Madagascar's health system faces recurrent challenges and crises such as famines, cyclones, droughts, and prevalence of malaria. The COVID-19 pandemic exacerbated the situation, intensifying pressing health needs such as accelerating the fight against neglected tropical diseases, prioritizing HIV control with a focus on the general population and people who inject drugs, reducing maternal mortality through improved emergency care, strengthening human resource skills, improving disease surveillance, and enhancing the national health information system based on previous investments. Development partners, governments, bilateral and multilateral organizations, and civil society, play a vital role in supporting the health priorities of the Government of Madagascar. However, improved harmonization and coordination of interventions are necessary to address the country's health challenges effectively.
The Global Action Plan for Healthy Lives and Well-being for All (SDG3 GAP) monitoring framework survey, which sought the views of national governments and relevant authorities in Madagascar, has been instrumental in emphasizing the need for a strengthened cooperation within the health community. The survey focused on assessing the alignment of multilateral agencies and development partners with national priorities and their collaboration with each other to increase efficiencies. A significant challenge highlighted by the Malagasy Ministry of Health (MoH) was the complexity in aligning the activities of Technical and Financial Partners, which include SDG3 GAP partners, with the government's healthcare priorities.
Reinstating a Strategic Health Sector Coordination Platform
Based on the survey results, the World Health Organization (WHO) initiated informal discussions with key Technical and Financial Partners to revitalize the existing Strategic Health Sector Coordination Platform. The platform involved SDG3 GAP agencies, including the United Nations Population Fund (UNFPA), United Nations Children's Fund (UNICEF), the World Bank (WB), the Global Fund to Fight AIDS, Tuberculosis and Malaria (GFATM), Global Alliance for Vaccines and Immunization (GAVI), and WHO. WHO and the United States Agency for International Development (USAID) serve as co-Chairs. Other members include representatives from the MoH, civil society, bilateral institutions such as France and the European Union (EU), international health organizations such as Médecins du Monde and Médecins Sans Frontières, and health coordination organizations such as PIVOT. The platform's objectives, vision, terms of reference, and meeting frequency were discussed and finalized through consultations with the Technical and Financial Partners. WHO's SDG3 GAP catalytic fund provided essential financial support to strengthen the coordination mechanisms and advance work on MoH-led prioritized technical areas.
Priority setting and alignment
A formal meeting, ‘Référence réunion de coordination du MSANP et des PTF’ (Coordination meeting between the Technical and Financial Partners and the MoH), was held in March 2023, involving 130 participants primarily to discuss health priority setting and alignment. Some of the priorities include, accelerating the fight against neglected tropical diseases, prioritizing HIV control with a focus on the general population and people who inject drugs, reducing maternal mortality through improved emergency care, strengthening human resources skills, improving disease surveillance, and enhancing the national health information system based on previous investments.
Figs.1&2: First in person meeting of the Ministry of Health with the Technical and Financial Partners after COVID-19, Antananarivo, March 2023. ©Flora Dominique Atta/WHO Madagascar.
Auxiliary health coordination mechanisms
In conjunction with the Strategic Health Sector Coordination Platform, the MoH has established several committees with support from the Technical and Financial Partners. These committees are designed to facilitate collaborative strategic planning and promote enhanced cooperation among stakeholders within the national health sector. Some of the committees are detailed below.
- Medicine and Health Products: WHO and the MoH co-lead this committee, convening quarterly meetings with the Technical and Financial Partners, as well as Salama Madagascar, the national-level medicines procurement agency. These meetings focus on addressing the country's demand for essential medicines and issues relating to access.
- Surveillance: WHO and the MoH jointly lead this committee, organizing meetings on a quarterly basis. The committee spearheads collaboration among stakeholders to coordinate national efforts for early detection, verification, evaluation and communication of health risks and threats. It continuously assesses potential health events.
- Vaccination: Co-led by WHO and UNICEF, this committee contributes to reducing morbidity and mortality from preventable diseases through vaccinations. It brings together UN agencies partnering with the Expanded Program on Immunization (EPI), implementing organizations GAVI, NGOs and the Technical and Financial Partners interested in vaccination.
