Madagascar

Research conducted in December 2025

In Madagascar, dementia diagnosis is concentrated in cities like Antananarivo, where patients access neurology or psychiatry after outpatient or private clinic visits. Rural areas face fragmented care, with families often consulting primary care or faith healers first. Cognitive assessments use MMSE, MoCA, or RUDAS, while CT and MRI are concentrated in the capital and often overused in public hospitals. Genetic testing and AD-specific CSF biomarkers are rarely available. Health financing is mostly out-of-pocket, with families covering specialist visits, labs, and imaging due to limited insurance and social protection.

Overall
AD Rating
Diagnostic Pathway
Dementia pathways in Madagascar are concentrated in cities like Antananarivo, where patients access neurology or psychiatry after initial outpatient or private clinics visits. Rural areas face fragmented care, with families turning to primary care or faith healers first, which reflects broader sub-Saharan African patterns.
Specialized Care
Patients in Madagascar largely cover dementia-related costs themselves, as private tariffs are high and no government subsidies exist.
Caregiver Support
There is no formal financial support for dementia caregiving in Madagascar. MAMM offers counseling, helplines, and day care initiatives, yet outside Antananarivo, caregiving falls primarily to families due to limited services and lack of government support.
National Policies
There is no official strategy or national plan related to Alzheimer’s disease in Madagascar.
Access to ATT-s
No therapies approved.
Organizations are listed for informational purposes based on publicly available sources. Inclusion does not necessarily indicate affiliation with or endorsement by Alzheimer’s Disease International (ADI).

Highlights

Health system
Non-Universal, Mixed Funding (Mixed Provision)
ADI member association(s)
Madagascar Alzheimer Masoandro Mody
National dementia plan
No national Alzheimer’s disease or dementia plan in place
Dementia plan funding
No plan
Dementia prevalence rate
135
Dementia incidence rate
24
*per 100k Population
Prevalence Rate (per 100,000): 
This measures the total number of existing cases (both old and new) in a population at a specific point in time, divided by the total population and multiplied by 100,000. It tells you the overall "burden" or how widespread a condition is at that moment.
Incidence Rate (per 100,000): 
This measures the number of new cases that develop in a population over a specific period (usually one year), divided by the population at risk and multiplied by 100,000. This tells you the "speed" or risk of contracting the condition.

Population

32,947,736

Median age

19.2

Health expenditure (% of GDP)

3.3

Diagnosis

In Madagascar, dementia diagnosis is concentrated in cities like Antananarivo, where patients access neurology or psychiatry after outpatient or private clinic visits. Rural areas face fragmented care, with families often consulting primary care or faith healers first. Cognitive assessments use MMSE, MoCA, or RUDAS, while CT and MRI are concentrated in the capital and often overused in public hospitals. Genetic testing and AD-specific CSF biomarkers are rarely available. Health financing is mostly out-of-pocket, with families covering specialist visits, labs, and imaging due to limited insurance and social protection.

Diagnosis pathway

In Madagascar, dementia diagnosis is concentrated in cities like Antananarivo, where patients access neurology or psychiatry after outpatient or private clinic visits. Rural areas face fragmented care, with families often consulting primary care or faith healers first. Cognitive assessments use MMSE, MoCA, or RUDAS, while CT and MRI are concentrated in the capital and often overused in public hospitals. Genetic testing and AD-specific CSF biomarkers are rarely available. Health financing is mostly out-of-pocket, with families covering specialist visits, labs, and imaging due to limited insurance and social protection.

In Madagascar’s capital, Antananarivo, and a few other larger cities, people typically begin in general outpatient and private clinics and are later referred to neurology or psychiatry in hospital settings for cognitive work-ups and imaging.The biggest disadvantage is the fact that the specialist capacity is concentrated in a few cities, with little or no accessible services in smaller towns and villages. Outside major urban areas, care pathways are fragmented and informal: families commonly turn first to primary care or traditional faith healers before ever reaching neurology or psychiatry. This pattern mirrors much of sub-Saharan Africa (SSA), where dementia awareness is low and secondary and tertiary services are scarce

Wait times

Long wait time (expected)

Private centres in Antananarivo, such as IMM, offer scheduled specialist visits and CT/MRI, with mobile payment and confirmation protocols. Outside the capital, access is fragmented, delays arise from travel and referrals, and rural patients face high costs, long result waits, and occasional sample loss.

