Madagascar Builds Cancer Care Foundations, Faces Urgent Need for More Resources

Madagascar has taken important steps in strengthening its cancer care system, but significant challenges remain in ensuring access to comprehensive treatment and early detection across the country. This is the key message from a recent joint imPACT review, carried out in June 2025 by the International Atomic Energy Agency (IAEA), the World Health Organization (WHO), and the International Agency for Research on Cancer (IARC).

The review found that Madagascar has laid solid foundations for cancer control—particularly in the areas of cervical cancer prevention, workforce training, and collaboration between health and radiation safety authorities. However, it emphasized that urgent action is needed to expand oncology capacity, strengthen prevention and early detection, and mobilize sustainable financing for long-term cancer care.

A Growing Cancer Burden

Cancer claims more than 14,000 lives annually in Madagascar, according to 2022 IARC estimates. Women are disproportionately affected, with nearly 8,000 deaths each year. The country records more than 20,000 new cases annually, and these numbers are expected to rise due to changing lifestyles, an aging population, and persistent risk factors such as infectious diseases.

Minister of Health Randriamanantany Zely Arivelo welcomed the review, stating:

“The Malagasy government is committed to improving cancer care in the country. This imPACT assessment is very timely, as we will use its findings to finalize our first national cancer control plan.”

Focus on Women’s Cancers

The most common cancer among women is cervical cancer, which carries a high mortality rate of around 30 per cent. Breast and colorectal cancers are also significant threats. Among men, the leading cancers are prostate, liver, and non-Hodgkin lymphoma, many linked to preventable or treatable infectious causes.

Encouragingly, the review found that Madagascar has expanded cervical cancer screening for precancerous lesions and will begin HPV vaccination in October 2025. The country has also modernized and distributed imaging services, improving diagnostic capabilities.

Health Workforce and System Strengths

Madagascar benefits from an established and generally qualified health workforce, supported by six medical faculties that train health professionals in key specialties, including surgery—a critical component of cancer treatment.

International experts highlighted progress since the country’s last imPACT review in 2015, praising efforts to expand cancer services and integrate prevention at the community level. According to WHO Representative Laurent Musango,

“The strength of the imPACT review lies in its analysis of the entire cancer continuum. Madagascar has a strong foundation for integrating cancer control into broader health systems.”

Key Recommendations: Building Capacity and Ensuring Safety

Despite progress, experts stressed the need to increase and retain oncology professionals, including oncologists, pathologists, and radiotherapy specialists. Without a larger specialized workforce, the demand for cancer services will continue to outstrip supply.

The review also called for:

• Strengthened radiation safety in medicine, ensuring protection for patients, staff, and the public.

• Long-term maintenance of nuclear medicine and radiotherapy equipment to sustain treatment services.

• Expanded pathology services with additional laboratories, staff, and supplies to improve early detection.

• Greater emphasis on community engagement for breast cancer awareness and prevention.

Radiation safety was highlighted as a priority. Vasiliki Kamenopoulou, IAEA radiation safety specialist, noted:

“Radiation safety is foundational to providing comprehensive cancer diagnosis and treatment. Madagascar is encouraged to reinforce its legal and regulatory framework in line with IAEA safety standards.”

Partnerships and Resource Mobilization

Looking ahead, the imPACT review urged Madagascar to mobilize resources through innovative strategies, including:

• Developing bankable investment documents to attract loans and international support.

• Strengthening public–private partnerships for infrastructure and service delivery.

• Leveraging international initiatives such as the IAEA’s Programme of Action for Cancer Therapy (PACT) and Rays of Hope, which connect countries with donors, technical expertise, and financial institutions.

Through these partnerships, Madagascar can improve access to modern radiotherapy, nuclear medicine, and diagnostic imaging, while also enhancing capacity-building for local health professionals.

Towards a National Cancer Control Plan

The findings of the imPACT review will form the basis of Madagascar’s first comprehensive national cancer control plan—a critical governance document that will guide prevention, early detection, treatment, and palliative care strategies for years to come.

The plan will also serve as a framework to align government action with international support, ensuring that cancer control is not only integrated into national health systems but also sustainably funded and equitably delivered.

A Defining Moment for Cancer Care in Madagascar

Madagascar’s progress since 2015 demonstrates political commitment and community-level integration of cancer prevention services. Yet, the challenges of workforce shortages, equipment sustainability, and financing remain pressing. With cancer incidence projected to rise, the imPACT review highlights both the opportunity and urgency for Madagascar to strengthen its cancer response.

By expanding partnerships, prioritizing women’s cancers, and ensuring strong governance, the country has a chance to set an example for other low- and middle-income nations facing similar challenges.