The western Indian Ocean genus Paracephaelis is revised. Sixteen species are endemic to Madagascar, 12 of which are new for science: P. aristata sp. nov., P. bardotiae sp. nov., P. capitulifera sp. nov., P. gautieri sp. nov., P. grandifructa sp. nov., P. longipedicellata sp. nov., P. orientalis sp. nov., P. pauciflora sp. nov., P. ranirisonii sp. nov., P. russata sp. nov., P. sambavensis sp. nov., and P. seyrigii sp. nov. Paracephaelis trichantha occurs on the east coast of continental Africa and on the islands of the Aldabra Group. One other species is newly described from the Comoros, P. comorensis sp. nov. Paracephaelis is characterized by sessile inflorescences, pubescent inflorescence and flower parts, ovules arranged at the periphery of the placenta, laterally flattened seeds with entire endosperm and a shallow elongate hilum, and pollen with supratectal elements. Of the Malagasy endemics, five species are assessed as Critically Endangered with P. sambavensis sp. nov. possibly Extinct in the Wild, three are Endangered, four are Vulnerable, one is Near Threatened, and three are Least Concern. Outside Madagascar, P. trichantha and P. comorensis sp. nov. are assessed as Vulnerable.