Here is the work of Health Economist Marilys Victoire Razakamanana as part of our weekly series Les Papiers de la Fondation, articles written by the researchers that the Foundation supports at the end of their research year. The Papiers de la Fondation, scientific articles of around twenty pages, present the results of their work in the form of working papers. They are written according to academic criteria for specialised or non-specialised audiences, in order to make the knowledge thus created accessible to all interested people and to allow for a broad debate.

Les Papiers de la Fondation: disseminating research and fostering debate

« Socio-economic analysis of the use of community-based care in Madagascar »

Marilys Victoire RAZAKAMANANA, PhD in Health Economy, tearcher/researcher at the Centre de Recherche pour le Développement, Catholic University Madagascar


The community care management was implemented in Madagascar in 2011. The aim was to overcome the problems of accessibility to care. However, although this program, many households still practice self-medication. Through this study, we looked for the causes of this weakness in the use of community care. Surveys were conducted in two districts of Madagascar. A comparative analysis between the different types of health care, in terms of cost, efficiency and quality of care offered was made. Socio-economic determinants of the use of community health worker (CHW) for children under 15 were also identified.

First, the households demand for health depends on their perception of health. Secondly, the services provided by private health centers satisfy the most households. But their services are the most expensive. In the second place, come the services provided by CHWs. The main determinants of the use of CHWs is the caregiver-care relationship, which is better than other types of care, the lack of waiting time during consultations and the low cost of services. Then, unavailability of materials and medicines demotivates the population to consult them.

Key words: Madagascar, demand for health, community health workers, socio-economic determinants.

Photo Credit: © Marilys Victoire Razakamanana