Madagascar is one of the world's poorest and least developed nations. For the poor of this island nation, life is precarious, turbulent and unpredictable. Extreme poverty is compounded with frequent natural disasters. Cyclones such as Tropical Storm Ivan, which struck the east coast of the sub-Saharan island in February 2008, are regular visitors bringing with them high winds, torrential rains, destruction and death.

Toamasina, Madagascar's second largest city, is also its main port. A once proud center of Francophone culture, the city and rural region just beyond today face the same formidable struggles as the rest of the country. More than two-thirds of the country's 19 million people live in abject poverty, surviving on less than $2 a day.

Two-thirds of the people do not have access to either clean water or sanitary means of human waste disposal. As a result, water-born illnesses cost the country 6 million lost work days and 5.5 million lost school days every year. Water-born diseases are the second highest cause of infant mortality.

A 2007 World Bank study revealed that 63% of the population is illiterate. Less than 20% of children complete middle school and only 7% finish high school. In rural areas, these percentages are much higher.

Most  of the country's households do not have adequate food and the high rate of malnutrition among children is responsible for stunted growth and developmental problems.

Caring Response Madagaascar Foundation responds to these needs through programs that emphasize economic stability, literacy, and better sanitation, health and hygiene.