# Corruption in Madagascar's health sector: when care comes with a hidden price tag URL: https://www.transparency.org/en/blog/corruption-madagascar-health-sector-when-care-comes-with-hidden-price-tag Type: Blog Published: 2026-11-05 Updated: 2026-11-05 --- Many Madagascans have to pay bribes for health care and inflated charges for medicines, with women being disproportionately represented among complainants. ![A person wearing a backpack and face mask places an anti-corruption awareness poster on a window. The poster, produced by Transparency International Initiative Madagascar and partners, encourages people who have witnessed or experienced corruption to seek free advice and report it.](https://images.transparencycdn.org/images/Web-blog-madagascar-nov-2026-ok.png?auto=compress&fit=crop&fm=webp&w=2000&h=1125) A volunteer displays an anti-corruption awareness poster in Madagascar, promoting free advice and support for people who have experienced or witnessed corruption. Photo: Transparency International Initiative Madagascar Posted on: 5 November 2026 ![](https://images.transparencycdn.org/images/Annie-Healion.jpg?auto=compress&fit=crop&fm=webp&w=1200) Annie Healion Global Coordinator, Advocacy and Legal Advice Centres (ALAC) In Madagascar's Atsimo-Andrefana region, 630 people reported in 2023 that they walked into a health centre expecting care and walked out having paid for something they shouldn't have had to pay for. Most of them — 576 — were women between 15 and 60. The other 54 were men in the same age bracket. Their complaints, filed with Transparency International Madagascar's network of [legal advice centres](https://www.transparency.org/en/alacs), known as a CAJACS, describe two of the most common faces of corruption in public health services: extortion for services that are supposed to be free, and inflated charges for medicines. It's a pattern that repeats, with local variations, across the island. ### Regional variation on the same corruption problem In Anôsy, 41 people reported similar practices at basic public health centres. Of these complainants, twenty were women aged 30 to 60. Fourteen were men in the same age group. In Boeny and Analamanga, however, the complaints the CAJAC recorded looked different: health kits — medical supplies meant for patients — were allegedly diverted for private use, and possible conflicts of interest among the officials responsible for distributing them were reported. Four regions, varying forms corruption, one underlying story: when a health system is under-resourced and under-supervised, the people who pay the difference are the patients who can least afford it — and disproportionately, women are far more often affected. ### What happens after you file a complaint? Filing a complaint with a CAJAC is only the first step, and the data on what happens next is sobering. Of the 630 complaints from Atsimo-Andrefana, 181 are still being handled by the institutions whose employees were implicated in the allegations: 74 have been resolved and,238 have been reffered to the relevant authorities. The remaining 137 had received no follow-up after the cases were handed over to the institutions concerned. That's roughly one in five people who came forward, described what happened to them, and then heard nothing back. Anôsy's numbers tell a similarly mixed story: most cases were either still being processed by the institutions concerned or had been referred to higher-level authorities, with only a single case fully resolved. In Boeny and Analamanga, where fewer complaints were logged overall, just one case per region made it to the relevant authorities. Taken together, the figures point to a system where reporting corruption is possible — CAJACs’ presence means people have somewhere to go — but where accountability depends heavily on the response of the institutions to which cases are referred. In too many instances, complaints do not stall at a CAJAC's door; they stall after the matter is handed over, when the relevant authorities seem to fail to provide feedback or to act on the cases referred to them. ### Why this fits a global pattern of corruption in health care None of this is unique to Madagascar. [Evidence shows](https://knowledgehub.transparency.org/guide/topic-guide-on-corruption-in-health-services/4493) that corruption reduces immunization rates, delays the vaccination of newborns, discourages the use of public health clinics, reduces citizens’ satisfaction with public health services, and increases waiting times at clinics. In some countries, World Bank surveys have found that up to 80 per cent of non-salary health funds never reach local facilities — money that should have paid for the medicines like the ones Atsimo-Andrefana's health centres were allegedly overbilling for. What the Madagascar data adds is insight into the forms corruption in health care is taking (overbilling, illegal fee extraction, diverted kits, conflicts of interest), a regional map of where each is concentrated, and a rough sense of what happens — or doesn't — once someone speaks up. ### The project behind the data This casework sits inside the [Inclusive Service Delivery in Africa (ISDA) project](https://www.transparency.org/en/projects/inclusive-service-delivery-africa), a regional initiative jointly implemented by Transparency International’s secretariat, our Global Health Programme, and national chapters in the Democratic Republic of Congo, Ghana, Madagascar, Rwanda, Zimbabwe and Canada, and funded by Global Affairs Canada. Its core objective is to improve access to education and health care services for women, girls and other groups at risk of discrimination by tackling the corruption-related barriers that stand in their way — which is precisely what the Atsimo-Andrefana and Anôsy figures put a number on. Our Madagascan chapter has also been building capacity beyond casework: earlier this year, it [partnered with a national anti-corruption in health care coalition](https://fr.allafrica.com/stories/202504030257.html) and used technical input from our Canadian chapter - to train civil society members on using advocacy tools and writing policy briefs in order to influence public health policy. It's a sign that the CAJAC data isn't just being filed — it's being turned into pressure for reform. ### The bottom line Corruption in Madagascar's health sector isn't abstract. It could come with a price tag attached to a prescription, a fee demanded at a clinic door, a box of supplies that never reaches the patients it was meant for. And, at least in the regions with the clearest data, it disproportionately harms women and girls. The CAJAC network gives people a place to report what happened to them. The next test is making sure that reporting translates into consequences often enough that patients feel it’s worth continuing to speak up about corruption. The CAJAC network is one outpost of a much larger effort. Across more than 50 countries, Transparency International's [Advocacy and Legal Advice Centres](https://www.transparency.org/en/alacs) (ALACs) offer the same free, confidential route into reporting corruption — in the [last year alone, they supported roughly 14,000 people across 53 countries](https://www.transparency.org/en/news/transparency-international-2025-while-corruption-spreads-heres-proof-change-is-possible), building on nearly 400,000 people assisted and close to 90,000 cases investigated since the network began in 2003. Health has proven fertile ground for this model elsewhere, too: in Ghana, [an ALAC investigation opened after a bribery-related hospital death](https://www.transparency.org/en/news/local-steps-global-goals-sustainable-development) exposed large-scale administrative corruption, prompted a national debate, and helped deter bribe demands at that hospital and others across the country. Madagascar's numbers are a local chapter of a pattern playing out, one complaint at a time, wherever an ALAC has opened its doors. ## Priorities - [Health](https://www.transparency.org/en/our-priorities/health-and-corruption) ## Countries - [Madagascar](https://www.transparency.org/en/countries/madagascar) ## Regions - [Sub-Saharan Africa](https://www.transparency.org/en/region/sub-saharan-africa) ## Projects - [All 4 inclusive service delivery Africa (ISDA)](https://www.transparency.org/en/projects/inclusive-service-delivery-africa) For any press inquiries please contact