JSI RESOURCES: Publications

Madagascar Technical Brief – Community-Led Transport Solutions Improve Access to Health Care


In Madagascar, the mortality rates for mothers and children under five (CU5) were 335 and 51 per 100,000 in 2019, respectively. To reduce maternal and under-five deaths, timely access to skilled care is critical before, during, and after pregnancy, and throughout a child’s first five years of life. Delays in seeking access to quality care are a key contributor to maternal and under-five mortality. Inadequate access to transport has been identified as one of the three major reasons for delays in access to health services and can worsen the clinical severity of cases, especially when complications exist.

In a context where the availability of transport is often low, the cost of emergency transport is frequently a major barrier. Moreover, difficult terrain and seasonal rainfall often limit access by motorized vehicles to many areas. In areas supported by the USAID Community Capacity for Health program, 44 percent of communities were inaccessible by car or truck for at least four months of the year and 20 percent were inaccessible for almost half the year. The implementation of transport strategies, along with other interventions, can contribute up to an 80 percent reduction in maternal deaths, and other crucial time savings for patients who are severely ill or experiencing complications. Maximizing the potential for communities to develop and manage their own emergency transport schemes (ETS) has been shown to be an effective method of increasing access to health care by drawing on available community resources.

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