▁hospital ▁b eds ▁per ▁ 1 0 , 0 0 0   people ▁and ▁a ▁total ▁of ▁ 3 , 1 5 0   do ctors , ▁ 5 , 6 6 1   n urs es , ▁ 3 8 5   community ▁health ▁workers , ▁ 1 7 5   ph arm ac ists , ▁and ▁ 5 7   dent ists ▁for ▁a ▁population ▁of ▁ 2 2   mill ion . ▁Fif teen   percent ▁of ▁government ▁sp ending ▁in ▁ 2 0 0 8 ▁was ▁directed ▁toward ▁the ▁health ▁sector . ▁Appro xim ately ▁ 7 0   percent ▁of ▁sp ending ▁on ▁health ▁was ▁contributed ▁by ▁the ▁government , ▁while ▁ 3 0   percent ▁origin ated ▁with ▁international ▁don ors ▁and ▁other ▁private ▁sources . ▁The ▁government ▁provides ▁at ▁least ▁one ▁basic ▁health ▁center ▁per ▁commune . ▁Private ▁health ▁cent ers ▁are ▁concentr ated ▁within ▁urban ▁areas ▁and ▁particularly ▁those ▁of ▁the ▁central ▁high lands . ▁ ▁Despite ▁these ▁bar riers ▁to ▁access , ▁health ▁services ▁have ▁shown ▁a ▁tr end ▁toward ▁improvement ▁over ▁the ▁past ▁twenty ▁years . ▁Child ▁imm un izations ▁against ▁such ▁dise ases ▁as ▁he pat itis ▁B , ▁di ph ther ia , ▁and ▁meas les ▁increased ▁an ▁average ▁of ▁ 6 0   percent ▁in ▁this ▁period , ▁indicating ▁low ▁but ▁increasing ▁avail ability ▁of ▁basic ▁medical ▁services ▁and ▁treat ments . ▁The ▁Mal ag asy ▁fert ility ▁rate ▁in ▁ 2 0 0 9 ▁was ▁ 4 . 6