Madagascar

Axes of intervention

Care and surgery
Training and skills transfer
Building and equipping hospitals
Prevention and screening

Start date: 2018

While Madagascar is considered one of the poorest countries in the world, its health system is fragile. That's why La Chaîne de l'Espoir is doing its utmost to develop cardiac surgery expertise there. Since 2018, it has been organizing missions, training caregivers and rehabilitating infrastructure to save Madagascan children with heart disease.

Background

The humanitarian emergency in Madagascar

40 deaths

per 1,000 births (compared with 4 in France).

0.2 doctor

per 1,000 inhabitants in Madagascar (compared with 3.39 in France).

75 %

of Madagascar’s population lives below the poverty line.

Sources: Unicef, WHO, World Bank

With a population of around 28 million, this Indian Ocean island is one of the ten poorest countries in the world. In recent years, the effects of global warming, causing periods of intense drought and violent climatic events such as cyclones, have accentuated the already precarious vulnerability of Malagasy families.

This very complicated situation is compounded by difficulties in accessing healthcare in Madagascar. Nearly 70% of the population works in the informal sector and is therefore ineligible for public health insurance schemes. What’s more, Madagascar lacks the health infrastructure and trained health professionals to meet all needs. This is particularly true for children suffering from heart disease. For example, while there are an estimated 3,600 new cases of congenital heart disease every year, many children with heart disease go undetected because of their distance from health care centers or the precarious situation of their families. Even if they are lucky enough to be diagnosed, very few can be operated on, due to the lack of human and technical resources in the country.

To remove these obstacles, La Chaîne de l’Espoir has been mobilized since 2018 through humanitarian missions in Madagascar with the ambition of developing pediatric heart surgery – until now non-existent.

Our humanitarian action for the children of Madagascar

Developing and structuring pediatric cardiac surgery in Madagascar

In Madagascar, our teams have one objective: to give children with heart disease access to the care they need. Without it, their chances of survival are virtually non-existent.

This is why we have set up a number of humanitarian initiatives in Madagascar that are complementary and structuring, such as :

Screening campaigns to identify children in need of heart surgery.
Every year, more than 200 children benefit from a consultation.
Organization of medical-surgical missions to the Soavinandriana hospital (CENHOSOA) in the capital, Tananarive, to diagnose and operate on children from all regions of the country.
Every year, some twenty children are operated on during these missions.
Transferring children with the most serious pathologies for surgery in France – to the CHU Félix-Guyon on Reunion Island or to other facilities in mainland France.
Since 2018, around 40 children have been transferred and saved each year thanks to our Children’s Care in France program.
Weekly remote ultrasound sessions, using the echoes® platform, to develop diagnostics, train local doctors and benefit from the expertise of cardiologists from CHU La Réunion and Bordeaux, in particular.
Since 2018, more than 150 echoes® consultations have been organized each year.

Training local healthcare professionals

These humanitarian actions in Madagascar are all accompanied by training for Madagascan hospital staff, with the aim of increasing their skills and autonomy – particularly for the most complex operations:

In a spirit of companionship, CENHOSOA’s Madagascan healthcare professionals consolidate their knowledge and practices alongside their French colleagues who take part in medical-surgical missions.
We support Madagascan doctors in their efforts to obtain an inter-university diploma (DIU) in surgical resuscitation of congenital heart disease from the Bordeaux Faculty of Medicine.
As part of the development of South-South cooperation, a number of Madagascan healthcare professionals have also received training at the Cuomo Cardiopediatric Center in Dakar, Senegal, which we built.
Finally, to encourage early diagnosis, we also train general practitioners and other medical and paramedical staff in the telltale signs of heart disease.

Open-heart surgery: a technical feat now possible in Madagascar

Finoana, one of the first children to undergo open-heart surgery at CENHOSOA in Madagascar

In Madagascar, La Chaîne de l’Espoir has also set itself the goal of strengthening health infrastructures, which are essential for providing quality care.

Now that local CENHOSOA teams can operate autonomously on closed hearts, a major milestone has been reached. Thanks to the rehabilitation of the care unit and the construction of a new technical surgical platform, open-heart surgery is now possible in Madagascar. These operations are extremely complex. They require sophisticated biomedical infrastructure and equipment, as well as trained healthcare professionals.

“Since 2016, the CENHOSOA medical team has been autonomous in handling closed-heart operations. For several years, we have wanted to perform open-heart surgery. Thanks to the rehabilitation and equipping of the cardiac surgery unit, the training of medical staff and the care of sick children, our dream is finally becoming a reality.”

Dr Nivohanta Ramamonjisoa, medical coordinator in Madagascar

This project has kept our teams and their partners motivated for several years. Even during the Covid crisis, which slowed progress on the project.

These efforts have been crowned with success: the first open-heart operation took place in the first half of 2024!

First open-heart surgery

In May 2024, four Malagasy children aged 8 to 13 underwent open-heart surgery at Cenhosoa, a hospital in the capital. A first in the country’s medical history and a tremendous human adventure started in 2018 by La Chaîne de l’Espoir.

Read the report

Creating a reference cluster in the Indian Ocean

Surgeons in the operating room during one of Madagascar's first open-heart operations

With this new open-heart surgery expertise in Madagascar, we are consolidating our commitment to structuring a genuine regional strategy for the Indian Ocean. This strategy is supported by the Agence Française de Développement (AFD), which has selected La Chaîne de l’Espoir to deploy cooperation between Madagascar and the Comoros, with the support of medical teams from the CHU Félix-Guyon La Réunion.

At the same time, we wish to continue to support the strengthening of the Malagasy healthcare system with upcoming projects for :

increase screening and awareness of the main causes of heart disease,
expand our areas of intervention as part of a regional cooperation strategy in the Indian Ocean, to reach the country’s most remote populations,
invest in oral health (directly linked to the onset of certain heart diseases),
create new partnerships with schools and hospitals in the capital and the provinces to promote health at school, etc.