USAID Mikolo

Project Overview

The USAID Mikolo Project in Madagascar reduced maternal, infant, and child morbidity and mortality by increasing the use of community-based primary health care services and encouraging women and children to adopt healthy behaviors. The five-year project directly served an estimated 4.6 million people living more than five kilometers from a health facility.

USAID Mikolo, which was implemented by MSH with partners Action Socio-sanitaire Organisation Secours, Catholic Relief Services, Institut Technologique de l’Education et du Management, Dimagi, and Overseas Strategic Consulting, Ltd, worked alongside the Government of Madagascar to strengthen the capacity of the national health system, particularly at the community level, to deliver high-quality health services along the continuum of care.

Over the life of the project, USAID Mikolo achieved significant gains in maternal and child health:

  • Continuing users of family planning increased from 66,465 in 2014 to 150,557 in 2018,

  • 130,250 children under five with diarrhea were treated with oral rehydration therapy by community health volunteers (CHVs)

  • 302,158 children under five with pneumonia were taken for appropriate care

  • The treatment rate for confirmed malaria cases in children under five treated with artemisinin-based combination therapy (ACT) by CHVs increased from 58% in 2014 to 93% in 2018

  • ACT stock-outs decreased from 20% in 2014 to 5% in 2018

  • 2,987,746 children were registered for growth monitoring and promotion activities

  • 118,664 women were referred by CHVs for antenatal care

  • Facility-level deliveries increased from 50,192 in 2015 to 115,148 in 2017

Additionally, the project, in partnership with the Ministry of Public Health (MOPH), introduced and scaled up innovative interventions, tools, and approaches, such as a mobile health application to improve the quality of CHV service delivery and reporting; a CHV peer supervision program to improve quality of care, reduce the human resources gap, and improve CHV motivation; a community-based commodity logistics management system, an epidemiological surveillance approach that incorporates community-level data to more rapidly respond to malaria outbreaks; Savings and Internal Lending Communities to increase access to credit and  economic empowerment of community members; and a series of approaches to assure, improve, and sustain the quality of community-based health services delivered by CHVs.

Overall, the gains made over the past five years helped to build a stronger and more sustainable health system that is responsive to the needs of Madagascar’s population. Through close collaboration and coordination with the MOPH, the project was able to effectively and efficiently transfer ownership of the activities, programs, tools, and materials over to the Government of Madagascar and its partners.


Project Team