ANTSOHIHY, Madagascar -- The Basic Health Centre or Centre de Santé de Base II in Anjalajala, near Antsohihy, the capital of Madagascar's northern Sofia Region, is housed in a recently renovated building and its status as a CSB II promises the availability of a trained doctor. But the doctor left for Antananarivo, the capital, in 2002 and has not been replaced, and whenever the remaining nurse is absent, services stop.
A guard sweeping the courtyard explains that currently the health worker is away visiting his mother and will only return in a week.
The situation at this clinic is not unique in Madagascar, where an already weak healthcare system has been in a state of decline since 2009 when the international community branded Andry Rajoelina's ousting of President Marc Ravalomanana a coup, and donors halted all but emergency aid.
In the absence of donor support, the Malagasy government made dramatic cuts to its budget for social services. In 2010, expenditure on health care fell by 30 percent compared to the year before, while the health budget for 2012 is half what it was in 2011.
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