JSI RESOURCES: Publications

Madagascar Technical Brief – A Bicycle Micro-Enterprise Approach to Improving Community Health Worker Mobility and Motivation in Rural Madagascar


In much of rural Madagascar, the lack of available and affordable transport hinders uptake of health services. In a country where over 60 percent of the population lives in rural areas, community health volunteers (CHV) have an essential role in health service delivery. In 2019, Madagascar had more than 35,000 CHVs serving 5,700 villages. CHVs have key roles in implementing Madagascar’s National Community Health Policy and the country’s strategy to achieve universal health coverage. CHVs do not receive a salary from the government. Furthermore, CHVs also face the same transport barriers affecting rural communities. 

The “enterprise box” or eBox initiative aims to improve CHV mobility and increase motivation and retention through the provision of bicycles and the opportunity for income generation while also contributing financially to local health insurance schemes. The eBoxes are bicycle sale and repair micro-enterprises managed by registered cooperatives that aim to meet some of the transportation needs of the local population. This initiative is part of a broader integrated approach by the USAID Community Capacity for Health Program to address transport-related barriers to accessing healthcare. The eBox initiative was designed to create sustainable cooperatives, relying on program support for the first few years.

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