AFRINGO e.V. has successfully carried out, in collaboration with the NGO Asoaviko Ambositra Association (AS.A.) the project titled Advancement of rural public health infrastructure in two sites in Madagascar: Imerintsiatosika and Andina (ADAMA), funded by the Else Kröner-Fresenius-Stiftung (EKFS). 

Madagascar ranges among the least developed countries and only a rudimentary healthcare system is in place. Frequently, medical personnel and life-saving diagnostic tools/medicine are absent, resulting in a lack of trust of the population in existing healthcare services coupled with limited expectations of receiving care. Medical expenses are often paid out-of-pocket, which leads to the fact that people commonly remain at home and do not seek life-saving healthcare. 

The ADAMA project directly addressed this issue by advancing healthcare in two healthcare facilities.

In Imerintsiatosika, 32km west of Antananarivo, ADAMA supported a Centre de Santé de Base II (CSB), which is run by the Ministry of Public Health (MOH) covering 72,000 people. In Andina, located 280 km south of Antananarivo, a community health center that covers a population of 55,000 in a remote rural mountainous area, heavily underserved with health services and exhibiting a high poverty rate and high maternal mortality, was supported.

In Imerintsiatosika, the existing infrastructure and equipment was improved. The expansion of infrastructure includes two new rooms, one to sterilize medical tools and one to serve as an urgently needed laboratory. In Andina, the healthcare center was improved with four additional rooms: one to examine special cases, one for births (obstetric support), one to serve as inpatient ward, one laboratory. This has been highly successful and the room is well occupied. At both sites, medical personnel (24/7) and essential drugs are permanently available.  

Training courses for village chiefs, community agents and school classes were conducted by ADAMA staff members several times per year (i.e. physicians, midwifes, nurses, program managers) ranging from control of infectious diseases (i.e. schistosomiasis, typhoid fever, deworming) to day-to-day knowledge pertinent to dental care and personal hygiene. 

The ADAMA project has been highly successful which is demonstrated by the increased trust of the population in the provided healthcare. The number of annual consultations almost doubled in Andina since inception of the program and significantly increased in Imerintsiatosika. Secondly, maternal care has improved; at the Andina center no child has died during birth. 

Lastly, both centers serve as a platform for other health interventions. In Andina, German dentists used the facility to treat the local population; a major schistosomiasis intervention took place using the facility as a hub. In Imerintsiatosika, a project on identifying typhoid fever disease burden is ongoing (Bill and Melinda Gates Foundation [BMGF]-funded). While ADAMA improves basic healthcare, the BMGF-funded project supports blood culture and diagnostics of bacterial pathogens – this combination has a major beneficial impact for the population. Because of the EKFS-funded ADAMA project, significantly more patients visited the CSB, making it possible to identify and confirm more typhoid fever cases, resulting in a Gavi application to introduce typhoid vaccines into Madagascar. 

In summary, the investment made by the EFKS in funding the AFRINGO e.V./AS.A.-led ADAMA project did not only impact the population directly by providing adequate healthcare services but has also provided significant benefits for the Malagasy population beyond the direct impact of the project, particularly by using the sites as platforms for other interventions.