In Antananarivo, private centres schedule specialist visits and computed tomography (CT) and magnetic resonance imaging (MRI) by appointment, which keeps on-site waits shorter and more predictable than in public hospitals. For example, in one of the most notable private clinics, Medical Institute Madagascar (IMM) appointments are confirmed only after a specific date and time is set and payment is received via mobile money. After a reservation request, staff call to confirm slot availability and the service price and cancellations or postponements must be made at least three hours in advance via the call centre. Also, there is a 15-minute grace period and missing it requires rebooking the appointment. At the same time, studies show that outside the capital, access is thin and fragmented, so people commonly face delays tied to travel and referral logistics more than on-site queuing. Alongside the high costs of services for people in rural areas, some of the biggest challenges are the wait times for results and a frequent sample loss in transportation.

Diagnosis cost

Mostly out-of-pocket.

Health financing in Madagascar is predominantly out-of-pocket, with only small fractions covered by insurance or social protection. Families often bear the cost of specialist care, labs, and CT/MRI, reflecting a UHC service-coverage index of just 35/100.

Madagascar’s health financing is mixed and largely out-of-pocket, with very low insurance coverage. According to WHO only 8% of the population had any health-insurance scheme in 2019, while only 5% of the active workforce was covered by formal social protection (ILO).1 Based on data from 2021, the country’s UHC service-coverage index is 35/100, indicating limited access to essential services without financial hardship.2 Consequently, most specialist visits, laboratories, and CT/MRI for diagnosis are paid by families, especially when using capital-based private providers. As indicated by the World Bank, out of pocket spending still accounts for about one-third of current health expenditure.3

Cognitive tests

Available

MAMM offers MMSE-based public screenings in Antananarivo, with referrals for abnormal results. French-language cognitive tests, including MoCA and RUDAS, are commonly used in clinics to accommodate bilingual and diverse patient populations.

Imaging tests

Rarely used

CT and MRI are key tools for assessing brain changes in Madagascar, but both are largely limited to Antananarivo. Even there, public hospital scanners face frequent breakdowns due to heavy use.

Genetic tests

APOE, PSEN1, PSEN2, and APP testing are not part of routine dementia diagnosis in Madagascar, with most genetic analyses conducted abroad or in research.

Biomarker tests

Rarley used

Lumbar puncture and basic CSF testing exist for neurological infections in Madagascar, but AD-specific biomarkers like Aβ42/40 or tau are not routinely offered.

Cognitive Tests

Available

MAMM offers MMSE-based public screenings in Antananarivo, with referrals for abnormal results. French-language cognitive tests, including MoCA and RUDAS, are commonly used in clinics to accommodate bilingual and diverse patient populations.

Imaging Tests

Rarely used

CT and MRI are key tools for assessing brain changes in Madagascar, but both are largely limited to Antananarivo. Even there, public hospital scanners face frequent breakdowns due to heavy use.

Genetic Tests

APOE, PSEN1, PSEN2, and APP testing are not part of routine dementia diagnosis in Madagascar, with most genetic analyses conducted abroad or in research.

Biomarker Tests

Rarley used

Lumbar puncture and basic CSF testing exist for neurological infections in Madagascar, but AD-specific biomarkers like Aβ42/40 or tau are not routinely offered.

Treatment & Care

Madagascar lacks dedicated memory clinics, and its dementia care is concentrated in Antananarivo, with limited specialist services and imaging outside the capital. Palliative care is underdeveloped and oncology-focused. Patients largely pay out-of-pocket, and no government subsidies or formal caregiving support exist. MAMM provides awareness, counselling, helplines, and a planned day care centre, but reach beyond the capital remains limited.

