USAID Mikolo

Measles in Madagascar

The community is the bedrock of epidemic prevention. A close relationship between community and health officials can mean the difference between an outbreak contained and an epidemic that costs thousands of lives and destabilizes an economy. In late 2018, Madagascar had a serious measles outbreak that infected 140,000 people and claimed the lives of 1,250 Malagasies, more than half of them children. MSH mobilized more than 3,000 volunteers to join the national response. These volunteers had been dealing with nutrition, malaria prevention and treatment, family planning, and other health interventions. When measles hit, we trained them on case management: detection, treatment referral, notification, and contact tracing. Thanks to this and other efforts, by early 2019 the outbreak was contained.


Through the USAID Mikolo Project in Madagascar, we worked alongside the Government of Madagascar to reduce 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 and 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
  • 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

In partnership with the Ministry of Public Health (MOPH), the project 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 ensure, improve, and sustain the quality of community-based health services delivered by CHVs.

We 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 to the Government of Madagascar and its partners.

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Community Health Volunteers on the Frontline of Malaria Prevention

In the effort to combat malaria in Madagascar, USAID Mikolo supports community health volunteers such as Fanamamy Retsilaky, who work hard to raise awareness about proper use of bed nets and prompt treatment when symptoms arise.

With her community struggling to access proper health care, local health volunteer Babera Georgette rallied her neighbors to build a new health center. Babera had received training on community health messaging, leadership, gender equality, and promoting healthy behavior change through the USAID Mikolo project. And she led her friends and neighbors to get the job done, a vibrant example of self-reliant, community-led health care.
Madagascar’s Ministry of Public Health, with support from USAID Mikolo, implemented a mobile health project to improve the quality of health care services provided by community health volunteers through standardizing care delivery, as well as the quality of and access to data emerging from their health activities.
Malaria is still among the main causes of death in Madagascar, especially among young children in remote areas. Community health volunteers such as Zafy André are on the frontlines in the fight against this deadly disease.
Community Health Volunteers save the lives of millions of rural populations in remote villages across Madagascar. They provide essential health care services to mothers and babies. Julienne is one of more than 7,500 community health volunteers supported by the USAID Mikolo project to improve health outcomes in isolated communities.

Donors & Partners


The United States Agency for International Development (USAID)

U.S. President’s Malaria Initiative (PMI)


Action Socio-sanitaire Organisation Secours

Catholic Relief Services

Institut Technologique de l’Education et du Management


Overseas Strategic Consulting, Ltd.