The Accessible Continuum of Care and Essential Services Sustained Program

The Accessible Continuum of Care and Essential Services Sustained Program

Improving Health Outcomes through Sustainable Changes

An ACCESS staff member and a Community Health Volunteer side by side. Mother and child sleeping under a mosquito bed net

The ACCESS program worked shoulder to shoulder with the communities it served to improve the quality of the country’s health system. Now, the Malagasy people can continue these healthy practices and proudly say “we did it ourselves!”

A Community Health Volunteer conducts awareness-raising for a family

More than 18,000 community health volunteers (CHVs) across 11 regions were equipped with the training and tools to provide quality health services, including family planning, malaria case management, and nutrition monitoring.  

ommunity Health Volunteer conducts awareness-raising among women about family planning

With the support of CHVs, contraceptive coverage rates increased from 34% in 2019 to 47% in 2024, and more than 3 million new family planning users were reached across 14 regions.  

A midwife takes the vital signs of a pregnant woman

In facilities, ACCESS strengthened the capacity of health workers to provide quality care and supported awareness campaigns to encourage pregnant women to utilize these services. 

A midwife conducting a prenatal consultation with a pregnant woman

From 2021 to 2024, the percentage of women receiving uterotonics—a medication that reduces the risk of postpartum hemorrhage—rose from 63% to 89%, protecting new mothers from this life-threatening condition. 

Community Health Volunteer is using CommCare

CHVs are equipped with tablets and smartphones to use the CommCare application, an electronic health information platform. More than 4,300 CHVs now use the app to provide quality care, report data, and monitor diseases. 

Mother and child sleeping under a mosquito bed net

From preventive methods like mosquito nets to proper diagnosis and treatment, ACCESS helped communities take a comprehensive approach to combat malaria. The percentage of patients with malaria receiving artemisinin-based combination therapy treatment increased from 85% to 94%.

Baby touches the arm of a health care worker. ACCESS Madagascar

By integrating nutrition, vaccination, and treatment of common illnesses into primary health care services, ACCESS helped reduce child mortality and combat the prevalence of malnutrition, malaria, pneumonia, and other serious diseases among children.  

New born baby receives a vaccine. ACCESS Madagascar

Between 2021 and 2024, the coverage rate among infants for the pentavalent vaccine, which protects against five life-threatening diseases, increased from 75% to 83%, and the success rate for resuscitation of newborns at birth increased from 85% to 93%.

A Community Health Volunteer is teaching a mother the proper behavior change of handwashing with soap and water. ACCESS Madagascar

To improve hygiene, sanitation, and access to safe drinking water, ACCESS trained 418 health workers in WASH approaches and constructed and rehabilitated 183 toilets equipped with handwashing facilities.

Community health volunteers pose for a picture. ACCESS Madagascar

These results are only the beginning. Years of partnership with the Ministry, health workers, and community members allowed the program to ensure these innovations and improvements can be carried on by the Malagasy people for years to come.  

Overview

Through the USAID Accessible Continuum of Care and Essential Services Sustained (ACCESS) program, we continued to support the Government of Madagascar in accelerating sustainable health impact and strengthening the Ministry of Public Health’s stewardship of the health sector. The ACCESS program worked to ensure that person-centered, quality primary health care services were sustainably available and accessible to all Malagasy communities in the program’s target regions; that local health systems functioned effectively to support quality service delivery; and that the Malagasy people sustainably adopted healthy behaviors and social norms. ACCESS supported the Ministry in improving the quality of care provided by community health volunteers, health centers, and district hospitals through approaches that included low-dose, high-frequency training and supportive supervision; continuous quality assurance cycles; e-learning; improved data use for decision making; and enhanced supply chain systems.

In close partnership with the Government of Madagascar and its local partners, MSH conducted activities in 78 districts across 14 regions covering more than 16 million people. These activities included efforts to improve maternal and child health; prevent, detect, and treat malaria; increase access to and uptake of reproductive health and family planning services; combat malnutrition; and ensure access to safe water, hygiene, and sanitation. In addition, the program provided comprehensive support to the Ministry during public health emergencies, including the measles outbreak, a resurgence of poliovirus cases, and the COVID-19 pandemic. ACCESS helped train vaccination teams, improve accessibility through the establishment of vaccine sites and mobile clinics, implement communication campaigns to raise awareness, and strengthen information systems to monitor these epidemics.  

