June 2025 — In Madagascar, a powerful grassroots movement is reshaping how communities care for mothers and children. At the heart of this transformation is the Care Group Approach, a community-driven model that is empowering women, improving child and maternal health, and strengthening the country’s primary health care system.

A Community-Led Model

The Care Group model is built on a simple but powerful idea: when women are empowered with knowledge, they become agents of change in their communities. Each group consists of 10 to 15 mothers, led by a trained “lead mother.” These lead mothers receive training on essential health topics—such as nutrition, hygiene, breastfeeding, and immunization—and return to their communities to share what they’ve learned. Group members then pass this knowledge on to their neighbours, creating a ripple effect that spreads accurate, culturally relevant health information throughout the community. This cascading model ensures that even the most remote households are reached.

The success of the Care Group approach lies in its community ownership and trust-based communication. By leveraging existing social networks and empowering local women, the model ensures that health messages are not only heard but also acted upon. It has proven especially effective in improving maternal and child nutrition, increasing access to health services, and promoting healthy behaviors. Mothers are more informed, children are better nourished, and communities are more resilient.

Boosting Immunization Through “The Big Catch-up”

One of the most impactful applications of the Care Group model has been in the area of childhood immunization. In the wake of the COVID-19 pandemic, Madagascar, like many countries, experienced a significant drop in routine vaccinations. Many children missed critical doses, leaving them vulnerable to vaccine-preventable diseases. To address this, the Care Group model has been integrated into “The Big Catch-up” strategy in Madagascar, an initiative aimed at restoring immunization coverage to pre-pandemic levels and beyond.

Through Care Groups, mothers receive critical information about the importance of vaccines, the risks of missed vaccination, and how to access services. This has been especially critical for reaching zero-dose children—those who have never received a single vaccine. By embedding immunization messages into the regular rhythm of Care Group meetings, Madagascar has been able to reconnect families with the health system and ensure that no child is left behind.

Madagascar continues to implement the Care Group Model approach for immunization and rigorous monitoring and evaluation of the impact of this intervention is in progress. Results on the impact of the Care Group Model toward reaching zero-dose and under-immunized children are expected later this year

Building Resilience and Lasting Change

Beyond health education, Care Groups foster solidarity, leadership, and resilience. They create safe spaces where women can share experiences, support one another, and build confidence. These groups become more than just a platform for learning—they become a source of strength and unity. This social cohesion enhances the community’s ability to respond to future health challenges and strengthens the overall fabric of society.

The model’s adaptability is another of its strengths. While it has been particularly effective in promoting positive nutrition and immunization practices, it can also be used to address a wide range of health and development priorities, including family planning, malaria prevention, and water and sanitation. Its flexibility makes it a valuable tool for building more responsive and inclusive health systems.

A Model for the Future

Madagascar’s Care Group approach is more than a health intervention—it’s a movement. By placing women at the center of community health, it is transforming lives, strengthening systems, and setting a powerful example for other countries.

As global health systems strive to become more inclusive and resilient, Madagascar’s experience with the Care Group Model so far shows that change begins with empowered communities—and that every mother, when supported, can be a leader in health.