Formative research to explore care-seeking perceptions and practices among low-income caregivers of young children in Anamalanga region

Title: Formative research to explore care-seeking perceptions and practices among low-income caregivers of young children in Anamalanga region
Principal Investigators: Lauren Rosapep
Timeline: April 2020 – Mayr 2021


SHOPS Plus Madagascar worked with the government to increase the private sector’s capacity to deliver high quality health products and services through activities that could be continued by local stakeholders, with emphasis on reaching the poor—especially those residing in Anamalanga Region.

Although Madagascar has seen significant health achievements in recent decades, gaps persist. Barriers limiting the use of health products and services continue to exist and some Malagasy caregivers still do not seek treatment or advice outside the home for their sick children. With significant challenges in the public sector, many clients, including the poor, rely on the private sector to meet their health needs. This is true also for caregivers who seek sick child care, with 32% going to the private sector according to recent assessments.

SHOPS Plus conducted a study to provide further nuanced information on caregivers’ current motivations and preferences for health care, and whether and how private, for-profit clinical providers are seen as an accessible source of care by the poor.

Objectives/research questions

  • Better understand the health seeking behaviors and motivations of low-income caregivers in Madagascar’s Anamalanga region.
  • Better understand the extent to which and how for-profit, private health facilities serve and reach poor clients.
    • Are private health facilities interested in expanding services to poor clients?
    • What, if anything, would for-profit health facilities need to better reach and serve low-income clients?


SHOPS Plus used qualitative methods to collect data from private providers and caregivers. In-depth interviews were conducted with a selection of private providers working in lower-income districts of Anamalanga region, as well as interviews with caregivers who live within the close vicinity of interviewed providers. The provider interviews allowed researchers to learn about the current ways in which private for-profit providers seek to engage and cater to poor clients. The caregiver interviews were intended to provide insight into whether and how lower-income caregivers who live within the vicinity of private providers see these providers as a viable and appealing source of care for themselves or their children.

The findings of this study helped SHOPS Plus, government stakeholders, and local private partners inform and fine-tune their support for increasing access to priority services, especially among the poor.

Status: Complete
Date of last update: October 2021

Learn more about our work in Madagascar and child health.



Sustaining Health Outcomes through the Private Sector (SHOPS) Plus is a five-year cooperative agreement (AID-OAA-A-15-00067) funded by the United States Agency for International Development (USAID). This website is made possible by the generous support of the American people through USAID. The information provided on this website is not official U.S. government information and does not represent the views or positions of USAID or the U.S. government.

Sign-up for our newsletter to get the latest updates from SHOPS Plus