Description
The U.S. Agency for International Development (USAID)/Madagascar’s Health, Population and Nutrition (HPN) Office implements programs in family planning/reproductive health (FP/RH); maternal and child health (MCH); nutrition; water, sanitation and hygiene (WASH); infectious diseases; and malaria prevention and control. HPN partners also coordinate with the Title II food security programs to increase the overall effectiveness and reach of USAID’s assistance. Madagascar is a priority country for Ending Preventable Child and Maternal Deaths (EPCMD), a President’s Malaria Initiative (PMI) focus country, and a USAID High Priority WASH Country. The HPN Office manages a budget that has increased by 35% over the last four years to $72 million annually. HPN oversees twenty-three cooperative agreements, grants, and contracts. The approved staffing pattern includes three US Foreign Service Officers, three Personal Service Contract (PSC) positions, one direct hire US CDC staff person, and 13 Foreign Service National (FSN) staff. The 2009 coup d'état plunged the country into crisis, stalling development initiatives and further deteriorating an already fragile health system. With financial and political restrictions placed on the Government of Madagascar (GOM) by the United States during this period, USAID/ Madagascar shifted to a humanitarian support strategy and invested nearly $250 million in innovative community health services and systems: scaling-up access to diagnosis and treatment for simple pneumonia, diarrhea, and malaria as well as oral and injectable contraceptives. USAID/Madagascar equipped and trained an extended cadre of more than 17,000 community health volunteers (CHV) in 13 of 22 regions covering about 1,200 mostly rural communes to expand basic, life-saving services. This system continues to provide health services to over 16 million people (81% of whom are rural), which represents 61% of the total population of Madagascar. Following successful elections in December 2013, multi- and bilateral organizations normalized relations; the US Government (USG) lifted restrictions in May 2014. The GOM initiated the development of a health sector development strategy, the Plan de Développement du Secteur Santé (PDSS) in January 2014. The plan outlines a five-year (2015-2019) strategy to improve health services and outcomes. This strategic document was reviewed and updated in 2020 taking into consideration the importance of digitization, although there is a lack of regulatory frameworks relative to digital health. In 2015, the GOM validated the Universal Health Coverage Strategy. This strategy aims to provide quality health services to every Malagasy citizen and to develop a financial protection mechanism. USAID supported the initiative; however, due to the lack of a clear vision and commitment from the new administration, the implementation of this strategy did not show progress, and is limited to very fragmented activities. In 2016, Madagascar developed its first national digital health strategy which envisions contributing to the universal health care objective. While Madagascar has made improvements in some health statistics, notably a marked increase in contraceptive prevalence rate, other indicators have stagnated or declined. Most notably, the country continues to suffer from significant infectious disease outbreaks, and the emergency response to these outbreaks draws resources away from building a functional national health system. The Ministry of Posts, Telecommunications and Digital Development is the information and communication technologies policymaker. Though one of the poorest countries in the world, Madagascar has one of the fastest broadband internet speeds in Africa. Despite what seems a technological advantage, only 13% of the population has access to electricity and only 2.1% of the population has access to the internet. Household penetration of mobile broadband is also relatively low, at just over a third of homes in 2016, with a significant difference between urban (73%) and rural areas (29%). Since the lifting of the restrictions in May 2014, the Mission’s efforts are now increasingly focused on using USG resources to strengthen GOM health systems. The appropriate functioning of health information systems impacts the success of all USAID programming and the ability of the GOM to adequately provide health services to its population. USAID’s Digital Strategy 2020-2024 outlines the Agency’s vision “to advance progress in communities in our partner countries to build sustainable systems through efficient, effective, and responsible digital initiatives that enhance security and economic prosperity, consistent with the American values of respect for individual rights, freedom of expression, and the promotion of democratic norms and practices.” The Digital Strategy aims for Missions to designate a Digital Development Advisor to guide the digital vision for USAID. The USAID Bureau for Global Health developed Vision for Action in Digital Health to align with the Digital Strategy and provides clear direction for the health sector to: 1) Assess and advance national and regional capacity for digital health, in particular that of leadership and governance, 2) Support the development of, and align investments to, national and, where appropriate, regional digital-health strategies, 3) Support the development of, and align investments to, a national digital-health architecture, and 4) Adapt, re-use, and, where needed, provide support to global goods. USAID/Madagascar, therefore, requires the services of a Senior Digital Health Advisor with a strong focus on health systems strengthening and policy to be hired through a Personal Services Contract. The Senior Digital Health Advisor is intended to be a senior broad-based position who will provide oversight and leadership of digital health investments within the HPN program, with a particular emphasis on one of USAID’s key investments, supply chain management, and provide expert guidance on cross-sectoral digitization opportunities in alignment with the Agency’s Digital Strategy . The Senior Digital Health Advisor will be based in Antananarivo and is expected to spend approximately 25% of his/her time traveling throughout the country to monitor program activities.