Case study: Building the business skills of private providers in Madagascar

The public health sector in Madagascar has struggled to serve the health needs of all citizens due to budget constraints and ongoing environmental and health crises. As such, family planning clients, including the poor, rely on the private sector to meet their health needs. In 2017, SHOPS Plus conducted a private sector assessment that revealed the quality of private health services is a major concern to numerous public and private stakeholders. The assessment also found that private providers in Madagascar often do not know how to best manage their businesses. This gap impedes providers’ ability to invest in their facilities and purchase supplies and equipment that could strengthen the practice environment for ongoing quality improvement.

SHOPS Plus support

SHOPS Plus acknowledged that access to finance and weak business management skills were significant barriers to quality improvement among private providers in Madagascar. The project provided technical assistance in business management to help private health facility leaders better manage their health practices, purchase necessary equipment, apply for loans, and make other decisions necessary to promote a work culture that prioritizes quality. One-on-one coaching was available to a few providers who requested it.

By partnering with AccèsBanque and local suppliers of health equipment and supplies, the project developed lending products specifically for private clinics. With support from the Development Finance Corporation’s Development Credit Authority Guarantee, clinics were able to access low-collateral, low-risk loans that enabled them to make investments in their practice environments, such as the purchase of ultrasound, radiology, x-ray, and other equipment or consumables that were previously unavailable, severely limiting the quality of service offerings.


SHOPS Plus supported 187 private facility owners and providers in Madagascar in improving their business management skills. Project staff administered a survey at the beginning of the interventions and during follow-up visits with individual private providers. The project assigned each facility a score that indicated its capacity to sustain its business management practices. The scores increased by 24 percent, on average. Improved skills have helped providers grow their businesses. For example, one provider’s improved bookkeeping practices allowed him to set aside part of his income to save for future projects, such as purchasing land to build a new medical center. Additionally, 158 new loans totaling $1.3 million were disbursed to private facility owners. These loans have been crucial in expanding the quality of services offered in private facilities. One husband and wife team obtained a loan to purchase equipment needed to complete the expansion of their maternity center. The improved facility and equipment allowed the owners to extend access to maternal care to additional women. Since the new addition opened, over 300 patients visited and an average of 30 babies were safely delivered each month.



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.

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