Despite abundant natural resources, Madagascar is one of the poorest countries on the planet. Between 2005 and 2010, the proportion of Malagasy living below the poverty line increased from 69% to 77%. Its development is hampered by latent political instability and numerous natural hazards such as hurricanes.

Un Enfant par la Main (as Enfants Sans Frontières) has been active in Madagascar since 1997. It helped rehabilitate the hospital "La Mère et l'Enfant" by creating a specialized autonomous unit within the hospital for mothers and their children.

It currently promotes access to education by supporting the Akany Solofo Center and the Saint Paul school. In 2016, it established a partnership with the "Enfants du Soleil" association to support a shelter and rehabilitation project for street children.