There are both private and public hospitals in the country’s capital, Antananarivo, where straightforward treatment and operations can be provided. However, healthcare facilities are limited and anyone requiring more complex surgery would need to be transferred to a hospital in South Africa or Reunion. Medical services are free to residents, but taking out a private, international healthcare insurance is strongly recommended for any expat living in Madagascar.
Medical problems on the island include malaria, leprosy, and tuberculosis, although healthcare programs are in place to combat these diseases. Expatriates living in Madagascar are advised to avoid drinking tap water unless it has been boiled.
Transport in Madagascar is primarily by road. An International Driving Permit is mandatory for all foreign nationals wishing to drive in Madagascar. Most car hire companies require customers to have had their main driving license for a minimum of 12 months and to be aged 23 or over. Some companies will only allow cars to be rented with one of their own drivers. People drive on the right hand side of the road in Madagascar.
The majority of roads are dirt tracks rather than paved (in fact, less than 15% of the roads are paved) and some may be particularly hazardous in the rainy season. A four wheel drive is essential if you intend to travel outside town. Beware of animals, carts and pedestrians on the roads. Expats in Madagascar should keep clear of certain routes, particularly in rural areas. It is recommended to keep your car doors locked when driving, especially when in Antananarivo, the capital city.
Within Madagascar’s towns, you will see and frequently be encouraged to hire one of the many rickshaws or pousse-pousses. You will also find plenty of taxis and fares are standardized, factoring in road conditions, as well as distance and time.
Rail services are very limited in Madagascar. A train line runs between Fianarantsoa and Manakara, with a journey time of at least 12 hours. First class tickets need to be reserved in advance. Boat trips are also available off some parts of the coast, with the opportunity for whale watching, snorkeling, and diving. It is advisable to ask for local recommendations to ensure you travel with a reliable operator.
Madagascar is a democracy but also one of the world’s poorest countries and has been politically unstable for several decades. Following the political coup of 2009, security conditions declined, but in 2014, democracy was restored and there are hopes for reduced civil unrest as a result.
In recent years, there have been incidences of rioting and kidnapping, as well as high numbers of robberies. Foreign nationals, whether they’re traveling on business or as tourists, could be vulnerable to crime. Pick-pocketing is common in towns, on beaches, and in the national parks. It is important to be vigilant when out and about, particularly in crowded places. If expatriates living in Madagascar wish to explore areas such as the national parks in their leisure time, it is advisable to go on organized tours where they’ll be accompanied by a guide and security personnel.