Networks of Care in Rural Madagascar for Achieving Universal Health Coverage in Ifanadiana District

Health Syst Reform. 2020 Sep 1;6(2):e1841437. doi: 10.1080/23288604.2020.1841437.


Health care is most effective when a patient's basic primary care needs are met as close to home as possible, with advanced care accessible when needed. In Ifanadiana District, Madagascar, a collaboration between the Ministry of Public Health (MoPH) and PIVOT, a non-governmental organization (NGO), fosters Networks of Care (NOC) to support high-quality, patient-centered care. The district's health system has three levels of care: community, health center, district hospital; a regional hospital is available for tertiary care services. We explore the MoPH/PIVOT collaboration through a case study which focuses on noteworthy elements of the collaboration across the four NOC domains: (I) agreement and enabling environment, (II) operational standards, (III) quality, efficiency, and responsibility, (IV) learning and adaptation. Under Domain I, we describe formal agreements between the MoPH and PIVOT and the process for engaging communities in creating effective NOC. Domain II discusses patient referral across levels of the health system and improvements to facility readiness and service availability. Under Domain III the collaboration prioritizes communication and supervision to support clinical quality, and social support for patients. Domain IV focuses on evaluation, research, and the use of data to modify programs to better meet community needs. The case study, organized by the domains of the NOC framework, demonstrates that a collaboration between the MoPH and an NGO can create effective NOC in a remote district with limited accessibility and advance the country's agenda to achieve universal health coverage.

Keywords: Networks of care (NOC); community health; health system strengthening; health-care quality; universal health coverage.

MeSH terms

  • Community Networks*
  • Health Care Reform / methods*
  • Health Care Reform / trends
  • Humans
  • Madagascar
  • Primary Health Care / economics
  • Primary Health Care / methods
  • Universal Health Insurance / trends*