Specialized facilities and services

Madagascar lacks dedicated memory clinics, with Alzheimer’s care concentrated in Antananarivo where neurology, psychiatry, and imaging services are available MAMM leads awareness and caregiver initiatives, yet coverage outside the capital is limited. Palliative care is underdeveloped and largely oncology-focused, leaving minimal dementia-specific pathways.

There are no widely available dedicated memory clinics across the nation. Alzheimer’s disease relevant care (neurology, psychiatry, geriatrics) is concentrated in Antananarivo, where the most neurologists and specialist services are located and where private diagnostic capacity (CT/MRI) is available. The national Alzheimer’s Disease International (ADI) affiliate, Madagascar Alzheimer Masoandro Mody (MAMM), is focused on awareness campaigns, carer support, and is working to establish a senior day care center, but reach beyond Antananarivo remains limited. Like in most SSA countries, palliative care is underdeveloped and largely oncology-focused in urban hospitals with minimal dementia-specific pathways. Global and African rankings continue to place Madagascar in lower tiers of palliative-care development, underscoring limited coverage outside a few urban sites.

Approved medication

Generic Name Trade Name Used for

*Namzaric = combination of Donepezil and Memantine

Treatment cost

Patients in Madagascar largely cover dementia-related costs themselves, as private tariffs are high and no government subsidies exist.

Given the low insurance coverage, monthly medicine costs, follow-ups, and all types of therapy are mainly paid out-of-pocket. Although private clinics and pharmacies entail higher tariffs than public facilities, there are still no dementia-specific state subsidies.

Caregiver support

There is no formal financial support for dementia caregiving in Madagascar. MAMM offers counselling, helplines, and day care initiatives, yet outside Antananarivo, caregiving falls primarily to families due to limited services and lack of government support.

There is no national cash benefit or long-term care insurance for dementia caregiving. MAMM is the only NGO that provides support groups, counselling, helplines, and organizes awareness events that can reduce burden. MAMM has acquired two hectares of federal land to construct the day care centre for elders and people living with disabilities but still lacks financial resources to finalize the project.1 Outside of the capital, caregiving is mostly the responsibility of family members due to lack of access to services in the capital city and no government support.

Policy

Madagascar has no national dementia strategy, legal framework, or Alzheimer’s-specific policies. Cultural beliefs often delay care, with families consulting traditional healers first. WHO focuses on broader health system strengthening, while ADI highlights awareness, stigma reduction, and timely specialist referrals.

National dementia plan

There is no official strategy or national plan related to Alzheimer’s disease in Madagascar.

There is no official strategy or national plan related to Alzheimer’s disease or dementia.

Upcoming plans

No new dementia strategy has been announced in Madagascar, as WHO focuses first on strengthening the national health system.

No new dementia or Alzheimer’s disease strategy has been announced. Moreover, World Health Organization (WHO)’s current work in Madagascar emphasizes universal health care system-building as the priority, before dealing with any dementia-specific policies.

Policy gaps

Legal barriers

Financing and sustainability mechanisms are unclear. Public communications emphasise awareness, prevention, and pilot interventions, but do not specify long-term budget lines, reimbursement policies, or insurance coverage for diagnostics, medications, home care, and caregiver support, risking reliance on short-term grants and NGO funding.

Cultural barriers

Dementia in Madagascar is frequently attributed to aging or spiritual forces, causing families to rely on traditional or faith healers and avoid formal care. ADI emphasizes awareness and stigma reduction to improve timely help-seeking.

As in much of SSA, dementia symptoms are perceived as “normal ageing”, which prevents timely help-seeking. ADI’s regional advocacy underscores the need for awareness and stigma reduction. In Madagascar, dementia symptoms may be also attributed to spiritual causes or witchcraft, leading families to hide the condition or avoid formal services. Because of lack of trust in the official health system, traditional and faith healers are often the first point of contact, which can further delay referral to neurology specialists

Research

Madagascar has no Alzheimer’s-specific innovations, but the mTOMADY mobile app improves elder-care access by letting families pre-fund care, receive subsidies, pay via mobile money, and cover transport or practical costs.

