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To help empower the Malagasy people to address their own health needs, the USAID/Santenet2 program introduced the social quality approach in 800 communes in Madagascar. The social quality approach is a community-based approach for encouraging service recipients to get involved in the availability, use, and quality of health services. This report, based on Santenet2 project data, correlation analysis, and qualitative data collection, illustrates the implementation process, successes and essential components to the successful implementation of the social quality approach.