The Ministry of Public Health has initiated several PBF pilots since 2013, funded by UNICEF, AFD, and the World Bank. After two years of implementation of PBF in the pilot districts, a review took place, and the Ministry committed itself to pursue PBF and to a scale up with the support of the World Bank.
The feasibility score for Madagascar’s PBF program was evaluated in January 2018 by the participants at 68%. The main problem identified (killing assumption!) is the too small budget per person per year of only US $ 2.00 (far below the minimum of US $ 4.00). In addition, there are problems with the monopoly of the Central Medical Stores for the supply of inputs to the government health facilities; the non-respect of the separation of functions between regulator and provider and; the lack of a policy for the sustainability of the financing of PBF activities.