Madagascar

Since 2019, HIH has supported…

25k+

People Supported in Alternative Livelihoods

58k+

Patient Visits

112+

Hectares Reforested

Biodiversity

Covering only 0.5% of Earth’s land, Madagascar contains 5% of Earth’s species, and 80% of its species live nowhere else. Madagascar is the fourth most vulnerable country to climate change in the world.

Work to date

In 2019, Health In Harmony launched programs in the Manombo Forest, including the Manombo Special Reserve, a protected area on Madagascar’s southeastern coast. The reserve is home to eight species of lemur, all of which are endemic to Madagascar and threatened by extinction. Designed by local communities, local programs address challenges such as affordable healthcare, resilient and adaptable farming techniques, and, most urgently, hunger, to form an integrated investment approach that can allow both communities and Manombo’s unique ecosystem to thrive. Now, Health In Harmony’s Madagascar affiliate HIH-FAMI collaborates with more than 12,000 local community members to address healthcare access, ongoing cycles of food insecurity, poverty, education, and climate resilience. In the four years to 2026, communities in Manombo averted over 90,000 tonnes of CO2 emissions by protecting the rainforest from logging.

Scaling in Madagascar began in 2024 through a partnership with HIH-FAMI, Doctors Without Borders (MSF), and the local Malagasy NGO, Ny Tanintsika (NT). HIH-FAMI and MSF have committed to a five-year joint pilot project to operationalize planetary health, positioning MSF’s best-in-class medical action in Madagascar inside an intersectional framework designed by communities through Radical Listening. HIH-FAMI and MSF will work beside NT, who brings over 20 years of experience working alongside communities in Ikongo, and local communities to implement community-designed water, sanitation, and hygiene (WASH), education, conservation, and agriculture projects.

A rural village with several small houses with thatched and metal roofs, surrounded by lush green trees and grass, with a few people sitting outside one of the houses.

Ongoing Impact

Research

Pandemic Prevention: Preventing the next pandemic, rather than responding to it, would save millions of lives and trillions of dollars. In Manombo, HIH is researching a potential solution to prevent pandemics at the source: supporting rainforest communities’ solutions to keep human and animal populations healthy. Since 2021, a team of researchers from the University of Antananarivo, University of Toamasina, Mahaliana Labs, Centre ValBio, Zoo New England, and Duke University have worked together with HIH and communities to collect samples from wildlife, livestock, plants, and people. These samples are being analyzed for the viruses, bacteria, and parasites they contain. Read more in ProPublica.

Sustainable Food Systems: In collaboration with the Madagascar Biodiversity Center, HIH-FAMI is piloting an innovative research project on sustainable food systems within a planetary health framework. This project explores using Black Soldier Fly farming as a regenerative solution for food production and ecosystem support. Black Soldier Flies are a high-protein food source for human consumption and poultry feed. At the same time, their frass is a potent organic fertilizer used both for cultivating wildlings for reforestation and for growing vegetables, supporting both human health and biodiversity restoration. Learn more.

Manombo

HIH-FAMI works alongside communities in Manombo to focus on maternal and infant health, provide training in alternative livelihoods and small business start-ups, and support strategic reforestation and climate-resilient agriculture training for increased food security.
Ikongo

In Ikongo, HIH-FAMI works with Doctors Without Borders (MSF), Malagasy NGO Ny Tanintsika (NT), and local communities to implement community-designed water, sanitation, and hygiene (WASH), education, conservation, and agriculture projects.