PMI Impact Malaria




PMI Impact Malaria in Madagascar

PMI Impact Malaria (IM) is the flagship global service delivery project of the U.S. President’s Malaria Initiative (PMI). To fight malaria and save lives, IM is supporting Madagascar’s national malaria control program (NMCP) in its efforts to strengthen malaria service delivery.

In 2018, IM began working with Madagascar’s NMCP to improve malaria case management at the community and public facility levels, with an emphasis on protecting those who are most at risk—particularly young children and pregnant women.

To advance malaria service delivery in Madagascar, IM focuses mainly on strengthening health worker competence and bolstering diagnostic capacity.


  • Madagascar Malaria Summary PMI Webpage
  • Malaria Service Delivery Photos PMI Impact Malaria Photo Library

Malaria Country Context

Madagascar’s entire population of about 25.6 million people is vulnerable to malaria. Malaria transmission in Madagascar is divided into four epidemiological zones: East Coast, West Coast, Central Highlands and the South. The East Coast has perennial transmission, the West Coast has seasonal transmission that typically runs from October to May, the Central Highlands has low levels of transmission, and the South has seasonal and unstable transmission. The malaria parasite species Plasmodium falciparum causes the majority of infections.

Malaria continues to be a major public health problem in Madagascar, with an estimated 2.3 million cases and 6,000 deaths in 2018. The national health infrastructure, information, and commodity management systems remain weak, and much remains to be done at central and regional levels to ensure quality services and sustainable health financing.


This is PMI Impact Malaria’s geographic coverage in Madagascar: 


PMI Impact Malaria has supported Madagascar’s NMCP in achieving these key accomplishments: 

  • Developed a national-level strategy for elimination and a protocol for malaria epidemiologic surveillance in line with global best practices and for use in determining malaria elimination activities. As well as created an elimination technical working group with implementing partners to inform the process. 

  • Conducted a feasibility assessment for elimination activities in two pilot districts and trained 74 private and public sector health workers from both districts on foci investigation around one malaria case. 

  • Strengthened malaria microscopy diagnostics by performing a training of trainers (TOT) workshop for Malaria Diagnostic Refresher Training (MDRT) for 16 participants, as well as hosting five MDRT sessions for a total of 105 participants from all 22 administrative regions of Madagascar.  

  • Updated and finalized the malaria microscopy quality assurance (MMQA) manual, which had not been updated since 2013 due to lack of resources, and distributed 200 copies to 175 labs.  

  • Developed a cadre of Outreach Training and Supportive Supervision Plus (OTSS+) supervisors selected from high-performing training participants. Madagascar now has 12 regional-level lab OTSS+ supervisors, 10 national-level supervisors, and OTSS+ rounds have been conducted in 45 health facilities. 


Click here for a printable version of this page: English and French

Photo Credit: Lan Andrian/PMI, Madagascar

Sources: PMI’s Madagascar Country Brief, PMI’s Madagascar Malaria Operational Plan FY 2020, 2019 World Malaria Report Madagascar Country Profile, PMI Impact Malaria Madagascar, and Madagascar's NMCP