Plan d’action national budgétisé en planification familiale à Madagascar

Objectives

Madagascar’s 2016–2020 National Budgeted Action Plan for Family Planning provides a costed national framework for rights-based, voluntary family-planning services. It seeks to increase modern contraceptive prevalence among women in union from about 33% in 2012 to 50% by 2020, reduce unmet need to 9%, and support improved maternal and child health, gender equality, poverty reduction and economic development.[1][2][3]

• Strengthen an enabling policy, legal and institutional environment, including dissemination and implementation of family-planning legislation, updated reproductive-health standards, postpartum family planning and youth-friendly services.[4][5][6]
• Generate demand by improving knowledge, addressing misinformation and sociocultural barriers, and engaging men, adolescents, parents, community, traditional, political and religious leaders.[7][8][9]
• Expand equitable access to integrated, quality services, especially for young people, poor households, remote communities, marginalised groups and women receiving antenatal, postnatal, post-abortion, obstetric-fistula or caesarean care.[10][11][12]
• Secure reliable availability, procurement, storage, distribution and logistics management of contraceptives, reproductive-health commodities and consumables at facility and community levels.[13][14][15]
• Increase sustainable financing through domestic budget allocations, partner mobilisation, a total-market approach and annual financing-gap analysis; the plan proposes a 5% annual increase in public allocations for reproductive-health and family-planning product procurement.[16][17][18][19]
• Strengthen supervision, coordination, data quality, monitoring and evaluation to support implementation and Madagascar’s Family Planning 2020 commitments.[20][21][22]

The five-year action plan is structured around six strategic areas: policy and enabling environment; demand creation; service provision and access; product security; financing; and supervision, coordination, monitoring and evaluation.[23][24]Its overall implementation cost is estimated at 463.7 billion Ariary, including 295.7 billion Ariary in programme activities and 167.9 billion Ariary for contraceptives and consumables.[3]

Implementation

Implementation uses a multisectoral public, private and community model led by the Ministry of Public Health through the Family Health Directorate. It combines community outreach, primary-health-centre and hospital services, private and social-marketing providers, supply-chain reform, targeted youth services and coordinated support from civil society and technical and financial partners.[25][26][27]

• Lead national implementation, policy dissemination, supervision and performance monitoring through the Ministry of Public Health and the Family Health Directorate, with coordination committees and focal points at national, regional and district levels.[25][26][28]
• Engage the ministries responsible for population, youth, education, justice, finance and other sectors, alongside non-governmental organisations, private providers, SALAMA, community structures, traditional and religious leaders, and development partners.[29][24][27]
• Deliver demand-generation activities through local-language media, mobile messaging, schools, peer educators, women’s and youth groups, farmer organisations, community dialogue and male-engagement initiatives, including the Raim-pianakaviana Mendrika pilot.[30][31][32][33]
• Provide youth-responsive services through youth-friendly health centres, youth spaces, centres, corners and kiosks; the plan envisages transforming more than 25% of public basic health centres in each district into youth-friendly centres.[34][35][36]
• Build provider and community-agent capacity through annual training plans, refresher training, integrated postpartum family-planning training, rights-based counselling and community activity packages.[37][38][39]
• Integrate family planning into maternal, newborn, post-abortion, nutrition, malaria, sexually transmitted infection and HIV services, while deploying selected community agents in remote areas and using vouchers or social franchising to improve financial access.[40][11][41][42]
• Strengthen commodity security through integrated procurement planning, needs quantification, storage rehabilitation, community supply points, CHANNEL logistics software, supervision and distribution arrangements linking SALAMA, district pharmacies, facilities and community structures.[13][14][43][44]
• Prioritise interventions with the greatest expected contribution to objectives where available funding is below estimated requirements, while mobilising additional public, partner and private-sector resources.[23][24][17]

The monitoring system links results, activities and indicators, using national surveys, health-sector records, administrative reports and tools including ImpactNow, Track20, CHANNEL and digital reporting platforms.[22][45][46]Key measures include contraceptive prevalence, unmet need, fertility, maternal and infant outcomes, demand satisfied, commodity availability, provider performance, service readiness, data quality and financing indicators.[22][47][48]The plan provides for integrated formative supervision, annual provider-performance assessments, routine data verification, regular technical and stakeholder coordination meetings, annual financing-gap analysis, quarterly online monitoring of the action plan and evaluation of the integrated strategic plan in 2018.[20][49][28][50][51]

Budget priorities include 160.7 billion Ariary for service provision and access, 87.6 billion Ariary for supervision, coordination, monitoring and evaluation, 27.7 billion Ariary for demand creation, 14.1 billion Ariary for product security, 5.4 billion Ariary for policy and enabling-environment activities, and 0.2 billion Ariary for financing activities.[3]Financing remains heavily dependent on external partners, and the plan therefore emphasises government budget growth, dedicated budget lines, tax exemptions for family-planning supplies, resource mobilisation and annual review of gaps.[23][17][52]

