CSB Strengthening
Healthcare in the Deep South
Ranking 177/193 on the Human Development Index, Madagascar remains one of the poorest and least developed countries in the world.1 Its health expenditure continues to be amongst the lowest globally, representing just 1% of national spending in 2020.2 Rural Community Health Centres (CSBs) bear the brunt of this burden, as spending is focused on urban areas, leaving remote communities deprioritised and beyond reach of professional and infrastructural development.
This is reflected in country-wide statistics which indicate that approximately half of all health facilities lack access to an improved water source and hygienic latrines. 3 Children are disproportionately impacted by these outcomes: 6% die before age five, with WASH-related diseases accounting for 25% of these deaths.4 Unsanitary conditions in CSBs perpetuate the transmission of WASH-related diseases which can be especially detrimental in medical environments where healthcare workers are in close contact with sick and injured patients. Additionally, women are disproportionately affected by the severe lack of hygienic health facilities. In addition to children, women are the primary seekers of healthcare, particularly for maternal and child health services. CSBs seldom have adequate facilities for care seekers to manage their menstruation with privacy and dignity, further exacerbating poor WASH conditions in CSBs for women in particular.
There is an immediate need for well-lit health facilities to ensure more efficient nighttime service delivery in both scope and quality, in order to improve health outcomes. This need is especially pronounced for childbirth services: 35% of girls aged 15-19 in Madagascar have begun childbearing, and amongst the poorest quintile – which rural CSBs primarily serve – this rate is 49%.5 In rural areas, where the fertility rate averages five children per woman and less than 11% of the population has access to electricity, well-lit health environments are critical to safely manage childbirth as well as emergency medical interventions at night. 6 Despite these needs, rural CSBs often face significant challenges in accessing electricity as extending the grid to remote areas is costly, unlikely to be prioritised over major public works projects, and oftentimes unfeasible due to high dispersion of rural populations.
SEED’s Response
SEED will be addressing these challenges by conducting construction projects at rural CSBs in Anosy, Madagascar, in order to achieve the following:
- The installation of fully functional solar energy systems
- The reparation and construction of latrines, menstrual hygiene management (MHM)/shower facilities, 10,000-litre rainwater harvesting systems with handwashing stations, and on-site accommodation for staff, patients, and families
- Delivery of Ministry of Health best practices WASH curriculum to CSB staff
The above outputs result in improved CSB infrastructure, increased continuity and quality of medical service delivery, and overall improved conditions for both CSB healthcare workers as well as patients.
Recent projects
Ambinanibe CSB (Completed April 2025)
- Construction of five latrines, complete with a handwashing station and an MHM/Shower facility
- Provision of a 10,000-litre rainwater harvesting system
- Provision of a 400-watt solar energy system
- WASH education sessions delivered to patients and their families
- Ministry of Health WASH training curriculum delivered to all CSB staff members
Project CSB Strengthening - Ambinanibe CSB - Final Report
Donors
Project CSB Strengthening has been made possible thanks to our partnerships with the Aeonian Foundation, Tenzing, Clark Mitchell, and the Silver Lady Fund.
Sources
1. UNDP, (2024). Human Development Report 2023-24. Available at: https://hdr.undp.org/system/files/documents/global-report-document/hdr2023-24reporten.pdf.
2. International Monetary Fund, (2023). Social Spending and Outcomes in Madagascar. Available at: https://www.elibrary.imf.org/view/journals/018/2023/035/article-A001-en.xml#:~:text=Education%2C%20health%2C%20and%20social%20assistance%20spending%20in%20Madagascar%20is%20among,deteriorated%20over%20the%20last%20decade.
3. UNICEF, (2024). In Madagascar, Access to Adequate Sanitation Assures Better Health. Available at: https://www.unicef.org/madagascar/en/stories/madagascar-access-adequate-sanitation-assures-better-health
4. UNICEF, (2017). Madagascar WASH Investment Case: Executive Summary. Available at: https://www.unicef.org/madagascar/media/1756/file/Madagascar%20WASH%20investment%20case.pdf
5. INSTAT & UNICEF, (2019). Enquête par grappes à indicateurs multiples-MICS Madagascar, 2018, Rapport final. Available at: https://mics-surveys-prod.s3.amazonaws.com/MICS6/Eastern%20and%20Southern%20Africa/Madagascar/2018/Survey%20findings/Madagascar%202018%20MICS%20Survey%20Findings%20Report_French.pdf
6. World Bank, (2020). Access to Electricity – Madagascar. Available at: https://data.worldbank.org/indicator/EG.ELC.ACCS.ZS?end=2020&locations=MG&most_recent_year_desc=false&start=2020&view=bar