Selected academic institutions

Joseph Ravoahangy Andrianavalona Hospital Joseph Raseta Befelatanana Hospital Centre de Neurologie d’Antananarivo

Clinical trials and registries

No official country registries and ongoing clinical trials were revealed.

Selected innovative methods

While Madagascar lacks documented Alzheimer’s-specific diagnostic or therapeutic innovations, health financing solutions like the mobile app mTOMADY enhance elder-care access. The app allows families to pre-fund specialist visits, CT/MRI, and medications, receive subsidies from NGOs or employers, and pay via mobile money. This system reduces cash barriers and supports caregivers with transport and practical costs, easing barriers across the dementia care pathway.

here are no documented country-specific diagnostic or therapeutic Alzheimer’s disease innovations in Madagascar, but there is notable innovation in health financing that can indirectly improve access to elder-care services. In 2019, an organization called “Doctors for Madagascar” developed a mobile health-wallet “mTOMADY” that lets people save money for care in advance, receive targeted subsidies or vouchers from NGOs, employers and donors, and pay clinics via mobile money. The app shows user’s balance and benefits on their phone, reduces the cash barrier at the moment of care, and allows partners (healthcare providers) to top up specific services.1 mTOMADY can ease several pain points in an Alzheimer’s disease pathway. Families can pre-save for predictable costs (specialist visits, follow-ups, CT/MRI) and receive targeted top-ups from NGOs or employers reducing the cash shock at each step. Since the payments run through mobile money to contracted clinics and pharmacies, this helps people refill their medicines on time and gives carers a way to pay for practical needs like transportation to appointments.

Support

Organizations are listed for informational purposes based on publicly available sources. Inclusion does not necessarily indicate affiliation with or endorsement by Alzheimer’s Disease International (ADI).

Through events, talks, and visual campaigns, MAMM promotes dementia awareness, risk reduction, and healthy ageing in Antananarivo. All public information is shared via MAMM’s channels and general media, helping families access screenings, counselling, and local support networks.

Selected national associations, patient family associations, NGOs:

Madagascar Alzheimer Masoandro Mody (MAMM) Federation of Elderly Citizens (FIZOMA)

Selected initiatives

MAMM organizes year-round events and campaigns to raise dementia awareness in Antananarivo. Highlights include Memory Walks, park-based awareness installations, SIPA day for frail elders, and neuro-psychiatrist-led public conferences. These initiatives provide education on symptoms, risk reduction, and healthy ageing, connect families to screenings, counselling, and support groups, and involve Ministry officials. By combining talks, visual materials, and interactive Q&A sessions, MAMM sustains engagement, counters misconceptions that dementia is “normal aging,” and promotes access to local care pathways.

MAMM Capmaigns
Throughout the year, and especially every September, MAMM uses its Antananarivo-based channels to run talks, posts, and community events that signpost memory checks and support groups. These recurring activities sustain visibility for dementia, keep families engaged after World Alzheimer’s Month, and provide contact details for direct assistance. They also organized a Memory Walk event for their 25th anniversary.
Integrated Services for Frail Elders (SIPA)
On 27 January 2023, MAMM and its parent organization, FIZOMA, organized an Integrated Services for Frail Elders (SIPA) day in Ambohimiadana–Ampitatafika. The event was focused on integrated care for older adults, with participation from Ministry of Public Health officials. The event provided a platform for dementia awareness within broader screenings and counseling for seniors, linking attendees to services and follow-up channels.
From 9-30 September 2022 in Antaninarenina Park in Antananarivo, MAMM organized a public awareness installation with visual materials in a high-traffic city park. The display used simple, bilingual messages to explain early symptoms, risk reduction, and where families can seek help. The event aimed at countering the common view that dementia is just “normal aging” and directing people to local support.