Monitoring & Evaluation

The National Budgeted Action Plan for Family Planning establishes a multi-level monitoring, evaluation and accountability system led by the Ministry of Public Health, principally through the Directorate of Family Health. It combines routine service and logistics reporting, supervision, surveys, programme databases, periodic evaluations and coordination mechanisms to monitor implementation and progress towards Family Planning 2020 commitments.[25][26][22]

• Track outcome indicators including modern contraceptive prevalence, unmet need for modern contraception, total fertility rate, unintended pregnancies, couple-years of protection, maternal mortality, infant mortality, maternal deaths averted and unsafe abortions averted.[22][45][47]
• Monitor the 2020 target of 50% modern contraceptive prevalence among women in union, up from 33.3% in 2012, alongside annual progress targets for modern and total contraceptive prevalence.[53][2]
• Use national surveys, annual health-sector statistical records, administrative reports, facility assessments, programme reports, receipt records, ImpactNow, Track20 and Track PSI as information sources.[22][45][47]
• Measure service and demand outputs including exposure to family-planning messages, method knowledge, availability of modern methods, trained providers, community-agent activity, youth-friendly services, counselling, post-abortion care and access to preferred methods.[46][54][55]
• Track commodity-security performance through stock-outs, completeness and timeliness of logistics reports, supply-chain supervision, CHANNEL database use, data quality and ordering information.[13][48][56]
• Undertake integrated formative supervision across facilities, districts, regions, pharmacy structures and community services, including regular provider-performance assessments, data verification and quality audits.[20][49][57][58]
• Maintain coordination committees at national, regional and district levels, including a proposed family-planning subcommittee under the reproductive-health committee and recurring technical committee meetings.[49][26][28]
• Prepare monitoring plans, dashboards and reports at all levels, with reports transmitted through regional, district, facility, community-agent and non-governmental organisation structures to central authorities.[50]
• Conduct annual financing-gap analyses and stakeholder reviews to align partner workplans and available resources with the action plan.[17][28]
• Evaluate the integrated family-planning and sexual and reproductive health strategic plan in 2018 and subsequently every three years, with review and restitution workshops.[21][50]

Reporting periodicity varies by indicator: survey indicators are generally measured every five years, some outcome measures every two years or annually, administrative indicators mainly annually, selected logistics and supervision measures quarterly or semi-annually, and Family Planning 2020 online monitoring quarterly.[22][45][47][48][51]Several extracts nevertheless identify weaknesses in data systems, indicator usability, qualified personnel, data use and coordination, and do not specify a single consolidated accountability or corrective-action framework.[53][59][22]

Costing & Financing

The five-year National Budgeted Action Plan is costed at 463.7 billion ariary for 2016–2020, including 295.7 billion ariary for programme activities and 167.9 billion ariary for contraceptives and consumables.[3]Financing is expected to combine increased government allocations, development-partner support, private-sector participation and resource mobilisation, but family planning remains substantially dependent on external support and partner-funded commodities.[23][16][17]

• Allocate major programme resources to service provision and access, at 160.7 billion ariary, and supervision, coordination, monitoring and evaluation, at 87.6 billion ariary.[3]
• Fund demand creation at 27.7 billion ariary, product security at 14.1 billion ariary, policy and the enabling environment at 5.4 billion ariary, and financing activities at 0.2 billion ariary over 2016–2020.[3]
• Provide 139.1 billion ariary for contraceptives and 28.8 billion ariary for consumables, together totalling 167.9 billion ariary.[3]
• Increase the health-ministry allocation for sexual and reproductive health and family-planning product procurement by 5% annually and establish a dedicated budget line that includes logistics-management costs.[17][18][19]
• Conduct annual financing-gap analyses, prioritise high-impact activities where available financing is below requirements, and align donor and implementing-partner workplans with the budgeted action plan.[23][17][28]
• Mobilise supplementary support from traditional and potential development partners, including Family Planning 2020-related partners, while pursuing private-sector engagement and a total-market approach for reproductive-health commodities.[16][17][18]
• Seek customs-duty and value-added-tax exemptions for public-sector and social-marketing family-planning supplies through finance-law and decree processes.[17][52][60]

Costing uses government rate documents, Madagascar suppliers and implementing partners, supplemented by regional African or international sources where local data are unavailable. Contraceptive projections use the 2012 ENSOMD contraceptive-prevalence rate and method mix as a baseline, with intermediate rates extrapolated linearly towards Family Planning 2020 targets.[21]The supplied material does not provide a consolidated statement of committed domestic and donor financing, a quantified overall funding gap, or wider macroeconomic assumptions.[24][21][28]