All medical services in Madagascar are free. Each province has a central hospital and local clinics, dispensaries, and maternity-care centers are supplemented by mobile health units. The main hospitals are the Hospital Befelatnana (1,300 beds) and Fort Dauphin Hospital (80). As of 1999, total health care expenditure was estimated at 2.1% of GDP. As of 1999, there were an estimated 0.1 physicians and 0.9 hospital beds per 1,000 people.
Malaria remains one of the major health problems. The current reorganization of the health service in Madagascar is an opportunity to establish new anti-malaria programs. The strategies of the fight against malaria consist of early care of malaria cases, drug interaction for pregnant women, and eradication of adult insects in the central highlands where malaria is common. The major endemic diseases are malaria, leprosy, and schistosomiasis. Tuberculosis is also prevalent. In 1995, there were 5,915 leprosy cases. In 2000, 47% of the population had access to safe drinking water and 42% had adequate sanitation.
As of 2002, the crude birth rate and overall mortality rate were estimated at, respectively, 42.4 and 12.2 per 1,000 people. The fertility rate in 2000 was 5.4. Only 19% of married women (ages 15 to 49) used contraception in 2000. The infant mortality rate in 2000 was 88 per 1,000 live births. The maternal mortality rate in 1998 was 490 per 100,000 live births. Immunization rates for children up to one year old for 1997 were: tuberculosis, 87%; diphtheria, pertussis, and tetanus, 73%; polio, 73%; and measles, 68%. As of 1999, 48% of children under five years of age were considered malnourished. Nearly 22.8% of schoolchildren suffered from goiter in 1996. The average life expectancy was 55 years in 2000.
At the end of 2001, the number of people living with HIV/AIDS was estimated at 22,000 (including 0.3% of the adult population). Deaths from AIDS in 1999 were estimated at 870. In the same year HIV prevalence was 0.14 per 100 adults.