In Zambia and Madagascar, access to essential health and sanitation services remains a significant challenge. According to the 2019 Human Development Report, only 63% of births in Zambia and 44% in Madagascar are attended by skilled health personnel. Maternal mortality ratios stand at 224 and 353 deaths per 100,000 live births, respectively. Furthermore, just 26% of Zambia’s population and 11% of Madagascar’s population have access to basic sanitation facilities, underscoring the urgent need for improved healthcare and infrastructure. Madagascar faces greater health and sanitation challenges than Zambia due to its limited infrastructure, economic constraints and remote geography, which restrict access to medical care and basic sanitation services. Economic constraints have further hindered progress in expanding health services, resulting in poorer health outcomes.
Our Response
Although the Time + Tide Foundation is primarily education-focused, we recognise the critical role that healthcare plays in enabling children and families to thrive. We therefore provide medical treatment for children requiring hospitalisation and specialist consultations, while also extending essential healthcare support to the broader .
In 2025, our medical team in Madagascar continued serving residents of the remote Ampisikinana District through our outreach programme, designed to reduce both the time and financial burden of accessing healthcare. Led by Dr. Julien and supported by three full-time and two part-time nurses, a total of 3,993 medical
consultations were conducted. These consultations were delivered over 2,068 hours of clinical service. We estimated that the avoided consultation fees, medicines and transport costs associated with these services resulted in community savings of approximately $83,014 USD. In 2025, we hired a nurse to establish a local clinic facility through which she can provide primary health services to residents of Antrema Village.