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Malagasy school children demo the Tippy Tap

Walter, Sanitation and Hygiene program

Water, Sanitation, and Hygiene

Water supply and sanitation coverage are serious problems in Madagascar, where diarrheal disease is the second most lethal illness among children under 5. Following on the successful USAID-funded Hygiene Improvement Project (HIP), C-Change has been working in four regions of the country with NGOs and civil society organizations to promote improved hygiene at scale.

The program promotes three key improved hygiene practices shown to reduce diarrheal disease: safe drinking water at point of use, use of improved latrines, and handwashing with soap at critical times.

C-Change’s behavior change strategy focuses on the household, with children under 5 as the ultimate targets. The main approach is to promote and negotiate “small doable actions” breaking down an ideal practice into components that may make it more feasible for households to begin to improve their hygiene practices and incrementally work toward the ideal.

Provision of simple behavior-enabling infrastructure and technologies—such as tippy taps (see the photo) and renovated latrines—enhance the behavior change being promoted. As part of this effort, C-Change is implementing Community Led Total Sanitation (CLTS), a private-sector partnership that manages urban sanitation and hygiene facilities and markets hygiene products.

Promising models for addressing sanitation needs in urban settings (blocs sanitaires in French) are emerging as business possibilities for local entrepreneurs. In communities targeted by CLTS the rate of open defecation has dropped significantly and latrine use has increased.

 Environment, HIV prevention, and young adults 

Scout troop in Madagascar invoved in the Akoay Dore program.

Unsustainable agricultural practices in Madagascar threaten destruction of both the rain forest and arable land. With a birth rate of 6.9 in sensitive areas or “hotspots,” the island’s population growth is outpacing conservation efforts, and slash-and-burn agriculture exacerbates the problem. Between 1990 and 2000, Madagascar lost 1.17 million hectares of forest. More than 80 percent of the forests are gone.

C-Change worked with youth in Madagascar through the Ankoay Doré (Golden Eagle) program to change the situation. Building on the Ankoay (Eagle) program and launched in partnership with Madagascar’s National AIDS Control Committee (CNLS), Ankoay Doré engages groups of young people and young leaders in a series of participatory life skills activities to become involved in social issues such as environmental degradation, hygiene, adolescent reproductive health, and HIV prevention. Ankoay Doré involves youth in community development and peer mentoring, using a mix of individual and collective activities to engage youth as leaders of national efforts to improve health and environmental sustainability.

To recognize and celebrate this leadership, the program holds festivals at which Ankoay Doré groups demonstrate their talents and skills using peer education, village theatre, and musical presentations. Neighboring communities are invited, and local media cover these events. This approach fuels interest among other youth to participate in Ankoay Doré programs and spawns an ever-growing number of youth engaged in sustainable environmental practices and healthy behaviors.

In addition, C-Change focused on helping strengthen the capacity of local organizations to use behavior change communication programming in health programs, initiating health programs to link schools and communities with environmental protection, and assisting people to advocate for their own health and that of their community.

USAID-funded activities in Madagascar that work directly with the Government of Madagascar have been suspended,  effective September 30, 2009. Humanitarian programs, including water, sanitation, and hygiene activities at the community level continue.


Quick Glance

Map of Madagascar from the CIA World Factbook  

Click map to enlarge



Total fertility rate

HIV prevalence
0.2% (adult population 15-49)

Contraceptive prevalence
40% (married women 15-49)


Sources: PRB 2011World Factbook 

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