@article{fdi:010082725,
  title = {{I}ntegrating health systems and science to respond to {COVID}-19 in a model district of rural {M}adagascar},
  author = {{R}akotonanahary, {R}. {J}. {L}. and {A}ndriambolamanana, {H}. and {R}azafinjato, {B}. and {R}aza-{F}anomezanjanahary, {E}. {M}. and {R}amanandraitsiory, {V}. and {R}alaivavikoa, {F}. and {A}ina, {A}. {T}. and {R}ahajatiana, {L}. and {R}akotonirina, {L}. and {H}aruna, {J}. and {C}ordier, {L}. {F}. and {M}urray, {M}. {B}. and {C}owley, {G}. and {J}ordan, {D}. and {K}rasnow, {M}. {A}. and {W}right, {P}. {C}. and {G}illespie, {T}. {R}. and {D}ocherty, {M}. and {L}oyd, {T}. and {E}vans, {M}. {V}. and {D}rake, {J}. {M}. and {N}gonghala, {C}. {N}. and {R}ich, {M}. {L}. and {P}opper, {S}. {J}. and {M}iller, {A}. {C}. and {I}hantamalala, {F}. {A}. and {R}andrianambinina, {A}. and {R}amiandrisoa, {B}. and {R}akotozafy, {E}. and {R}asolofomanana, {A}. and {R}akotozafy, {G}. and {V}ololoniaina, {M}. {C}. {A}. and {A}ndriamihaja, {B}. and {G}architorena, {A}ndres and {R}akotonirina, {J}. and {M}ayfield, {A}. and {F}innegan, {K}. {E}. and {B}onds, {M}. {H}.},
  editor = {},
  language = {{ENG}},
  abstract = {{T}here are many outstanding questions about how to control the global {COVID}-19 pandemic. {T}he information void has been especially stark in the {W}orld {H}ealth {O}rganization {A}frica {R}egion, which has low per capita reported cases, low testing rates, low access to therapeutic drugs, and has the longest wait for vaccines. {A}s with all disease, the central challenge in responding to {COVID}-19 is that it requires integrating complex health systems that incorporate prevention, testing, front line health care, and reliable data to inform policies and their implementation within a relevant timeframe. {I}t requires that the population can rely on the health system, and decision-makers can rely on the data. {T}o understand the process and challenges of such an integrated response in an under-resourced rural {A}frican setting, we present the {COVID}-19 strategy in {I}fanadiana {D}istrict, where a partnership between {M}alagasy {M}inistry of {P}ublic {H}ealth ({M}o{PH}) and non-governmental organizations integrates prevention, diagnosis, surveillance, and treatment, in the context of a model health system. {T}hese efforts touch every level of the health system in the district-community, primary care centers, hospital-including the establishment of the only {RT}-{PCR} lab for {SARS}-{C}o{V}-2 testing outside of the capital. {S}tarting in {M}arch of 2021, a second wave of {COVID}-19 occurred in {M}adagascar, but there remain fewer cases in {I}fanadiana than for many other diseases (e.g., malaria). {A}t the {I}fanadiana {D}istrict {H}ospital, there have been two deaths that are officially attributed to {COVID}-19. {H}ere, we describe the main components and challenges of this integrated response, the broad epidemiological contours of the epidemic, and how complex data sources can be developed to address many questions of {COVID}-19 science. {B}ecause of data limitations, it still remains unclear how this epidemic will affect rural areas of {M}adagascar and other developing countries where health system utilization is relatively low and there is limited capacity to diagnose and treat {COVID}-19 patients. {W}idespread population based seroprevalence studies are being implemented in {I}fanadiana to inform the {COVID}-19 response strategy as health systems must simultaneously manage perennial and endemic disease threats.},
  keywords = {pandemic response ; public health system ; health system strengthening ; data platform ; {COVID}-19 ; {MADAGASCAR}},
  booktitle = {},
  journal = {{F}rontiers in {P}ublic {H}ealth},
  volume = {9},
  numero = {},
  pages = {654299 [10 ]},
  year = {2021},
  DOI = {10.3389/fpubh.2021.654299},
  URL = {https://www.documentation.ird.fr/hor/fdi:010082725},
}