Madagascar ACCESS Activity (Accessible Continuum of Care and Essential Services Sustained): Midterm Evaluation Report

Madagascar ACCESS Activity (Accessible Continuum of Care and Essential Services Sustained): Midterm Evaluation Report
Citation: Bergson, S., Moonzwe, L., Indriamihaja, Rakotonirina, J., Jacobs, B., Koch, R. (2022). Madagascar ACCESS Activity (Accessible Continuum of Care and Essential Services Sustained) Midterm Evaluation Report, Chapel Hill, NC, USA: Data for Impact.
Abstract: This midterm evaluation examined the progress of the Accessible Continuum of Care and Essential Services Sustained (ACCESS) program to identify promising approaches, ongoing challenges, and recommendations. The evaluation focused on five questions:

  1. To what extent has Access improved the quality of health services and the continuum of care?

  2. To what extent did ACCESS implement a capacity building approach and how effective has it been?

  3. To what extent have the ACCESS social and behavior change initiatives been implemented?

  4. How effective is the program’s approach to supportive supervision and monitoring, while building Ministry of Public Health (MOPH) leadership and capacity to conduct these efforts on its own?

  5. What are recommendations across all questions that will reinforce and strengthen ACCESS activities and initiatives for the duration of the program?


The evaluation used a mixed methods approach, including primary data collection through key informant interviews and focus group discussions; secondary review of program documents; and analysis of existing program and MOPH District Health Information Software data. The data suggested that ACCESS is achieving its intended objectives. These objectives include improving health service quality and the continuum of care, developing a capacity building approach at the subnational level, and promoting healthy behaviors and supportive supervision. Work towards these objectives contributed to health systems strengthening.

The data also indicated continuing challenges around lack of health seeking behavior, preferences for seeking services from private providers or traditional healers, poor infrastructure at community and basic health center levels, and programmatic delays with capacity building and quality improvement. The COVID-19 pandemic has exacerbated these challenges, particularly in relation to capacity building and quality improvement. Key recommendations include improved planning/coordination of joint supportive supervision activities; meeting equipment/infrastructure needs; and acceleration of the district graduation approach rollout and certification process.
Shortname: TR-22-493 D4I
Author(s): Susan Bergson, Dr. Lwendo Moonzwe, Prof. Julio Rakotonirina, Balkissa Jacobs, Rebekah Koch
Year: 2023
Language: English
Region(s): MADAGASCAR