Madagascar’s maternal mortality and neonatal mortality rates are among the highest in the world, with 478 deaths per 100,000 live births and 26 per 1,000 live births, respectively as of 2013, and have flat-lined. Many factors influence the stagnation and high level of maternal and newborn mortality, including the quality of reproductive health services offered (Millenium Development Goals Survey, 2013).
A baseline health facility assessment conducted by MSCP in 2014 in 15 regions of Madagascar revealed many gaps in the availability and operational capacity of the 65 target health facilities assessed: 56% of centres de santé de base (CSBs, primary health centers) have electricity, 53% have access to drinking water and 34% of CSBs and 36% of district hospitals have functional blood pressure machines. Few health providers have received adequate training: only 19% of midwives in CSBs are trained in basic emergency obstetric and neonatal care (BEmONC) and postpartum care and, in general, essential drugs were missing at every level of the health system.