Programs & Projects

Improvement of the Cost-Recovery System for Health Products in Madagascar

April 1, 2016 - October 30, 2016


The objective of this project was to make recommendations to improve the financial mechanism used to recover logistics and administrative costs for the provision of essential medicines in Madagascar. This public-sector “cost-recovery” system has historically faced challenges in both performance and sustainability. WDI developed a report which identified system bottlenecks and provided recommendations to address these challenges. This report was created through an in-depth document review and interviews conducted with various actors in the cost-recovery system.

The majority of the bottlenecks identified were fundamental, centering on roles and responsibilities which were poorly defined and enforced, as well as an underlying structure which inhibits effective performance management. WDI’s report, along with previous audits and reports on the same topic, led the Secretary General of Madagascar’s Ministry of Health to initiate a full, structural reform of the existing cost recovery system, rather than making only incremental changes to the system. This reform process began in 2017 and is ongoing.

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