Reimbursed Care Access in Madagascar

Currently classified as a strictly controlled substance under national drug scheduling laws, with no authorized medical use outside of approved clinical research. # #

Currently classified as a strictly controlled substance under national drug scheduling laws, with no authorized medical use outside of approved clinical research. #

There is no publicly available evidence of a national regulatory registration or a public reimbursement pathway for esketamine (Spravato) in Madagascar; esketamine has specialised approval and restricted distribution in jurisdictions where it is registered (for example, Spravato in the United States under FDA REMS). Clinical use of esketamine requires certified treatment settings and post‑administration monitoring where approved, and it is typically not available through standard national formularies without explicit regulatory registration. # #

Ketamine is an established, authorised anaesthetic and analgesic agent in Madagascar and is widely available in public and private hospitals for surgical, obstetric and emergency indications. Multiple facility surveys and anaesthesia-capacity assessments document routine availability and use of ketamine in Malagasy hospitals, particularly in settings with limited oxygen and advanced monitoring resources, where ketamine’s profile is clinically useful. #

Regulatory/medical context: ketamine is listed on the World Health Organization’s Model List of Essential Medicines as an essential anaesthetic (and thus is commonly included in national essential medicines lists and hospital formularies worldwide). Its use for psychiatric indications (e.g., off‑label low‑dose ketamine for treatment‑resistant depression) is an off‑label practice in many countries but requires local clinician oversight, hospital protocols and controlled dispensing; there is no evidence of a structured, reimbursed psychiatric ketamine program in Madagascar’s public health financing. #

Reimbursement and access: for surgical and anesthetic indications ketamine is procured and used within hospital supply chains (public and private) rather than through a specialized reimbursed outpatient psychotherapy program. There is no documented national reimbursement policy for ketamine when used for psychiatric indications in Madagascar; psychiatric use would therefore be off‑label, clinic‑level practice if undertaken and not part of an insured benefit package. #

Currently classified as a strictly controlled substance under national drug scheduling laws, with no authorized medical use outside of approved clinical research; consequentially preparations containing DMT (including ayahuasca) are subject to legal restriction or legal uncertainty in many national systems, including Madagascar. # #

Currently classified as a strictly controlled substance under national drug scheduling laws, with no authorized medical use outside of approved clinical research. #

Currently classified as a strictly controlled substance under national drug scheduling laws, with no authorized medical use outside of approved clinical research. (Ibogaine is rarely authorised clinically worldwide and, where studied, access is normally restricted to licensed clinical trials.) #

Currently classified as a strictly controlled substance under national drug scheduling laws, with no authorized medical use outside of approved clinical research; because ayahuasca contains DMT the brew is treated as controlled in jurisdictions that control DMT. National legal treatment of ayahuasca can vary, but in Madagascar there is no documented legal framework permitting therapeutic or ritual ayahuasca use. # #

Currently classified as a strictly controlled substance under national drug scheduling laws, with no authorized medical use outside of approved clinical research. Mescaline-containing cacti and extracts are commonly controlled or treated as illegal when intended for psychoactive use. #

Currently classified as a strictly controlled substance under national drug scheduling laws, with no authorized medical use outside of approved clinical research. Novel synthetic phenethylamines (the 2C family and related analogues) are controlled in most national legal frameworks and are not part of any recognized medical or reimbursed therapeutic program in Madagascar. #