Resource Library

Madagascar ORS Case Study

In 2009, the ORS coverage in Madagascar was less than half the global average at 16.9%.  This case study examines the context within which ORS use was promoted in Madagascar looking at several factors:  product, marketing, provider training, supply and financing.  The case study articulated the following conclusions:  

Context played an incredibly large role in determining the degree of success or failure to scale. Madagascar’s 2009 conflict resulted in reduced funding, supply chain interruptions and marketing delays. In addition, the poor infrastructure of the health system provided a ‘ceiling’ from the start of what was achievable, simply because large swaths of the population were inaccessible to the health system.

Supply and demand-side interventions were frequently out of sync with each other due to delays on both sides. Though delays were frequently attributable to the above contextual factors, both the chosen ‘mass media’ marketing strategies and the lack of local product sourcing reduced the amount of flexibility in the scale-up program and made it less resilient against contextual complications

Caregiver preferences were ignored until the most recent POUZN scale-up attempt—data from the 2009 DHS survey indicating that 59% of episodes do not reach a facility were indicative of how critical demand-side interventions are, yet this has been an area of neglect until very recently.