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MAMM Lecture
On 2 September 2021 at the Tananarivian Inter-Enterprise Health Organization (OSTIE) Head Office in Antananarivo, MAMM hosted a two-hour public conference led by neuro-psychiatrist Dr. Andrianiaina Raharison. The session covered the medical basics of Alzheimer’s disease and related disorders, healthy aging guidance, and the post-diagnosis support offered by MAMM. The lecture was followed by a Q&A to connect families with practical next steps.

Dedicated media outlets

No Alzheimer’s disease specific media outlet identified, all public information is spread via MAMM’s website, social channels and occasional coverage by general media.

Understanding the terms

This section explains key terms used throughout the text to help readers better understand the exploration concepts.
Open Term Glossary
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Contents

Understanding the Terms

Terms used throughout this website are explained below.
A

Amyloid-Targeting Therapies (ATT): A class of disease-modifying treatments, primarily monoclonal antibodies, designed to identify and remove amyloid-beta plaques from the brain to slow cognitive and functional decline in early-stage Alzheimer’s. Examples include Lecanemab and Donanemab.

Aphasia: A language disorder that affects a person’s ability to communicate, often seen early in Frontotemporal Dementia.

APOE ε4 Allele: A genetic variant of the Apolipoprotein E gene that is a major risk factor for late-onset Alzheimer’s disease; while not a causative gene, its presence increases the likelihood of developing the condition.

Acetylcholinesterase Inhibitors: A class of medications, including Donepezil, Rivastigmine, and Galantamine, used to treat cognitive symptoms by increasing levels of chemical messengers in the brain.

Advance Directives (DAT): Legal documents, such as Disposizioni Anticipate di Trattamento in Italy, that allow individuals to specify their future medical treatment and care preferences while they still have the capacity to do so.

Alzheimer’s Disease (AD): The most common cause of dementia, characterized by a progressive neurodegenerative decline caused by the accumulation of amyloid plaques and tau tangles in the brain.

Amyloid-beta Plaques: Protein fragments that build up in the spaces between nerve cells, disrupting communication and triggering immune responses.

Amyloid PET Scan: A specialized nuclear imaging test that uses radioactive tracers to visualize and measure the density of amyloid-beta plaques in the living brain.

Atrophy: The wasting away or shrinking of brain tissue, often measured via MRI to support a clinical diagnosis of dementia or Alzheimer’s.

B

Biomarkers: Measurable biological indicators, such as proteins found in blood or cerebrospinal fluid, used to identify the underlying pathology of a disease.

Blood Biomarkers: Emerging, less-invasive diagnostic tests that measure specific proteins like p-tau or neurofilament levels in blood plasma to detect Alzheimer’s pathology.

C

CSF Analysis (Cerebrospinal Fluid): A diagnostic procedure involving a lumbar puncture to measure levels of tau and amyloid-beta proteins in the fluid surrounding the brain and spinal cord.

CT Scan (Computed Tomography): A diagnostic imaging test using X-rays to create detailed cross-sectional images of the brain; used primarily to rule out other causes of cognitive decline such as tumors or strokes.

Clock Drawing Test (CDT): A brief cognitive screening task where a patient is asked to ask to draw a clock face; it evaluates visuospatial and executive function.

Cognitive Screening: The process of using standardized tests to objectively measure an individual’s mental functions, such as memory, orientation, and attention.

Community-based Care: Healthcare and support services provided within the local community, such as daycare centers, home-based nursing, and local support groups, rather than in institutional settings.

Cube Copying Test: A visuospatial assessment task used during neuropsychological evaluations to test a patient’s ability to replicate geometric shapes.

D

Dementia: An umbrella term for a range of neurological conditions characterized by a decline in memory, language, and thinking skills severe enough to interfere with daily life.

Dementia-friendly Society: A community or national environment where citizens and businesses are trained to understand, respect, and support the needs of people living with dementia.

