ZIG begins policy dialogue with the Madagascar Ministry of Health

In November 2023, a two-day workshop was organised in Antananarivo, Madagascar with the domestic Minister of Health, heads of directorates responsible for essential public health functions, and other relevant stakeholders to disseminate the results of the first year of the ABCM project and initiate a policy dialogue. Under the Global Health Protection Programme (GHPP), the 3-year funded project “Assessing and Building Capacities: Madagascar Public Health System” is supporting the Madagascar Ministry of Health in understanding the needs and current status of the public health system. It aims to provide evidence of the capacity of the current system to deliver the essential public health functions. The project is a joint effort with the Madagascar Ministry of Health and the National Institute of Public and Community Health (Institut National de Santé Publique et Communautaire, INSPC).

Workshop participants from the Madagascar Ministry of Health, the National Institute of Public and Community Health (INSPC), Laboratoire d’Analyses Médicales Malagasy (LA2M), several units of the RKI and other relevant stakeholders. Photo: RKI

The first year of the study (2023) focused on a desk review, a series of key informant interviews, and secondary data analysis of the Integrated Disease Surveillance and Response System (IDSR) in order to map and understand the current status of the public health system, the public health functions, and initially identify potential needs.

Initial results focused on four main areas of attention: (1) Fragmentation of the system in regard to collaboration and coordination across the system, (2) prioritisation of limited resources, (3) implementation of policy, (4) factors which should be monitored, prepared for and learned from. The workshop in November 2023 utilised these results to initiate a policy and prioritisation conversation on key areas to consider for policy change across the system and functions. Public health emergency management, surveillance capacities and the establishment of a national reference laboratory were all seen as the strongest areas and to have particularly benefited and improved from the COVID-19 pandemic context.

The decentralisation of the system was further highlighted as key opportunity, matching nicely with the sister GHPP project “Assessing and Building Capacities: Decentralised Structures of Madagascar's Public Health System“ (ABCdM) implemented by the Bernhard Nocht Institute for Tropical Medicine (BNITM). This similarly highlighted the continued need for further strengthening the community health worker programme within the country. One finding of major discussion surrounded the misalignment of financial and technical partners and the Ministry of Health’s priorities. The workshop resulted in 109 actionable recommendations towards strengthening Madagascar’s public health system. A short list of the most feasible and actionable recommendations was identified around seven themes:

1. Coordination, collaboration and governance;
2. Epidemiological surveillance;
3. Emergency management, preparedness, resilience and response;
4. Community engagement;
5. Information sharing, research and financial resources;
6. Laboratories and diagnostics;
7. Human resources in health.

The results of the workshop will inform in-depth research and potential development of competences in public health functions over the next two years of the project.

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