- Health System Strengthening (HSS): To ensure in-depth analysis of the utilization of data, challenges, and priorities in the sector, seven (7) sub-committees have been established with an aligned agenda on health system priorities. The following sub-committees focus on specific areas and hold joint meetings with the MoH to address implementation challenges:
- Leadership and Governance sub-committee
- Service Delivery sub-committee
- Human Resources sub-committee
- Information System sub-committee
- Health Inputs, Infrastructure, Materials and Equipment sub-committee
- Health Financing sub-committee
- Community Health sub-committee
WHO co-leads with the MoH the sub-committees on Leadership and Governance and Health Information System, while the World Bank co-leads the sub-committees on Health Financing and Human Resources for Health. - Health Cluster: As part of the UN emergency coordination system, a health cluster was established to build consensus on humanitarian health priorities and related best practices, as well as to strengthen system-wide capacities. In a country facing chronic humanitarian crises and susceptible to climate change and natural disasters, the Health Cluster is crucial for ensuring an effective and predictable response. It is co-chaired by WHO and the MoH.
- Reproductive, Maternal, Neonatal, Children, and Adolescent Health: This committee, under the leadership of the MoH, serves the commitments around women's and children's health. It collaborates closely with various departments of the MoH, including the Mother and Child Health Directorate, to align priorities and monitor progress.
- H6+: Focused on planning and implementing integrated systems, policies, and strategies for reproductive, maternal, neonatal, infant, and adolescent health, H6+ is led by UNFPA. H6+ harnesses the collective mandates and strengths of SDG3 GAP partners, including UNFPA, UNICEF, UNAIDS, WHO, the World Bank. Additionally, it includes USAID and its partners, such as Jhpiego. The leadership rotates every year, and H6+ operates with an annual workplan harmonized with national priorities and regional commitments.
The Reproductive, Maternal, Neonatal, Children, and Adolescent Health committee stays connected with H6+ through the Technical and Financial Partners when there's a need for technical assistance or pressing agendas arise.
Looking ahead
Attributed to the MoH feedback on the SDG3 GAP monitoring framework survey, the complexity in aligning the activities of the Technical and Financial Partners with the government’s healthcare priorities was identified and in turn the Strategic Health Sector Coordination Platform has been revitalized following the partners’ consultations. The Platform continues to gather insights from the committees and facilitate the dissemination of pertinent information to both bilateral and multilateral development partners within the country, as well as other stakeholders in the health sector through the regular quarterly meetings.
Leveraging on the strengthened coordination mechanisms and working together with the WHO Department of Delivery for Impact, the MoH identified priorities and developed joint action plans, and continues to track progress in the priority areas, ensures that partners are aware of their targets, timelines, and allocated budget to support their goals as well as identifies the priority areas that are falling behind along with the communities that need to be targeted for assistance. Furthermore, on invitation from the MoH, WHO ran a scoping mission that involved three levels of the organization (Headquarters, Regional, and Country Offices), alongside national counterparts, to develop acceleration plans for the priority areas.
SDG3 GAP partners continue to leverage the Strategic Health Sector Coordination Platform and its associated committees, with the aim to accelerate the implementation of the country’s health priorities.
What is the SDG3 GAP?
The Global Action Plan for Healthy Lives and Wellbeing for All (SDG3 GAP) is a set of commitments by 13 agencies that play significant roles in health, development, and humanitarian responses to help countries accelerate progress on the health-related SDG targets. The added value of the SDG3 GAP lies in strengthening collaboration across the agencies to take joint action and provide more coordinated support aligned to country owned and led national plans and strategies.
The improvement of the Strategic Health Sector Coordination Platform means that the government is better positioned to tackle health priorities, improve the effectiveness of health systems, and ensure the efficient use of resources. The Platform allows for greater clarity of development partners’ roles in the health sector as well as transparency and accountability.