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Public Health in MADAGASCAR
Full index of Country Studies-Madagascar MadagascarPublic HealthLife expectancy at birth has gradually improved from an average of 37.5 years for men and 38.3 years for women in 1966 to an average of fifty-two years for men and fifty-five years for women in 1990 (for a combined average of fifty-four). Malaria remains the most serious tropical disease, although eradication campaigns against mosquitoes waged since 1948 initially resulted in spectacular declines in incidence and a dramatic decrease in the island's mortality rate during a twenty-year period. Indeed, in some regions, especially the central highlands, these campaigns were almost completely successful, although malaria continues to be prevalent in the coastal regions, especially the east coast. As prevention practices faltered during the late 1970s and throughout the 1980s, the mosquito staged a comeback. The effect on a population with a significantly reduced resistance to malaria was devastating. For example, the Malagasy Ministry of Health reported 490,000 cases and 6,200 deaths from malaria in 1985, but these figures rose--to 760,000 cases and 11,000 deaths--in 1987. As of 1994, other serious diseases included schistosomiasis, tuberculosis, and leprosy. The prevalence of schistosomiasis, a parasitic ailment that spreads primarily through the passing of human wastes into ponds, irrigation canals, and slow-moving streams, reflects the continued lack of adequate sewage facilities, especially in the rural areas. Occasional outbreaks of bubonic plague occur in urban areas, the most recent of them in 1990. Yet Madagascar has been spared many of the diseases common in tropical countries, such as trypanosomiasis, cholera, brucellosis, and yellow fever. The occurrence of sexually transmitted diseases (STDs) has increased during the 1980s and the 1990s. It is estimated that 287 of 100,000 inhabitants have gonorrhea, and 220 of 100,000 have syphilis. According to data collected from 9,574 inhabitants treated for STDs in 1987, the breakdown by type of disease was as follows: gonorrhea (38 percent); syphilis (33 percent); trichomoniasis (20 percent); and candidiasis (8 percent). According to data compiled by the World Health Organization, only three cases of acquired immune deficiency syndrome (AIDS) were reported in the 1990-92 period, and six cases in 1993, earning Madagascar a 0.0 "case rate" (reported cases per 100,000 population). The government has committed itself to the principle that good health is a right of each Malagasy citizen, and has made significant strides in the area of health care. A number of new hospitals and medical centers were built in various parts of the country during the 1970s and the first part of the 1980s. However, about two-thirds of the population reside at least five kilometers from a medical center, resulting in the May 1993 finding of UNICEF that 35 percent of the population lacked adequate access to health services. Economic decline has led to a deterioration in medical services during the late 1980s and the early 1990s. In 1976, of the national budget, 9.2 percent was allocated to health care; this percentage dropped to 6.6 percent in 1981, 4.5 percent in 1990, and 2 percent in 1994. For example, as of 1993, according to UNICEF, the country had only one physician per 17,000 people. Important regional differences also exist. For example, in some provinces the ratio was as low as one physician for 35,000 persons. For the entire island, in 1993 a total of 234 medical centers were under the direction of one doctor, and the remaining 1,728 centers were under the direction of paramedics, midwives, nurses, health aides, or sanitarians. For those unable to obtain modern medical treatment, traditional medicine--the use of herbs or the exorcism of malicious spirits--remains popular. Additional factors contributing to health problems include overcrowding (in some areas five to eight persons live in a room fourteen meters square), contagious diseases such as the plague, and inadequate garbage disposal facilities. Infant mortality has risen from sixty-eight per 1,000 births in 1975 to 109 per 1,000 in 1980 and 150 per 1,000 in 1990. Malnutrition, diarrheal diseases, respiratory infections, and malaria are major causes of infant deaths. Madagascar had a serious malaria epidemic in 1990 causing the death of tens of thousands; efforts are underway for annual antimalarial campaigns, especially in the Hauts Plateaux. Data as of August 1994
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RECENT NEWS Mining and biodiversity offsets in Madagascar 
(08/30/2009) Rio Tinto's ilmenite mine in southeastern Madagascar is among the largest on the planet. At peak capacity, its owners say, it could produce as much as 2 million tons of the stuff—worth roughly $100 a ton—each year, to be shipped off and smelted abroad. What's left of it after refining—some 60 percent of the ore that arrives from Madagascar—will be sold for $2000 a ton as titanium dioxide, a pigment used in everything from white paint and tennis court lines to sunscreen and toothpaste.
