In February 2022, Madagascar grappled with the devastating impact of cyclones Batsirai and Emnati, which precipitated a sharp decline in health conditions across three regions. This crisis led to increased malaria, respiratory illnesses, and diarrhea, exacerbated by a rise in unvaccinated children due to disrupted healthcare services. Compounding the situation, extensive agricultural damage caused heightened malnutrition rates, collective food poisoning (TIAC), and poisoning by Consumption of Marine Animals (ICAM).  In response, the World Health Organization (WHO) funded and launched mobile clinics in the hardest-hit areas, providing primary healthcare, antenatal and postnatal care, immunizations, family planning, and nutritional surveillance. This initiative markedly improved healthcare delivery, disease monitoring, and bolstered local resilience, leading to significant improvements in healthcare coverage. Isolated villages experienced over a 40 percent increase in healthcare access, attendance at health facilities in the Grand Sud Est region rose from 29 to 37 percent, and the number of individuals receiving emergency care from mobile clinics surged by 48.6 percent. The initiatives undertaken align with the World Health Organization's thirteenth General Program of Work (GPW13), aiming to enhance the protection of an additional 1 billion people from health emergencies. Furthermore, these efforts are consistent with the Country Cooperation Strategy (CCS), particularly the second strategic priority, which emphasizes improving preparedness and response capabilities for health emergencies, natural disasters, and epidemics.

How did Madagascar, with the support of WHO, achieve this?

In response to the catastrophic cyclones, WHO Madagascar swiftly mobilized support, activating all three of WHO’s organizational levels to conduct rapid risk assessments in the affected regions. The event was quickly classified as a grade two emergency, unlocking vital internal financial resources, including the WHO Contingency Funds for Emergency (CFE). This funding was crucial for early lifesaving actions and was further augmented by additional resources from the United Nations Central Emergency Response Fund (CERF).

Central to the effective response was the implementation of the Health Cluster Approach, a strategy that enhanced coordination among humanitarian actors and enabled strategic joint management of the response. Under WHO Madagascar's adept leadership, the health cluster was rejuvenated at both national and regional levels, consolidating resources from a wide array of sectors and stakeholders, including the Ministry of Health (MOH) emergency department, non-governmental organizations (NGOs), the Global Action Plan for Healthy Lives and Well-being for All (SDG3 GAP) agencies[1], and other partners. This collaboration was instrumental in the efficient coordination of mobile clinics and the distribution of medical supplies and equipment.

^{WHO in the field offering free healthcare as part of its mobile clinic activities in in the south-eastern region of Madagascar, April 2023.}
Photo credit: WHO Madagascar/ Flora Dominique Atta

A key component of the response strategy was the deployment of an Emergency Medical Team (EMT), a joint effort between WHO and the governments of Poland and Madagascar. Within just three weeks post-cyclone, WHO Madagascar had deployed a 17-member multidisciplinary EMT team, comprising public health specialists, doctors, nurses, epidemiologists, and logisticians. Their expertise emergency medicine and water, sanitation and hygiene (WASH) strategies, policies, and best practices was crucial in meeting urgent health needs, treating injuries, and preventing the spread of diseases in the cities of Manakara and Mananjary.

To ensure sustained support, WHO provided comprehensive technical expertise, including a Health Cluster coordinator, epidemiologists, a monitoring and evaluation officer, a data manager, and a logistician. Collaborating closely with the MOH, WHO aided in setting up 14 mobile clinics in five enclaves and hard-to-reach districts. Each clinic, staffed by 2 healthcare providers and 2 community workers, played a vital role in delivering healthcare services, focusing especially on vaccine-preventable diseases and event monitoring in communities more than 5 kilometres from the nearest health facility. This had a dramatic impact on the community, as described by Tantely Rosa, a 21-year old fish seller in Marokarima, Vatovavy region, who said "with my pregnancy, I had no chance of having a prenatal consultation in a Basic Health Center (CSB) to benefit from follow-up by qualified healthcare staff. The remoteness of the area, and the deteriorating state of the roads due to Batsirai and Emnati, prevented me from going to the CSBs. Now, with these mobile clinic teams coming to us, I'm delighted and relieved. I have the care and medication I need for a healthy pregnancy. I wish these mobile clinics would continue their activities for the lives they save every day as they pass through our community. The population really needs them".

WHO maintained high standards of care by extensively training and supervising the mobile clinic teams, ensuring adherence to health guidelines and treatment protocols for prevalent diseases. In managing medicines and health program inputs, WHO provided specialized expertise to improve warehousing, financing mechanisms, infrastructure, and the implementation of DHIS2. Additionally, WHO oversaw the procurement and distribution of essential medicines, health supplies, and vaccines. Innovatively, WHO explored the use of drones to deliver critical items, such as family planning resources and vital medicines, to remote areas, a solution that remains available to support emergency responses throughout the country. As explained by Mrs Raherinirina Nomenjanahary Lea Claude, Chief of the Basic Health Center (CSB) of Vohilava, "by rehabilitating and upgrading our facilities we have been able to expand our services. Improved accessibility has created a better working environment where individuals can receive timely and effective healthcare interventions. This not only saves more lives but also strengthens the overall resilience of our communities against health challenges."

From March 2022 to September 2023, the 14 mobile clinics across the three regions (Atsimo Atsinana, Vatovavy, and Fitovinany) achieved significant results, despite challenging terrain. They treated over 30,000 patients, provided routine vaccinations to 7,900 children, and administered COVID-19 vaccines to 6,690 adults. Moreover, they offered family planning services to 1,423 individuals and conducted numerous health consultations, including 1,129 antenatal and 276 postnatal consultations, along with 4,567 consultations for malaria and 3,476 for acute respiratory infections. Nutritional monitoring reached 6,976 children, identifying 538 cases of severe and 1,088 cases of moderate acute malnutrition for follow-up.

"The work carried out by the mobile clinics have made a considerable contribution to restoring health services, especially vaccination services, in basic health centers during the cyclone emergency, and to covering areas usually inaccessible to health services, as well as enclaved localities or fokontany (villages)"

- Dr Yasmine Laetitia Lydie, General Secretary of the Ministry of Health