The development of social protection mechanisms in low-income countries is a major challenge in the face of significant issues related to poverty, health and adaptation to climate change. The aim of this article is to investigate the policy-making process in Madagascar by examining the power relations among the main organizations involved in this national policy. Using a mixed-methods approach combining policy network analysis and thematic analysis, we conduct a detailed analysis of the Malagasy policy network, the multi-actor power relations and recent developments in national social policy. The findings highlight the important role played by international organizations in shaping national social protection policy through the financing of social assistance programs, support for institutions in charge of policy design and implementation and the dissemination of transnational ideas. Drawing on the case of Madagascar, this study illustrates the growing importance of social assistance programs in low-income countries.