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While some health indicators in Madagascar are on par with international and regional standards, the country is lagging behind in others. This is largely explained by the vulnerability of two groups: (i) children under five and (ii) women who are pregnant and give birth. The Government has designed and implemented, with donor support, a sector strategy that has started to produce results. Child mortality declined significantly between 2003/04 and 2008/09 and a series of initiatives were launched to improve maternal care. Yet, results have been unequal so far, excluding many poor and/or isolated households. Furthermore, recent gains have been put at risk by the negative impact of the political crisis on the delivery of health services and well-being of the population. This policy note provides an analysis of the evolution of key health indicators over the past few years, and proposes a series of recommendations to support improving access to health services for the most vulnerable and to address some of the more systemic issues that prevent the efficient use of financial and human resources in the sector.