In Madagascar, 35 percent of deaths among children under five are related to malnutrition
The World Bank has provided $10 million for nutrition programs on the island
5550 community nutrition sites are now thriving, helping families
Soanierana (Maroantsetra), November 11, 2008—A community nutrition program co-financed by the World Bank has proven to be a success in Madagascar, where the rate of malnutrition – 42 percent among children under age five in 2003/2004 – remains a source of concern.
Each year, close to 60,000 children die before their fifth birthday, with 35 percent of these deaths being linked to malnutrition, according to Sofia Bettencourt, the World Bank’s acting Country Director based on the island. “At the dawn of the third millennium, this situation is unacceptable, all the more so since it can be easily avoided,†she emphasized.
This observation prompted the Malagasy Government to make combating malnutrition one of the pillars of the Madagascar Action Plan, which sets forth the country’s road map for the 2007-2012 period. Combating malnutrition is also one of the Millennium Development Goals, used by the government as a frame of reference for formulating a National Nutrition Policy, which sets the target of halving the rate of malnutrition by 2015.
With this objective in mind, 5,550 community nutrition sites were set up throughout Madagascar, with support from the National Community Nutrition Program (Programme National de la Nutrition Communautaire, PNNC). The World Bank is one of the main partners of the Malagasy Government assisting with implementation of the PNNC through funding to the tune of US$10 million.
“Through the National Community Nutrition Program, the Malagasy Government, with assistance from the World Bank, is undertaking activities aimed at building the awareness of the Malagasy population with respect to malnutrition problems,†explained Maryanne Sharp, the World Bank’s project leader.
“In fact, a better understanding by the population of measures to avoid the harmful effects of malnutrition is critical in order to ensure improved growth of children,†she said.
In Maroantsetra district, in the northeastern part of the island, work is being done at 91 sites to tackle a malnutrition rate of 17 percent. The sites in this district include Soanierana, eight kilometers from the downtown area. It includes two fokotany (neighborhoods) with a total population of 2,645—238 of whom are children 59 months or younger.
Once a month, mothers bring their children to the site to be weighed and to participate in nutritional education activities, using a system of rotation based of five predefined age groups. The Soanierana site is managed through close collaboration with the PNCC, a local NGO named Fagnanko, and the community as a whole.
The Community Nutrition Agent – An Extraordinary Pillar
The Soanierana community nutrition site benefits from the work of an outstanding leader named Benary. This mother, who is roughly 40 years old, was elected by her peers to become the community nutrition agent. She is responsible for managing the site, which opens its doors three times per week.
“I conduct activities with mothers who have children under age 5, and also with the program’s other target groups – adolescents between the ages of 13 and 20, as well as pregnant and breast-feeding women,â€Â Benary explains. She oversees weighing activities, dispenses advice to mothers, and conducts home visits to monitor the growth of children. She also directs cooking classes.
As a result of the synergy among the different actors involved, the results achieved at the Soanierana site are instructive. Since the opening of the site in November 2001, the number of children plagued with extreme malnutrition has been halved.
“I already had three children before this community nutrition site was opened. They were therefore not able to benefit from nutritional monitoring. My fourth child had this opportunity, and I can really see that he is more energetic and alert than his older siblings,†said Laurence, who has been visiting the site for the past few months.
The Entire Community Comes Together to Run the Site
The dynamism and effectiveness of the site goes beyond the responsibility of Benary and mothers. Baban’ny zaza, a fathers’ association, is responsible for maintenance work at the site. The building was built by residents of the fokotany with material salvaged from a school destroyed by a cyclone.
Families also contribute to the ingredients used in cooking classes and to the purchase of some cooking utensils. However, to avoid putting too much pressure on household budgets, vegetables are grown in a community vegetable garden. These vegetables are used in cooking sessions, and unused surplus food is sold in order to replenish the coffers of the nutrition site.
However, if a mother is having problems feeding her family, she can request vegetables from this community plot.Â
“This site is successful because of the exceptional level of mobilization of community members, who, despite their very modest living conditions, joined hands to make it work,â€Â said Lubna Bhayani, a health economist at the World Bank. Â
Moving Toward the Millennium Goals
Prime Minister Charles Rabemananjara chairs the National Nutrition Council. He underscores the fact that “the success of the nutrition project that was once supported by the World Bank has made Madagascar one of the African few countries that can say that it has achieved the Millennium Development Goals with respect to malnutrition. For this reason, it has set up a separate program, funded through the State budget, within the National Nutrition Office (Office National de Nutrition), the new entity responsible for coordinating efforts to combat malnutrition in Madagascar.†The PNNC is an integral part of the National Nutrition Office.
Although the challenge is daunting, every child who moves out of the severe or moderate malnutrition range on monitoring charts represents a small step forward for families. It is, however, a step that counts.
