Scaling up success in Madagascar

Originally published on November 11, 2015.

Investments in improved agriculture are most likely to impact nutritional outcomes when coupled with interventions that address behaviors around food. As part of Land O'Lakes International Development’s focus on scaling up approaches to agricultural development that are nutrition-sensitive, we work with households to build their knowledge about the importance of feeding their families healthy diets, while enabling them to leverage increased agricultural production and income to support improved nutrition. In order to reach large numbers of households and ensure that educational resources remain in the community after projects end, we often work through existing front-line workers, both paid and volunteer.

Since 2009, Land O'Lakes has collaborated with community health volunteers (CHVs) in Madagascar with interventions that are tackling food insecurity and undernutrition in the country’s eastern and southern regions through the USAID-supported Strengthening and Accessing Livelihood Opportunities for Household Impact (SALOHI) and ASOTRY (Malagasy for “harvest”) projects. Through multiple implementing partners, the projects will reach over 900,000 households in total. Both programs address a range of development issues, including health, nutrition, agriculture, emergency preparedness and resource management. Through this multi-faceted approach, Land O'Lakes is helping communities become more resilient to disasters and economic shocks, while improving food security, and decreasing dependency on external assistance.

Community health volunteers will work through care groups led by mothers in the community, enabling them to reach more mothers with increasing frequency and fostering learning and discussion among them.

Lessons learned from the SALOHI project being applied to the implementation of ASOTRY

Jeannie Razafinadramanana, a CHV since 1998, says she never imagined that her passion and commitment to volunteerism would enable her to play an important role in transforming the dynamics within her hamlet of Tataho. But after joining forces with the SALOHI program, she significantly bolstered her knowledge base and learned to provide more substantive health and nutritional support to a wider segment of the community.

“Before the training, I did things like distribute medicine to women, administer vaccines and hand out mosquito nets,” Jeannie explained. “But most mothers gave birth traditionally. They never saw a doctor for pre- or post-natal care. They didn’t weigh their children to find out whether or not they were malnourished, nor did they pay much attention to what constituted a healthy diet.” Those who were sick were typically only provided with traditional natural compounds, she said, and children were rarely vaccinated. Now, she says, nearly all children in her hamlet are vaccinated for a variety of potentially detrimental illnesses, including Hepatitis A, B and C, Rubella and Polio.

Scaling-success.pngWith support from SALOHI and the Land O'Lakes team working in Tataho, Jeannie taught mothers how to use the benefits they were reaping from the program, such as increased income, to invest in healthy, nourishing foods. “The dietary training I’ve provided has focused largely on how to improve existing staples to make them more nutritious, rather than trying to switch residents’ diets altogether. For example, I’ve shown my clients how they can add meat, small fish or oil to cassava dishes, to make them more nutritious.” CHVs also promote new recipes utilizing produce from homestead gardens promoted by the project.
Traditionally, the women in her community exclusively breastfed their children for only 2 months, and then they would be transitioned to solid food. She now counsels women on the importance of exclusively breastfeeding for the first 6 months, and about how prolonging breastfeeding for an extended duration can even be an effective means of family planning.

“At first, the community didn’t fully embrace the new ideas I was trying to spread. But, later on, mothers were able to see for themselves the difference in their children’s health and mortality when they sought medical care for their families. This helped convince them of its importance,” Jeannie explained.

Jeannie Razafinadramanana, a community health volunteer with the SALOHI project, with one of her granddaughters.
Together, SALOHI’s interventions had a significant impact on children, resulting in a decrease in stunting (an indicator of chronic malnutrition) among children 0-59 months of age from 47% to 41% and underweight (an indicator of acute malnutrition) from 29% to 20%. Sixty percent (60%) of women reported that they were implementing at least one behavior promoted by the CHVs, such as hand-washing with soap, using bed nets to prevent malaria, and ensuring children receive Vitamin A supplements. Due to increases in agricultural production and income, members of SALOHI’s Farmer Field Schools reported that they face food shortages for only half a week out of the year, as opposed to 5.5 weeks before the start of the project.

Land O'Lakes, in partnership with the Adventist Relief and Development Association (ADRA) and Association Intercooperation Madagascar (AIM) is now scaling up SALOHI’s success through the ASOTRY program. Land O'Lakes is targeting some of the most hard-to-reach areas of the country’s south, where many households face water shortages and the risk of drought, storms and locusts. ASOTRY draws on learning from SALOHI to engage CHVs such as Jeannie in even more effective ways. For example, in ASOTRY CHVs will work through care groups led by mothers from the community, enabling them to reach more mothers with increasing frequency, and foster learning and discussion among them. CHVs continue to have one-on-one interactions at Growth Monitoring and Promotion (GMP) sessions, where they weigh children and provide mothers with advice based on the child’s age and growth trajectory. Based on learning from SALOHI, ASOTRY is holding GMP sessions closer to communities and placing greater focus on training CHVs to provide effective counseling.  ASOTRY is also investing in stronger formative research to inform behavior change communications approaches designed to help households overcome barriers to improved nutrition that are specific to the local context, and providing CHVs with mobile phones and video job aids to assist them in communicating with families.