, MPs and government officials worked on the bill.

SIF Program Inputs

  • June 2015: Senior Program Officer co-organizes legislative workshop
  • December 2014: Malgache counterparts join DRC, Congo, Senegalese, Cameroonian, and Malian delegates in Sabin-sponsored peer review workshop
  • August 2013: Malgache counterparts attend Sabin-sponsored colloquium
  • November 2012: Malgache counterparts join DRC and Congo delegates in Sabin-sponsored legislative peer review workshop
  • June 2012: Malgache counterparts share draft immunization bill with DRC officials in Sabin-sponsored study tour
  • November 2011: Senior Program Officer organizes advocacy and legislative workshop
  • June 2011: Senior Program Officer and Program Director organize MP briefing
  • March 2011: Malgache counterparts attend Sabin-sponsored colloquium
  • February 2011: Senior Program Officer organizes MP briefing
  • December 2009: Senior Program Officer and Program Director introduce SIF program to Malgache government