Post-conflict African states face profound challenges in rebuilding their health systems. Madagascar, following a period of political instability, serves as a pertinent case for examining healthcare delivery within an African post-conflict recovery context. This meta-analysis aimed to synthesise existing literature to systematically identify and analyse the principal challenges and emergent opportunities for the medical system in post-conflict Madagascar, thereby providing an evidence base for policy and intervention. A systematic search of electronic databases and relevant organisational reports was conducted. Identified studies were screened against pre-defined inclusion criteria. Data were extracted using a standardised form and analysed through thematic synthesis to identify recurring themes pertaining to systemic challenges and opportunities. Key challenges included severe healthcare workforce shortages, particularly in specialist surgical and midwifery staff. Fragmented supply chains for essential medicines and widespread damage to primary care infrastructure were also predominant. Identified opportunities centred on the documented success of community health worker programmes and the potential for digital health technologies to circumvent traditional barriers to care. The medical system in post-conflict Madagascar is characterised by deep-seated structural weaknesses but also demonstrates clear avenues for innovative, context-specific strengthening. Sustainable recovery necessitates a dual focus on addressing acute resource deficits and investing in resilient, community-embedded models of care. Prioritise training and retention of national healthcare workers. Integrate proven community-based models into the formal health system. Foster partnerships for sustainable health infrastructure investment. Develop robust health information systems to support service delivery and monitoring. health systems strengthening, post-conflict, Madagascar, medical challenges, Africa, maternal health, healthcare access This synthesis provides a consolidated African perspective on health system reconstruction, offering evidence to guide policymakers and non-governmental organisations working in post-conflict settings across the continent.
Randrianasolo et al. (Thu,) studied this question.