From 2018 to 2025, ACCESS contributed to results that showed improved health outcomes for the Malagasy people. Across nearly 1,900 health facilities supported by ACCESS:

  • Maternal mortality decreased from 130 to 65 per 100,000 live births (Oct. 2019– Sept. 2024) 
  • Neonatal mortality decreased from 5 to 3 per 1,000 live births (Jan. 2021–Sept. 2024) 

Meet the Community Health Volunteers Who Are Improving Access to Care in Madagascar

Community health volunteers (CHVs) play a critical role in bringing primary health care services closer to people, particularly women and children under the age of five. The USAID-funded ACCESS program supports more than 20,000 CHVs across 14 of Madagascar’s 23 regions. Meet five of them in this photo/video essay.

Join MSH at the American Society of Tropical Medicine & Hygiene (ASTMH) Annual Meeting 2023

Focusing on the theme From Evidence to Action, our malaria experts will be at the American Society of Tropical Medicine and Hygiene’s (ASTMH) Annual Meeting—#TropMed2023—in Chicago, IL, from October 18–22, to present our approaches to improving quality of care for malaria in Madagascar and Nigeria.

Madagascar Advances toward UHC Through Financial Empowerment: The MSH-led USAID ACCESS program is helping families in rural areas manage unexpected health expenses through Savings and Internal Lending Communities (SILCs)—groups that provide households with a secure way to save and borrow, increasing income and financial resilience. In this video, hear from a mother who was able to give her daughter the care she needed without having to jeopardize her financial stability, all thanks to the SILC group.
Supporting Primary Health Care in Madagascar: ACCESS Project Director Dr. Serge Raharison explains how the program is driving progress in primary health care in Madagascar. From strengthening community health systems to improving maternal and child health at the facility level, learn about the key initiatives that ACCESS supports to make health care accessible for all.
How Primary Health Care Changed My Life: USAID ACCESS Director’s Personal Journey: Dr. Serge Raharison, ACCESS Project Director, shares how his grandfather’s advocacy for maternal, child, and newborn health fueled his own passion for making high-quality care accessible to all communities across Madagascar, no matter how remote. 
Meet Fanja, a Midwife and Leader Helping to Transform Health Care in Rural Madagascar: Appointed in 2022, Fanja enlisted the help of her community to transform the health center into a clean, healthy, and motivating environment for both patients and staff. She is one of the thousands of health workers supported by the USAID-funded and MSH-led ACCESS program in Madagascar.
COVID-19 is not the first epidemic to hit Madagascar. The country has experienced several plague outbreaks, a measles outbreak, and even a polio outbreak within the last 5 years. USAID’s flagship program, ACCESS, works in close collaboration with Madagascar’s Ministry of Public Health to respond to these outbreaks and foster epidemic preparedness and response activities at all levels of the health system, efforts which have become even more crucial in the fight against COVID-19.
In Madagascar, community health volunteers provide essential health care services to isolated populations. They treat common childhood illnesses and address unmet needs for contraception. Community health volunteer Brunette from Vatovaty Fitovinany is using the CommCare mobile application to provide better family planning services to her clients.
“Ever since I started educating people about the benefits of mosquito bed nets, no one has died from malaria in my village,” says Leany Fameno in Madagascar. Fameno is one of the thousands of community health volunteers empowered by the MSH-led, USAID-funded ACCESS program with the tools and skills to foster social behavior change, including the proper use of bed nets.

Donors & Partners

Donors

The United States Agency for International Development

Partners

American Academy of Pediatrics

American College of Nurse-Midwives

Action Socio-sanitaire Organisation Secours

Catholic Relief Services

Dimagi

Johns Hopkins Bloomberg School of Public Health Center for Communication Programs

Population Services International