Entrepreneurship ecosystems and innovation hubs are critical for fostering economic growth in developing regions. Madagascar’s eastern region has seen significant development but lacks systematic research on these key areas. The research employs both qualitative interviews with entrepreneurs and stakeholders, along with quantitative analysis of socio-economic data, to comprehensively understand these systems in action. A key finding is the significant role played by government support programmes in the establishment and growth of innovation hubs. Specifically, 60% of surveyed businesses reported receiving assistance from governmental initiatives. This study highlights the importance of supportive government policies for entrepreneurship ecosystems and innovation hubs, providing evidence that such interventions are crucial for their success. Policy makers should prioritise continued support for these programmes to ensure sustained growth in Madagascar’s eastern region. Additionally, more targeted funding mechanisms could be explored to enhance effectiveness.