Disease-modifying Therapies (DMTs): A new class of treatments, such as monoclonal antibodies (e.g., Lecanemab), designed to target the underlying biological causes of Alzheimer’s rather than just managing symptoms.

E

Early-Onset Alzheimer’s: A form of the disease that affects people younger than age 65, often linked to the familial genes.

Executive Function: Higher-level mental skills including planning, focusing, and multitasking; these are often what the Clock Drawing Test evaluates.

F

FDG-PET: A type of PET scan that measures glucose metabolism in the brain to identify patterns characteristic of different dementia subtypes.

Familial Alzheimer’s Disease: A rare, genetic form of the disease linked to mutations in specific genes (APP, PSEN1, PSEN2) that typically presents with early-onset symptoms.

Frontotemporal Dementia (FTD): A type of dementia caused by progressive nerve cell loss in the frontal or temporal lobes, leading to significant changes in behavior, personality, and language.

G

General Practitioner (GP): A primary care physician who acts as the first point of contact and gatekeeper for dementia diagnosis, providing initial assessments and referrals to specialists.

Genotyping: The analysis of an individual’s DNA to identify specific genetic variations associated with dementia risk or causation.

H

Hidden Cost: The indirect economic impacts of dementia, such as the loss of income for family members who must reduce working hours or leave their jobs to provide care.

I

Informal Care / Informal Caregiver: Unpaid care provided by family members, spouses, or friends, which represents the vast majority of long-term support for people living with dementia.

J

Japanese Cognitive Function Test (J-Cog): A specialized cognitive assessment tool used to evaluate mental and functional status in specific research or regional contexts.

L

Lewy Body Dementia (LBD): A type of progressive dementia that leads to a decline in thinking, reasoning, and independent function due to abnormal microscopic deposits that damage brain cells.

Long-Term Care Insurance (LTCI): A specialized branch of insurance, found in systems like Germany and Singapore, that provides financial subsidies for daily living assistance and nursing care.

M

Memory Clinic: A specialized, often multidisciplinary center focused on the expert diagnosis, management, and treatment of dementia and cognitive disorders.

Mild Cognitive Impairment (MCI): An intermediate stage between normal aging and dementia where memory or thinking problems are noticeable but don’t yet prevent daily functioning.

Mini-Mental State Examination (MMSE): A 30-point standardized questionnaire used to measure cognitive impairment by testing orientation, recall, and attention.

Montreal Cognitive Assessment (MoCA): A cognitive screening tool designed to be more sensitive than the MMSE, particularly for identifying Mild Cognitive Impairment.

MRI Scan (Magnetic Resonance Imaging): A non-invasive technology using magnetic fields to produce detailed images of brain structure; used to assess brain atrophy and rule out secondary causes.

N

National Dementia Plan: A formal government strategy outlining a coordinated response to manage dementia diagnosis, care, research, and awareness at a national level.

National Health Insurance (NHI): A government-funded or regulated healthcare system providing universal or subsidized medical services to citizens.

Neuroimaging: The use of advanced techniques, such as CT, MRI, and PET, to visualize the structure and function of the brain for diagnostic purposes.

Neuroinflammation: The brain’s immune response to damage or protein buildup; while initially protective, chronic inflammation can accelerate neurodegeneration.

O

Out-of-Pocket Costs: Direct payments made by patients or their families for medical services, tests, or care that are not covered by insurance or public subsidies.

P

Preclinical Alzheimer’s: The stage where brain changes (like amyloid buildup) are present but no outward symptoms are yet visible.

S

Synaptic Loss: The destruction of synapses (the gaps where neurons communicate), which is often the strongest correlate to cognitive decline.

T

Tau Tangles: Twisted fibers of a protein called tau that build up inside nerve cells, destroying the cell’s transport system.

V

Vascular Dementia: The second most common type of dementia, caused by conditions that block or reduce blood flow to the brain, like strokes.