What we achieve
In recent years Madagascar has shown progress in improving the health status of the country's children: notably is it one of few countries in Africa that has succeeded in reducing deaths among children under five. In 1990, the under-five mortality rate was 168 deaths per 1,000 live births. In 2008, this has fallen to 106 deaths per 1,000 live births.
Disparities in child health indicators have also begun to decline - and it is among Madgascar's least wealthy people that the highest gains for vaccination coverage have been felt. Biannual Mother and Child Health Weeks are without a doubt among the most important ways of reaching some of the most excluded women and children.
Disparities in child health indicators have begun to decline, but many of the gains made in recent years are at risk being reversed.
Elsewhere, water, sanitation and hygiene projects in communities and schools, accompanied by radio programmes that focus on health issues, are helping to encourage long-term behaviour change that will increase the sustainability of UNICEF's work.
Training national health agents is helping to reinforce the national capacity to identify and treat malnutrition in children - particularly in those areas most vulnerable to food insecurity. To help reduce neonatal and maternal mortality, more than 100 health workers have been trained in emergency obstetric care since the beginning of the current UNICEF country programme in Madagascar.
Unfortuately many of these gains risk being reversed as a result of socail and economic hardship caused by Madagascar's unresolved political crisis of early 2009. While UNICEF continues to support the training of community health workers in some of Madagascar's most remote regions, many health facilities lack equipment and medicines.
In this time of political instability, UNICEF's continued work to protect Madagascar's most vulnerable children is critical.