In all, MSAADA has handled nearly 100 projects in Madagascar, having a total floor area of about 60,000 square meters (or about 650,000 square ft). Projects include schools for the blind and deaf, facilities for lepers, churches, and housing. In addition to the hospitals and dispensaries developed for SALFA, a new hospital was built for the Baptist Mission at Mandisara on the west coast of the island.

MSAADA was first invited to the country to help with the development of facilities for SALFA, the Medical Services system of the Lutheran Church in Madagascar. This system grew to become the primary health care system on the island given the absence of a consistent government care system. The Lutheran missionary doctor who organized and raised funds to build and staff that system was knighted by the Malagasian Government in recognition of his work and accomplishment before he retired and returned to the USA.

MSAADA designed and built several facilities for this system, including new Health Centers at the remote locations of Vangaindrano and Sambava, additions to the Ambrohibao Medical Center in Antsirabe and the construction of the multi-story headquarters and pharmaceutical production building in Antananarivo. Though site visits and design work were at first made from the MSAADA office in Tanzania and the United States, an office with a resident architect from the United States and with a Malagasy staff was quickly established to supervise construction of already funded projects and to do new concept designs etc.

Many other churches, missions and other organizations were also served by MSAADA while we were there for different types of projects.  That included work for other indigenous churches, as well as the US Embassy and the projects included spaces of worship and dwellings for such indigenous churches as the FJKM, the Assembly of God and the SDA, as well as missions as the AIM and the Nazarene Ministries.

Many areas of Madagascar are remote from the capital with no roads or very rough roads connecting areas like Sambava and the far south and north areas of the island. One project site for a new church at the Toby in Ankaramalaza could only be reached by canoe up a river from the coast. Roofing, cement, and other materials for construction not available locally were brought to the project by river to construct a church with seating capacity for 850 people.

MSAADA Madagascar continues currently under the direction of Malagasy staff since the departure of the last expatriate managing architect in the early 2000s, but as an organization independent of MSAADA Architects here in Minneapolis, Minnesota, USA.