Health, Nutrition, and Population in Madagascar, 2000-09

WORLD BANK WORKING PAPER NO. 216
AFRICA HUMAN DEVELOPMENT SERIES
Health, Nutrition, and Population
in Madagascar 2000–09
Maryanne Sharp
Ioana Kruse
THE WORLD BANKWORLD BANK WORKING PAPER NO. 216
Health, Nutrition,
and Population in
Madagascar 2000–09
Maryanne Sharp
Ioana Kruse Copyright © 2011
The International Bank for Reconstruction and Development/The World Bank
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ISBN: 978-0-8213-8538-8
eISBN: 978-0-8213-8551-7
ISSN: 1726-5878 DOI: 10.1596/978-0-8213-8538-8
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4Contents
Acknowledgments ....................................................................................................................ix
Acronyms and Abbreviations .................................................................................................. x
Executive Summary ............................................................................................................... xiii
1. Introduction and Context ..................................................................................................... 1
Country and Sector Context............................................................................................... 1
Objectives and Organization of the Country Status Report .......................................... 2
Available Data and Reports .............................................................................................. 3
2. Sector Outcomes and Demographic Trends ..................................................................... 5
Demographic Trends .......................................................................................................... 5
Child Health ......................................................................................................................... 7
Maternal Health ................................................................................................................. 12
Nutritional Status of Children and Women .................................................................. 14
Other Communicable Diseases Contributing to Mortality and Morbidity in
Madagascar ................................................................................................................. 16
Non-Communicable Diseases .......................................................................................... 19
Meeting the Millennium Development Goals (MDGs) ............................................... 20
3. Behaviors Conducive to Be er Health Outcomes ........................................................ 25
Behaviors and Interventions A ff ecting Child Health ................................................... 25
Community Factors and Behaviors A ff ecting Nutritional Status of Children ......... 29
Maternal Health and Reproductive Health ................................................................... 36
Communicable Diseases ................................................................................................... 43
Health Care Access and Utilization by the Poor ........................................................... 48
4. Health System Performance .............................................................................................. 56
Sector Organization ........................................................................................................... 56
Quality of Services .. 66
5. Sector Financing .................................................................................................................. 78
Financing of the Health Sector ........................................................................................ 78
Equity of Health Spending ............................................................................................... 90
Effi ciency Issues of Health Spending .......................................................................... 100
Scope for Creating Fiscal Space ..................................................................................... 104
Potential Impact of the Crisis on the Health Sector ................................................... 105
6. Strengthening Accountability in the Health Sector .................................................... 110
The Importance of Accountability for Health ............................................................. 110
Governance and Accountability in the Malagasy Context ........................................ 111
iii
4iv Contents
Appendixes .............................................................................................................................. 131
Appendix 1. Indicators and Outcomes ......................................................................... 133
Appendix 2. Child Nutrition and Early Childhood Development .......................... 135
Appendix 3. Health Financing ....................................................................................... 138
Appendix 4. Best Practices in RBF from around the World ...................................... 142
Appendix 5. Summary of CSC Ratings in Anosy during implementation and
follow-up ................................................................................................................... 143
References ................................................................................................................................ 145
Boxes
Box 2.1. Maternal mortality in Madagascar ..........................................................................13
Box 3.1. Maternal knowledge and self-e ffi cacy.....................................................................32
Box 3.2. Creation of a National Community Nutrition Program .......................................34
Box 3.3. Pilot to cover the direct and indirect costs related to emergency
obstetrical and neonatal care in the regions of Boeny and DIANA ...........................42
Box 3.4. Distance to the nearest health center: the case of a village in
Majunga region ..................................................................................................................50
Box 3.5. Santé Sud program .....................................................................................................51
Box 4.1. Quality of infrastructure a ff ecting maternal and neonatal health ......................68
Box 4.2. Response of the public to suspension of user fees (2001-2004) ............................71
Box 5.1. A brief presentation of Madagascar’s budget execution process ........................85
Box 5.2. Some key elements of the equity funds at the health center level ......................94
Box 5.3. Some key elements of the equity funds at the district hospital level ..................96
Box 5.4. Community Insurance Scheme (Mutuelle) of Ankazomanga-Ouest..................98
Box 5.5. Two examples of pilot community-based health insurance schemes in the
regions of Haute Matsiatra and Atsinanana ..................................................................99
Box 5.6. Selected country experiences with decentralization ...........................................103
Box 6.1. Accountability of FANOME and drugs for the poor ..........................................115
Box 6.2. Increasing utilization of basic maternal and child health interventions
through RBF .........