Nearly one in two children under five years old suffer from chronic malnutrition in Madagascar, according to the 2018 Global Nutrition Report. Malnutrition is more prevalent in some parts of the country due to economic disparities, lack of resources and increased poverty. For example, children in the highlands are most affected by stunting, where levels exceed 60 percent (UNICEF Country Profile, Madagascar, 2016). To put that into perspective, consider that such levels more than double the highest public health threshold set at 30 percent. The costs associated with stunting represent 14.5 percent of the country’s GDP according to estimates of the Cost of Hunger study (2016). This nutritional situation remains a concern for the most vulnerable populations and contributes to the persistence of poverty.

To combat this issue, the Government of Madagascar has long been committed to a multi-sectoral approach at the highest level since its early adherence to the SUN Movement in February 2012. For the first time, nutrition has been included in the ‘Plan Emergence’, a strategic document of the General Policy of the State that will soon be released. The National Office of Nutrition (ONN) is responsible for monitoring the inclusive implementation of the National Nutrition Policy (PNN) and its Nutrition Action Plan (PNAN). Its attachment to the Prime Minister makes it an institution particularly well-placed to coordinate and monitor the contribution of different sectors to nutrition, provided that ONN has the tools and means to do so.

Within this framework, the ONN made a request for technical assistance on the UNNNAM III (Nutrition Action Plan III - 2017-2021) to help ensure that its implementation is on track, looking to the UN Network Secretariat. Madagascar joined a list of 25 other countries which have undertaken the Nutrition Stakeholder and Action Mapping exercise to gage the coverage levels of nutrition actions on the path to scale up. Additionally, this was the first time that Japan financed a UNN-supported mapping exercise.

The mapping will bring an accountability framework putting beneficiaries at the center of programs and actions. It is also catalyzing capacity building at the sub-national level with the participation and training of more than 50 M&E regional assistants. “Mapping addresses the need to involve and build the capacity of decentralized institutions for strong multi-sector coordination from the community to the central level,” said Dr. Lucie Solofonirina, National Coordinator of the ONN and SUN Government Focal Point after the launching workshop in Antananarivo.

The multi-sectoral approach of the mapping included 27 actions that engage sectors including health, agriculture, WASH and social protection. The national mapping team included technical focal points from the ONN, Ministry of Agriculture, Ministry of Health, National Institute for Geography and Hydrography, National Statistics Institute as well as UN colleagues from the United Nations Children’s Fund (UNICEF) and the World Food Programme (WFP). This not only ensures ownership of the exercise but also helps to institutionalize the mapping within government institutions.

The first phase took place over 6 days, in late August 2019, including all stakeholders involved in the field of nutrition in Madagascar. More than 100 participants attended the launching workshop, where technical and financial partners undertook a prioritization exercise to identify which nutrition actions would be mapped. The process was initiated by the National Coordinator of the ONN, the Deputy Secretary of the Prime Minister, the Deputy Country Representative of WFP and the Monitoring and Evaluation Officer of UNICEF. A mapping specialist from the UN Network Secretariat travelled to Antananarivo to join these actors and introduce workshop participants to the mapping tool’s objectives, process and methodology, expected results, and other features.

The mapping team spent three days building capacity for the supervision of data collection and data capture. One of the days focused on the mapping module, using the District Health Information (DHIS2) software for customization, data collection, data entry and basic analysis. During this period, the team proposed a preliminary long list of nutrition actions, target groups, implementation mechanisms and geographical levels that was validated during the workshop.

The mapping exercise itself will take roughly four months to be completed, including the data collection phase, data cleaning, analysis and dissemination of results. This will make it possible to reframe and deliver the package of priority interventions with a proven impact by targeting the geographical areas not previously covered. The goal is to identify existing gaps among the different demographics to boost coverage for hard-to-reach populations.

Funding was made possible by WFP, UNICEF and the Japanese International Cooperation Agency (JICA).

Photo credit @ UN Network Secretariat/Sarah Cruz