Fishing and tourism are the main source of income for the coastal district of Atsinanana, but although there is plenty of water, it carries diseases such as malaria. The lack of sanitation spreads illnesses even further.
The capital city, Antananarivo, is located in Analamanga, a very poor area with a huge lack of sanitation services. Most people do not have access to a clean toilet and faeces are deposited into the environment without treatment.
Women spend an average of two hours per day collecting water in Vakinankaratra. Combined with a severe lack of sanitation, severe diarrhoea is very common.
Menable is largely agricultural and one of the poorest regions in Madagascar. Violent hurricanes have affected the River Manambolo which runs through the district, dried out paddy fields and destroyed existing toilets and water sources.
Analanjirofo is prone to cyclones that have become increasingly severe in recent years. These cyclones contaminate existing water supplies, spreading disease and making recovery difficult.