Poverty & Healthcare

Widespread poverty and stunting

Poverty is widespread across the country; well over two-thirds of Madagascans live below the poverty line, surviving on less than a dollar a day.


Vegetable plot in Vontovorona

The children of small-scale subsistence farmers are more likely to enjoy better health. This is because they eat more vegetables, since these are grown specifically to feed the family. However, in years when there are droughts or floods, many families go hungry.

The very low income of many households is one reason why the health of children is often extremely poor. Madagascar has one of the highest rates of stunting in the world, with half of all children suffering from stunted growth because of an inadequate diet.

It is common for families to rely on rice and cassava for the bulk of their meals – see Food & Daily Life. Often households are too poor to have meat or fish regularly, or to buy fresh fruit and vegetables. This means that many children are not eating the kinds of foods they need for proper growth.

Seeking treatment

Finding a doctor

SOS medical centre in Antsirabe

There are only 3,150 doctors in Madagascar, which equates to just 1.6 physicians for every 10,000 people (World Health Organization, 2005-2010).

There are a number of state hospitals in the main towns and cities. Basic care is provided free here, but families have to pay for supplies such as bed sheets, dressings and food. And hospitals also suffer from a shortage of staff, particularly specialist surgeons.

For poor families from rural areas, there is also the cost of reaching the nearest hospital. But when people are very ill, travelling is sometimes the only option. Many rural health centres lack trained staff and a number have been closed in recent years due to a shortage in government funding.

Depending on the illness, people may seek the help of local healers instead. With the island’s rich flora, traditional healers have access to many plants with medicinal qualities. Plants are collected from forests or arid areas, depending on the region and the healer’s knowledge. Medicinal plants can usually be dried to provide a year-round supply.

Churches and international aid organisations (such as UNICEF) are involved in helping to train more health workers and run or supply health centres.

Common diseases

Common illnesses include tuberculosis and malaria. Outbreaks of cholera can also occur, particularly during the rainy season.

HIV/AIDS has not affected the island as greatly as it has on the mainland of Africa. Only around 0.2% of adults are infected with the disease (a prevalence similar to the UK). Nevertheless, the disease has still claimed the lives of one or both parents of around 11,000 children (according to UNAIDS, 2009).