The health system in Madagascar is mainly designed by the French model and provides various health care facilities at different levels. In rural areas there are the “Centers de Santé de Base (CSB I), larger villages have the CSB II and in cities there are” Centers Hospitaliers de District de Levels I and II (CHD I and CHD II). Antananarivo has the best hospitals (Centers Hospitaliers de Référence = CHR and the Centers Hospitaliers Universitaires = CHU) with a large number of beds and relatively well-trained medical staff. Although the Ministry of Health regularly improves through new programspromises, Madagascar’s health system is badly organized, financially and staffed under-supplied and not freely accessible to all citizens. Significant medical gaps exist, particularly in rural and remote areas. The infant mortality rate has declined, but is still at 53.6 / 1000 births in 2018 (Germany: 4/1000), as is the case with maternal mortality (2017: 335 / 100,000 births, Germany: 3.3 / 100,000 births). Life expectancy averages 65.9 years, a relatively high figure for a sub-Saharan country. The density of doctors is due to lack of funding declined, as were the health expenditure cut (approx. 3% of GDP, 2014). Infrastructural deficiency, poverty and a lack of doctors are responsible for the fact that many sick people tend to trust traditional medicine. There is no health insurance.
According to oxfordastronomy, Madagascar has been in the global headlines recently due to the outbreak of the pneumonic plague. Plague outbreaks have occurred at regular intervals since the 19th century (but in this case the bubonic plague, which is less infectious than the pulmonary plague). Apparently the pathogen was brought in by merchant ships from India. Poor hygiene, ignorance of the routes of infection, a lack of isolation of the sick and panic among those infected can lead to an epidemic spread of the disease, the most recent being at the end of 2017. Pneumonic plague is transmitted by droplet infection and is therefore particularly infectious. It is relatively easy to treat with antibiotics; all the more frightening is the fact that 2017 more than 200 Malagasy people died of the disease before the all-clear could be given.
There is a high risk of malaria of the predominant, dangerous form caused by “Plasmodium falciparum” (Malaria tropica) all year round in all parts of the country, including the cities and in the coastal areas. Chloroquine resistance has been reported. By raising awareness and educating the population, the number of cases of malaria decreased between 2000 and 2009, but then increased again. The political crisis, climate change with higher precipitation and the appearance of new vectors (malaria carriers) seem to be responsible for this.
Nationwide there is an increased risk of infection for various infectious diseases such as hepatitis A, B, C and E, typhoid or polio (polio). Actually already defeated, polio reappeared in 2015, probably also due to the fact that medical professionals placed more emphasis on containing the plague and neglected the fight against polio. Bacterial dysentery, amoebic dysentery, lambliasis and worm diseases are common in the digestive tract, including schistosomiasis. The inadequate health care, poverty and insufficient education are also responsible for the fact that there is little vaccination against childhood diseases such as measles. The result was, for example, the outbreak of a measles epidemic in March 2019, in which at least 1,000 people – mostly children – died.
With the onset of the rainy season in November, there is a risk of dengue and chikungunya fever. These viral diseases are transmitted by mosquitoes and are mainly dangerous to children.
Madagascar has an overall low HIV / AIDS rate. The number of infected people is increasing, but totaled 0.3% in 2018. This can be explained, on the one hand, by the island situation of Madagascar, which prevented it from spreading like in other African countries. In addition, the initiation of awareness- raising campaigns at an early stage contained the epidemic spread of HIV / AIDS in its early stages.
As worldwide, Madagascar has not been spared from the Corona crisis 2020. The government was one of the first African countries to close its borders and suspend all regional and international flights from March 20, 2020. German tourists were affected by a delayed return campaign to Germany. President Rajoelina is attracting attention worldwide because he claims to have found a cure for the Corona Covid19 virus: an herbal tea that contains the anti-malarial plant wormwood. He receives support from the Catholic Church. Other African countries are showing interest. The WHO doubts the effectiveness and warns that all Africans should also receive drugs that have been proven in clinical tests and effective against Covid19 – if they come on the market. Rajoelina defends herself against criticism and accuses the WHO of not recognizing the effectiveness of the drug because it comes from a poor African country. He even goes so far as to urge other countries to withdraw from the WHO – a thunderclap for global health efforts against Covid 19.
No vaccinations are required to enter Madagascar, unless you come from a yellow fever endemic area. The Federal Foreign Office provides current medical information. For long-term stays, for individual trips with simple accommodation or for practical work in health or social services, it is advisable to expand the existing vaccination protection with vaccinations against polio, cholera, typhus, hepatitis A and B, rabies and meningococci. Polio, in particular, which was almost entirely contained in Europe, was able to develop in 2015 spread again in Madagascar. The overall risk of malaria is high, the risk is greatest in the damp east coast regions, and least in the dry south and also in Antananarivo. In addition to exposure prophylaxis, a doctor should decide on appropriate medication in an emergency. Hygiene plays an important role in avoiding diarrhea and / or cholera. Cholera broke out epidemically in 2000, but no cases have been reported since then.
The plague has occurred repeatedly in the central highlands since the 1920’s. The bubonic plague is the most common form: It even occurs regularly with up to 500 cases a year. In 2017 it became known that some people had contracted the highly contagious pneumonia. Panic among the population could be avoided, however, as the acute wave of illness was officially declared over in December 2017. But there was another case in 2018. It is to be hoped that this disease can soon be completely contained, because the danger also discourages many tourists from visiting the island.
Corona did not spare Madagascar either. Before entering Madagascar in 2020, tourists should find out from the responsible authorities whether and how a stay can be organized.