Our work in 🇲🇬 Madagascar has shown us both the beauty and the fragility of the country. The current situation affects the communities we work with and the health systems that sustain them. What is happening: In recent weeks, peaceful protests over power and water shortages have grown into nationwide unrest. After violent repression, the president fled, and a military commander dissolved democratic institutions and declared a two-year military-led transition. ❤️🩹 The likely consequences for health are serious. Madagascar’s Ministry of Health depends on international donors for about half of its budget. Under an unconstitutional government, funding may be frozen, leading to delayed salaries, disrupted medicine and vaccine supplies, and leaving the poorest without essential care. Our projects in Madagascar continue. Yet what is unfolding is deeply connected to the communities and health systems we engage with every day. We stand with our partners as they navigate this uncertainty and hold hope for collective strength, care, and the continuation of essential health services. For more reflections and context, read Julius's post below.
To my network, particularly those connected to Africa: A few reflections on the situation in Madagascar. As many of you know, Madagascar is a country of extraordinary beauty and potential, yet faces great challenges. It ranks among the poorest nations in the world with around 80% of the population living in extreme poverty (below $2.15 per day, 2017 PPP). One in three adults cannot read or write and for many, even basic healthcare remains out of reach. At the same time, the country sits on vast reserves of nickel, cobalt, and rare earth minerals and is the world’s largest vanilla exporter - resources that could fuel prosperity but instead deepen inequality. In recent weeks, Madagascar has seen major civic unrest. What began as peaceful protests over chronic power cuts and water shortages has grown into a nationwide call for transparency, human rights, and an end to corruption. When the protests were met with repression (around 20 people killed and hundreds injured) parts of the military broke ranks. Two days ago, the President fled the country. A military commander has since dissolved democratic institutions (including the Senate and High Constitutional Court) declared himself interim president, and promised a military-led transition with elections within 2 years. This is a military coup by definition. It echoes earlier crises/coups in 2002 and 2009. What this means for health: The likely consequences are serious: Madagascar’s Ministry of Health depends heavily on international donors to pay health workers, purchase medicines, and run public health programs. Roughly 50% of the Ministry’s budget come from foreign aid. Under an unconstitutional government, most direct budget support will likely be frozen. Based on 2009 experience, this could mean: > Salaries for health workers delayed or suspended > Procurement of medicines and vaccines disrupted > Training, follow-up, health campaigns halted After the USAID funding stop earlier this year, a freeze in multilateral funding will be a double hit likely reversing years of fragile progress and leaving the poorest communities without access to essential care. My hope and concern: Having worked with colleagues and communities in Madagascar for 16 years, I have seen their resilience, empathy, and commitment to a better future. My hope is that this moment of crisis becomes a moment of real renewal, that capable and honest leaders will emerge to rebuild institutions for the better, strengthen the economy, and restore trust. But I also worry. If this opportunity passes without real reform, entrenched power structures will only grow stronger, elitism will thrive and a small group of people will tighten its grip on wealth and power while accountability will weaken and the most vulnerable will contain to pay the price. My hope lies in a new generation of young Malagasy who, despite fear and hardship, are raising their voices peacefully and courageously for a fairer future. Alefa Mada!! 🇲🇬