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May 1, 2024

From Medical Practice to Advocating for Vaccination in Madagascar: A Committed and Inspiring Journey

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Discover the inspiring journey of Eli Ramamonjisoa, a trained physician and In-Country Coordinator for the Global Health Advocacy Incubator (GHAI) Immunization program in Madagascar. He shares his passionate commitment to vaccination and health care financing, despite the challenges faced. 


  1. In your initial training and career path, as a medical doctor, what motivated you to leave mainstream medicine to get into health financing advocacy? 
    My entire professional life has been devoted to public health in general and child survival in particular. I have over 40 years of experience in these fields. Health financing has always interested me, and I've benefited from a number of training courses to improve my skills. 


  2. Why are you particularly interested in immunization? 
    When I started practicing as a doctor in 1983, I was assigned to a rural hospital a long way from the country's capital. I was confronted with many cases of vaccine-preventable diseases such as whooping cough and measles. Many children were also dying of diarrhea and pneumonia, and the under-five mortality rate at the time was 250 per 1,000 live births in these rural areas. The population was extremely poor, and the hospital had nothing. But thanks to immunization and other very simple, inexpensive measures, we were able to significantly reduce child mortality. These encouraging results prompted me to intensify my efforts, and that's what enabled me to gradually climb the professional ladder to positions of greater responsibility over the years. 


  3. What are the challenges and joys of working with multiple stakeholders to promote the financing and roll out of immunization plans in Madagascar? 
    The joys are many, because working on the financing of primary health care in general, and immunization in particular, has enabled me to perfect my knowledge of my country's economic and social realities after 14 years in other African countries. There's also the joy of being able to contribute to my country's development with my modest skills. I also have experience of working in teams and in multicultural environments.   
    The challenges are many, but the solutions are achievable in the short and medium term. They make the work motivating, and all the stakeholders seem to be willing to work together to find these solutions and apply them in a spirit of good understanding and collaboration. The main challenges are the poverty of the population and the great scarcity of state resources. Staying the course and helping to run an immunization program with very limited state resources is a difficult but rewarding task. 


  4. How do you compare Madagascar's immunization within the Gavi Alliance efforts to those of comparable African countries? 
    I've been to many French-speaking African countries in my previous job, but the partnership framework between the GAVI Alliance and other stakeholders in Madagascar is one of mutual understanding, good cooperation and sharing of experiences.


  5. Where do you see GHAI's vaccine advocacy in Madagascar over the next five years? 
    I see the task of advocating for increased domestic health funding becoming increasingly difficult over the next five years, given the country's economic outlook and the political will to make courageous and difficult decisions. However, the potential solutions are numerous, and civil society organizations are very dynamic and committed. Parliamentary debates are also beginning to take shape.