Situación y prioridades

Situación de la protección social

Ranked 177 out of 193 (HDI 2021), Madagascar remains one of the poorest countries in the world where 80.7 per cent of the population lives on less than US$1.90 a day. Social protection is fragmented with expenditures spread across small-scale, isolated, and low impact programmes. 40 per cent of the social protection spending is allocated to civil servants and their families, who represent less than 1 per cent of the population. The largest social security scheme for formal private sector workers covers less than 2 per cent of the total population. The largest social assistance programme was launched in 2016: A conditional on education cash transfer and focused in rural areas, it only covered 5 per cent of extremely poor households in 2018, but the government has made its expansion a priority.

The country has an ambitious social protection agenda, with a vision under the National Social Protection Strategy (NSPS) that half of the vulnerable population will benefit from effective social protection coverage by 2030. Its overall objective is that 15 per cent of households living in extreme poverty will have access to effective social protection coverage within the next five years.

The action plan is structured around four main pillars: (i) social transfers, (ii) access to basic social services, (iii) support for livelihoods, and (iv) strengthening of the contributory social protection scheme. The country has initiated several reforms to expand social protection coverage, including health, through both non-contributory schemes for the poorest and contributory schemes for those able to pay.

For vulnerable populations, cash transfer programs have been implemented since 2016, alongside the development of a universal health coverage (UHC) framework, including a dedicated institution and fund to support coverage for the poorest.

For contributory groups, coverage is being gradually extended to self-employed and liberal professions. Strong synergies between income protection and health insurance reforms call for an integrated approach, with a unified registration system and benefit packages aligned with beneficiaries’ capacity to contribute.

However, social protection coverage is still limited. For instance, social health protection mechanisms are scattered, but reaching universal health coverage is a government priority, through contributory and non-contributory mechanisms, although they are not yet operational as of November 2020.

Prioridades del gobierno

A significant majority of the Malagasy population lacks social protection, particularly non-salaried workers, who constitute a substantial portion of the workforce. Currently, only 5 per cent of the active population, primarily salaried employees, benefit from social coverage. To address this, the relevant ministerial departments have set an ambitious goal: to extend coverage to 25 per cent of the workforce, including non-salaried workers, through adapted contributory schemes.

Between 2021 and April 2022, the ILO successfully designed and operationalized an innovative health financing mechanism for improving access to healthcare for vulnerable populations in the Anosy and Androy regions. This included establishing a fully digitalized health fund implemented through the mTOMADY platform, enabling integrated and efficient management of beneficiaries, financing flows, and service providers.

This facilitated the identification and enrollment of 1,861 vulnerable agricultural households, granting them access to subsidized healthcare services through a network of 11 accredited health providers. Strong institutional partnerships were also established, including formal approvals from district health authorities and contractual agreements with participating providers for effective implementation of the scheme. The ILO invested in capacity building by training enrollment agents and healthcare workers and provided continuous technical assistance and field supervision. The scheme was fully operationalized through the deployment of digital tools, user account creation, and providing connectivity and equipment, leading to the launch of healthcare service delivery in early 2022. Additionally, efforts were made to enhance the visibility of the initiative through communication materials and media, leading to greater awareness of the scheme. The ILO played a central role in piloting an integrated and scalable model of digital health protection for vulnerable populations.

At the end of 2023, the Malagasy government with ILO support conducted an experience-sharing mission with Côte d’Ivoire on extending social protection to informal sector workers. Following this, the Ministry of Labor, Employment, and Public Service in collaboration with all stakeholders, developed a roadmap for extending social protection to self-employed workers aligning with the priorities of the new General State Policy (PGE).

Implementing this roadmap fostered fruitful collaboration between the Ministry of Labor and the IRAY health insurance mutual, aiming to cover self-employed and informal workers. An awareness phase has already reached approximately 1,500 people in the Vakinankaratra region, a key step in the inclusion of these often-marginalized groups. Concurrently, the National Social Insurance Fund (CNaPS), with ILO technical support, launched national consultations to collect data for an actuarial study. This study is essential for creating a retirement social security offer tailored to self-employed workers, ensuring their long-term financial security. In the health sector, the ILO, in collaboration with the Ministry of Public Health, established Community-Based Health Insurance (AMBC) in the Amoron’i Mania region, already enabling over 2,000 members of the informal sector platform structures (SOAVA) to benefit from health coverage.

Finally, the ILO contributed to updating the National Social Protection Strategy, reinforcing contributory scheme mechanisms and aligning the strategy with international standards. These efforts aim to promote universal, inclusive, and sustainable social protection, reducing inequalities and ensuring fundamental labour rights for all Malagasy people. These advancements demonstrate the government and its partners’ commitment to achieving the 25 per cent coverage goal and to building a social protection system adapted to Madagascar’s economic and social realities.