The Accessible Continuum of Care and Essential Services Sustained Program

The Accessible Continuum of Care and Essential Services Sustained Program


Community Health Worker in Madagascar puts up educational poster about COVID-19 prevention.

Across 14 regions, ACCESS helped reach more than 4 million people with COVID-19 messages and vaccination information through social and mass media dissemination.

Madagascar midwife

Since 2018, we have reached more than 1.5 million regular users of family planning and helped more than 450,000 women complete antenatal care.

ACCESS helped empower community health volunteers to test more than 1.3 million children for malaria and treat more than 400,000 children with first-line malaria treatment.


Through the Accessible Continuum of Care and Essential Services Sustained (ACCESS) program, we continue our support to 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 works to ensure person-centered, quality primary health care services are sustainably available and accessible to all Malagasy communities in the program’s target regions, that local health systems function effectively to support quality service delivery, and that the Malagasy people sustainably adopt healthy behaviors and social norms. ACCESS supports the Ministry in improving the quality of care provided by community health volunteers, health centers, and district hospitals through approaches that include 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 is conducting activities in 78 districts across 14 regions, home to more than 16 million people. The program is also providing comprehensive support to the country’s COVID-19 response plan.

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.
Dr. Serge Raharison

Project Director

Project Contact

Dr. Serge Raharison, MSc, has 28 years of experience in public health program implementation, design and management. He graduated from the Medical School of Antananarivo and earned his Master’s Degree from the London School of Hygiene and Tropical Medicine. He started his career as a frontline care provider in humanitarian crises, then gradually led the implementation of health and development initiatives with MSF, CARE, JSI, Chemonics, FHI360, and others. In the late 2000s, Dr. Raharison was appointed by the Government of Madagascar as Secretary General of the Ministry of Public Health in his native country, before moving to the US to join the USAID Maternal and Child Survival Program (MCSP) team in Washington DC, from where he supported country programs in the DRC, Guinea, Rwanda, Mali, Liberia, and Haiti. In March 2019, Serge returned home to Madagascar to work with MSH.

Donors & Partners


The United States Agency for International Development


American Academy of Pediatrics

American College of Nurse-Midwives

Action Socio-sanitaire Organisation Secours

Catholic Relief Services


Johns Hopkins Bloomberg School of Public Health Center for Communication Programs

Population Services International