Madagascar has very low immunization coverage, with only 32 percent of children ages 12–23 months having received all their vaccinations, with only 59 percent having received the full three doses of the pentavalent five-in-one vaccine against diphtheria, tetanus, pertussis, hepatitis B, Haemophilus influenzae type b infections (DTP-hepB-Hib), according to the 2018 Multiple Indicator Cluster Survey (MICS). This rate is lower than the Expanded Programme on Immunization’s (EPI) standard set by the Global Vaccine Action Plan of 90 percent at the national level and at least 80 percent in each district for all antigens
Despite these gaps in population coverage and several logistical, procurement, data, and surveillance challenges, Madagascar declared the elimination of neonatal tetanus in 2014, and in June 2018, the country obtained polio-free status from the World Health Organization. Maintaining these gains is a national priority. Numerous challenges persist, making the country vulnerable to the resurgence of vaccine-preventable diseases.
To overcome the challenges, Madagascar initiated a strategy—the Reaching Every Child (REC) approach—based on WHO and UNICEF’s Reaching Every District (RED) approach, to strengthen EPI, with the aim of revitalizing routine immunization activities in all districts. The objective of the REC approach is to protect all women and children from vaccine-preventable diseases through sustained increases in immunization coverage.