Destruction worsens in Madagascar (08/20/2009) Armed bands are decimating rainforest reserves in northeastern Madagascar, killing lemurs and intimidating conservation workers, despite widespread condemnation by international environmental groups. Appalling photos reveal lemur carnage in Madagascar (08/20/2009) New pictures released by Conservation International depict a troubling development in Madagascar: the emergence of a commercial bushmeat market for lemurs. In the aftermath of a March coup that saw Madagascar's president replaced at gunpoint by the capital city's mayor, Madagascar's reserves — especially in the northern part of the country — were ravaged by illegal loggers. Armed bands, financed by foreign timber traders, went into Marojejy and Masoala national parks, harvesting valuable hardwoods including rosewood and ebonies. Without support from the central government — or international agencies that pulled aid following the coup — there was no one to stop the carnage. But now it emerges that timber wasn't the only target. Saving the tsingy forests in Madagascar (08/17/2009) After the success of their Sahafina Forest project, Biodiversity Conservation Madagascar is now branching out to the tsingy forest of Beanka, a project set to launch in October this year. Biodiversity Conservation Madagascar (BCM) has been granted a 25-year lease on a 14,000-hectare area of dry hardwood forest, the Beanka tsingy, situated 75 km east of Maintirano in western Madagascar. 'Tsingy' are spectacular razor-sharp limestone pinnacles found on the west and north of the island, formed by acidic rain erosion. The deciduous forests that inhabit them are characterized by high plant and animal endemism. The Malagasy organization plans to apply the same principles here – protection of the forest, socio-economic development and forest restoration – that brought them success with their last project, the 2,500-hectare forest block of Sahafina on Madagascar’s east coast. Lessons from the crisis in Madagascar, an interview with Erik Patel (08/11/2009) On March 17th of this year the President of Madagascar, Marc Ravalomanana, resigned his post. This made way for Andry Rajoelina, mayor of Madagascar's capital, to install himself as president with help from the military. The unrest and confusion that usually accompanies such a coup brought disaster on many of Madagascar's biological treasures. Within days of Ravalomanana's resignation, armed gangs, allegedly funded by Chinese traders, entered two of Madagascar's world-renowned national parks, Marojejy and Masoala parks, and began to log rosewood, ebonies, and other valuable hardwoods. The pillaging lasted months but the situation began to calm down over the summer. Now that the crisis in Madagascar has abated—at least for the time being—it's time to take stock. In order to do so, Mongabay spoke to Erik Patel, an expert on the Critically Endangered Silky Sifaka and frequent visitor to Madagascar, to find out what the damage looks like firsthand and to see what lessons might be learned. Despite violent protests and coup, Daewoo continues to hold cropland in Madagascar (06/19/2009) Despite violent protests that have left more than 100 dead and led to the ouster of a democratically-elected president, Daewoo Logistics Corp. continues to hold 218,000 hectares of cropland in Madagascar, according to a new campaign by Rainforest Rescue. Conservation success in Madagascar proves illusory in crisis (06/12/2009) Despite the popularity he enjoyed abroad, domestic support for ousted president Marc Ravalomanana eroded rather quickly last February when he went head to head with Andry Rajoelina, the rookie mayor of Madagascar's capital. Rajoelina rallied disparate opposition groups to the cause and soon toppled the incumbent to become, at his own proclamation, President of the "High Authority of Transition." For the country as a whole, the results have not been encouraging. The tourism industry has shriveled to a shadow of itself, important donors have suspended non-humanitarian aid, and a power vacuum has set in in remote regions of the island, wreaking havoc on some of its most fragile and prized ecosystems. Forest Recovery Programs in Madagascar (06/01/2009) Despite being one of the last habitable land masses on earth to be settled by man, Madagascar has lost more of its forests than most countries; less than 10% of its original forest cover now remains, and much of that is degraded. Political turmoil that erupted earlier this year continues to rumble on and the ensuing lawlessness has created the opportunity for illegal logging syndicates to plunder national parks, most notably Marojejy and Masoala, for valuable hardwoods and wildlife. Approximately 200 new frogs discovered in Madagascar threatened by political instability (05/11/2009) Amid the amphibian extinction crisis—where amphibians worldwide are disappearing due to habitat loss, pollution, and a devastating fungal epidemic—the Spanish Scientific Research Council (CSIC) has announced some good news. In a survey of the island-nation of Madagascar they have identified between 129 and 221 new species of frogs. The discovery of so many new species nearly doubles the island's total number of frogs. More news
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