Climate change poses an increasing threat to achieving development goals and is often considered in development plans and project designs. However, there have been challenges in the effective implementation of those plans, particularly in the sustained engagement of the communities to undertake adaptive actions, but also due to insufficient scientific information to inform management decisions. Madagascar is a country rich in natural capital and biodiversity but with high levels of poverty, food insecurity, population growth, and exploitation of natural resources. The country faces development and environmental challenges that may be intensified by climate change. The objective of this review is to provide a synthesis of the best-available information regarding climate change impacts on sectoral interests in Madagascar. To do this, we conducted a review of recent literature and conducted formal discussions with development agencies, non-government organizations (NGOs), and other stakeholders. Climate risks in Madagascar include increasing temperatures, reduced and more variable precipitation, more frequent droughts, more intense cyclones, and rising sea levels. We synthesized the observed and projected impacts of climate change on water resources, agriculture, human health, coastal ecosystems, fisheries, and terrestrial ecosystems and ecosystem services, and we discuss ongoing climate adaptation and mitigation activities. Because sectoral challenges and opportunities are linked, coordination among development organizations would be beneficial as they create new climate adaptation and mitigation initiatives.