Terminal Illness & End-of-Life Planning in Madagascar: 5-Step Official Checklist

1. 1

   Coordinating Palliative Care, Hospital Follow-Up, and Medical Coverage

   • Hospital care pathways and supportive care: In Madagascar, specialized treatment for serious illnesses, pain management, and supportive care are coordinated through university hospital centers (such as CHU Joseph Ravoahangy Andrianavalona or CHU Joseph Raseta Befelatanana in Antananarivo) and regional referral hospitals operating under the supervision of the Ministry of Public Health (Ministère de la Santé Publique) [5]. Families can request a comprehensive clinical summary from the attending medical team detailing the treatment protocol as well as arrangements for outpatient follow-up or home-based support [5].
   • Health coverage and medico-social services: For private-sector salaried employees and their dependents, primary medical coverage is provided through inter-enterprise medical services (corporate health organizations such as OSTIE or AMIT) working alongside the National Social Security Fund (Caisse Nationale de Prévoyance Sociale - CNaPS) and hospital facilities under the Ministry of Public Health (Ministère de la Santé Publique) [4] [5].
2. 2

   Documenting Medical Wishes and Designating a Trusted Family Representative

   • Written statement of care preferences: While your family member retains full decision-making capacity, they may write, date, and sign a statement expressing their preferences regarding medical treatments, pain relief, and the refusal of disproportionate interventions [5]. This statement should be handed to the attending physician at the healthcare facility under the Ministry of Public Health (Ministère de la Santé Publique) for inclusion in the patient's medical file [5].
   • Appointing a trusted family spokesperson: Families should ensure that the ill person designates in writing a trusted relative authorized to communicate with the medical team, receive confidential clinical updates, and convey the patient's wishes if their condition later prevents direct communication [5].
3. 3

   Bank Mandates, Notarial Powers of Attorney, and Legal Protection

   • Executing a notarial power of attorney while legal capacity is intact: Under Malagasy civil law, a mandate or power of attorney is legally valid only if the principal possesses full mental capacity at the time of signing [1] [2]. It is therefore essential to arrange promptly for a licensed notary in Madagascar (who can visit the home or hospital) or to complete official administrative legalization of a power of attorney in accordance with the procedures published on the Official Portal of Administrative Procedures (Portail Officiel des Démarches Administratives - Torolalana), authorizing a trusted representative to manage routine affairs, collect income, and administer property [1] [2].
   • Dedicated bank powers of attorney: Alongside a notarial mandate, the ill person should sign the internal power-of-attorney forms required by each Malagasy bank where they hold an account to prevent any interruption in accessing funds needed for medical and household expenses [2].
   • Judicial protection of adults if capacity becomes impaired: If your family member's mental faculties become permanently impaired before a power of attorney has been executed, the family must petition the competent Court of First Instance (Tribunal de première instance) to open a guardianship (tutelle) or court-supervised legal administration proceeding [2].
4. 4

   Activating Disability Benefits and Maintaining Social Rights

   • Private-sector disability or unfitness pension entitlements: When a salaried worker registered with the National Social Security Fund (Caisse Nationale de Prévoyance Sociale - CNaPS) suffers permanent physical or mental unfitness preventing them from continuing salaried employment before the normal retirement age, a medical application for disability or early retirement due to medical unfitness can be submitted to the National Social Security Fund (Caisse Nationale de Prévoyance Sociale - CNaPS) [4]. The fund's medical advisor assesses the degree of incapacity based on certificates issued by physicians under the Ministry of Public Health (Ministère de la Santé Publique) [4] [5].
   • Extended sick leave and preservation of entitlements: Medical certificates for prolonged work stoppage must be submitted within statutory deadlines to the employer and to the National Social Security Fund (Caisse Nationale de Prévoyance Sociale - CNaPS) (or to the employing ministry for civil servants) to preserve statutory allowances and pension rights [4].
5. 5

   Preparing a Will and Organizing Civil Status and Property Documents

   • Drafting a will under Law No. 68-012: While your family member retains full legal capacity, they may organize the distribution of their estate by executing an authentic will before a notary, a holographic will (entirely handwritten, dated, and signed by the testator), or a mystic (sealed) will in accordance with Malagasy succession law [2]. Engaging a notary ensures secure custody of the will and compliance with statutory rules [2].
   • Advance verification of civil status records and land titles: Families are advised to gather and verify now, following the procedures on the Official Portal of Administrative Procedures (Portail Officiel des Démarches Administratives - Torolalana), recent certified full copies of the birth certificate, civil marriage certificate, family record book (livret de famille), land status certificates (certificats de situation juridique from the Land Registry), and registration statements from the National Social Security Fund (Caisse Nationale de Prévoyance Sociale - CNaPS) [1] [2] [4]. If an asset or heir is located abroad, consular legalization or transcription of civil status documents can be coordinated in advance through the Ministry of Foreign Affairs of Madagascar (Ministère des Affaires Étrangères de Madagascar) [3].

Official Authorities & Verified Contacts

Official Sources Checked by Clarvia

1. [1]
   Official Civil Status Procedures and Documents in the Municipalities of Madagascar — Portail Torolalana (Gouvernement de la République de Madagascar)
2. [2]
   Official Civil Status Services and Procedures in Madagascar — Portail Torolalana (Gouvernement de la République de Madagascar)
3. [3]
   Consular Public Services: Issuance and Transcription of Civil Status Records — Ministère des Affaires Étrangères de la République de Madagascar
4. [4]
   Institutional Information and Benefits of the National Social Security Fund (CNaPS) — Caisse Nationale de Prévoyance Sociale (CNaPS Madagascar)
5. [5]
   Official Portal of the Ministry of Public Health of Madagascar — Ministère de la Santé Publique (Madagascar)