The document summarizes mutual health schemes (MHOs) established in Madagascar with support from Positive Planet and Sanofi. It discusses how three MHOs were created between 2012-2013 to provide health coverage to informal workers, reaching over 30,000 beneficiaries by 2015. The MHOs partner with various organizations and provide services like hospitalization, consultations, and drugs. They aim to expand coverage to 67,000 people by diversifying services and ensuring financial sustainability without subsidies by 2018.

1. Zina – Mutual health schemes in Madagascar
European Microfinance Week
November 19th 2015

2. AGENDA

3. 3
 The great majority of the population in Madagascar
does not benefit from any form of health coverage.
 Medical consultation is often forgone. Among the
most recurring reasons declared:
 55% - sickness deemed not serious enough
 23% - costs are too high
 In between 2010 and 2012, on behalf of Sanofi,
Positive Planet carried out 5 feasibility studies in order
to assess the potential for building a mutual health
insurance scheme in Madagascar.
 Microentrepreneurs in the informal sector displayed a
strong interest towards the opportunity of joining a
mutual health scheme.
 In between 2012 and 2013, Positive Planet, in
partnership with Sanofi, contributed to the creation of
, and of a common management
platform,
of the population
resort to self-
medication*
of working-age
population does not
have access to social
protection at all*
of the population lives
further than 5 kms
away from the Centre
Santé de Base*
*Source: Declaration by the Malagasy President
during the International Symposium on Social
Protection (Anosy, May 11th 2014)
*Source: Enquête Périodique auprès des
ménages, INSTAT, Madagascar, 2012-2013
*Source: Health Districts Directorate, 2014 ;
Stratégie de Coopération, OMS, 2009

4. 4

in
Madagascar
 in charge of
technical support, consulting, training and
development

(August 2015)
 :
 Pharmacies
 Drug stores
 Public and private hospitals
 Centre de santé de base (CSB)
 Healthcare centers
 Private clincs
 Doctors
 Partners : Fondation Mérieux, Marie Stopes
International (MSI), Population Services
International (PSI), Programme Mahefa
(USAID)
Diana
Sofia
Sava
Analamanga
Itasy
Bongolava
Vakinankaratra

5. 5
 To contribute to the enhancement of healthcare access for informal sector workers in
Madagascar.
 To foster synergies among public and private actors, as well as civil society organizations,
within the scope of the National Health Strategy (Stratégie Nationale de Santé).
 To favour the protection of the resources of farmers and microentrepreneurs.
 To participate to the implementation of a durable health coverage in Madagascar.
To expand the offer of the 3 MHOs to 67.000 beneficiaries, through geographic extension,
diversification of their services, institutional anchorage and the achievement of sustainability.
 : 3-year cycles : 2010 – 2012 ; 2013 – 2015; 2016 – 2018
 : 7 regions : Analamanga, Itasy, Vakinankaratra, Amoroni’mania, Diana, Sofia, Sava
 : informal sector workers, microentrepreneurs, farmers, hotel staff, MFIs members
and the overall population of the intervention zones

6. 6
- Subsidizing subscriptions
- Financing development
activities
- Providing direct
intervention with regards
to health, mobile
telephony, cash transfer,
etc.
Subscriptions
Management
Healthcare
services
Subscriptions
(subsidized or
direct)
Operating
expenses of the
MHOs and of the
platform
Contribution by
donors
MHOs
development
activities
(Third party payment)
Subscriptions are due
to match total costs
starting from 2018
Reimbursement

7. 7
emprunteurs et épargnants) de l’IMF OTIVTANA
:
 Partner: OTIVTANA (IMF)
 Target: Borrowers and savers at OTIVTANA
 Types of membership: Borrowers of over 1million Ariary, voluntary subscribers
 Treatements covered
 : Hospitalization and Surgery
 : Consultation, Drugs
 Subscription Conditions
 Borrowers :
 Savers:
 Required formalities
 Subscription fees: 2.000 Ar
 Copy of the National Identity Card
 Copy of the Family Register
 Identity photo for every beneficiary of the MHO

8. 8
emprunteurs et épargnants) de l’IMF OTIVTANA Partners: ADAPS, Symrise (FIMPALA), Association of hotel personnel, MFIs, AFDI
 Target: Vanilla and cacao producers, market gardeners , borrowers and savers, hotel
staff, overall population in the target zones, municipal association
 Types of membership: Subsidized (100% or partially), voluntary
 Treatements covered
 : Hospitalization and Surgery
 : Consultation, Echography, Laboratory, Radiography, Delivery,
Dentistry
 : Drugs
 Subscription Conditions
 Membership fee: (7 pers)
 Additional contribution: (for family members over 18,
exceding the 7th)
 Extra fee:
 Required formalities
 Copy of the birth certificate

9. 9
emprunteurs et épargnants) de l’IMF OTIVTANA
 Partners : SYMRISE
 Target : Vanilla producers
 Types of membership : Subsidized 100%
 Treatements covered
 Hospitalization, Surgery, Maternity
 Consultation, Routine Treatements, Radiology, Echography,
Ophtalmology, Laboratory, Dentistry, Stomatology
 Drugs
 Subscription Conditions
 Membership fee: (7 pers)
 Additional contribution:
 Required formalities
 Copy of the birth certificate

10. 10
Borrowers
Savers
Rural Population
Urban Population
Subsidized
Voluntary
Subsidized
Voluntary
Rural Population
Urban Population
Rural Population
Urban Population

11. Contracted healthacare providers
11

12. 12
(Jan-Jul 2015)
(end of August
2015)
(end of August 2015)
1 doctor* per
352
beneficiaries
1 doctor* per
158
beneficiaries
1 doctor* per
44 beneficiaries
* Private doctor, centre de santé de base, centre de santé, private clinics
Almost healthcare services were coverd under third party payment
since the beginning of 2015
Gastrointestinal
Infections
Influenza-like
illness
Parasitic disease
Gastrointestinal
Infections
Influenza-like
illness
Parasitic disease
Gastrointestinal
Infections
Influenza-like
illness
Parasitic disease
(end of August 2015)
Drugs
Consultation
Hospitalization

13. Phase 3 – Objectives 2018
13
• Developping the offer for
each MHO
• Raising thr number of their
• Extension of their
• Reinforcement of the
services provided to the
MHOs :
•
• Viability of the
Participation to the
implementation of the
MHOs Plateform Institutional Anchorage

14. 14

15. 15
Antanimora
Antananarivo - Madagascar
Tel /Fax: +261 20 22 640 01
www.positiveplanet.ngo
florence.duvauchelle@positiveplanet.ngo
Antanimora
Antananarivo - Madagascar
Tel /Fax: +261 20 22 640 01
www.plositiveplanet.ngo
felana.rajomarison@positiveplanet.ngo
Tel: +39 347 32 44 266
marialivia.derubeis@hotmail.it