Three questions to Andrimampionona Razakandrainy, Head of GRET Madagascar’s Nutrition and Health Program

Interview with Andrimampionona Razakandrainy, Head of GRET Madagascar’s Nutrition and Health Program

Focus 2030 : GRET has been fighting malnutrition in Madagascar for almost thirty years. What are the main nutritional challenges facing the country today?

Andrimampionona Razakandrainy, Head of GRET Madagascar’s Nutrition and Health Program :  Malnutrition is a major public health problem in Madagascar. If we focus on chronic malnutrition - a condition caused by long-term nutritional deficiencies or illnesses and manifested by short stature relative to age - in children under 5, the most problematic, the national situation has evolved positively over the last 30 years. The prevalence of chronic malnutrition has fallen from almost 55% in 1992 to 40% in 2021. However, the situation remains alarming, and many challenges remain. Indeed, even for stunting, prevalence remains very high, and Madagascar is among the countries in the world with the highest number of affected children. The prevalence of underweight among young children also remains very high, particularly in the south of the country, where 15.2% of children are underweight according to the 2021 demographics and health survey (EDH). This is mainly due to recurrent food insecurity caused by climatic phenomena such as low rainfall and violent winds. In terms of micronutrient deficiency prevalence, the results of a national survey will be released shortly, but citing only iron deficiency, one child in two is anemic and one woman in four is anemic.

The underlying and fundamental causes of malnutrition are very diverse in Madagascar. Beyond the quality, accessibility and use of health services, which are often problematic, multiple factors come into play. Here are just a few examples.

Poor management of agricultural resources, with the result that it is farmers who are most often affected by food and nutritional insecurity during the lean season. This is a paradox, given that it is mainly in areas with very high agricultural production potential, such as the highlands, that the highest rates of chronic malnutrition are recorded: between 49 and 52% according to the 2021 demographics and health survey.

Poor dietary practices, due both to a lack of knowledge and to the difficulty of changing bad behavior despite efforts to raise awareness of recommended practices. The Malagasy diet is generally unbalanced and lacking in variety, with a high carbohydrate content and very little intake of essential nutrients such as proteins, vitamins and minerals. To illustrate: only 20% of young children have access to an acceptable minimum food intake.

What’s more, the nutritional quality of food products on the market is very often poor, while the financial access of poor households to good-quality food is limited.

Focus 2030 :  What is GRET’s approach to helping fight malnutrition in Madagascar? What main projects have you developed or are you currently implementing to improve the nutritional situation of the Malagasy population?

Andrimampionona Razakandrainy :  GRET’s intervention strategy aims to prevent the various forms of malnutrition in the long term. To achieve this, GRET advocates a global approach. It addresses both the immediate determinants of malnutrition - inadequate food intake and disease - and its underlying determinants - food insecurity, inappropriate care and feeding practices, inadequate access to resources and quality health services, and levels of education and social protection.

For GRET, prevention and the mobilization of all sectors are key issues. It prioritizes specific actions to improve the diets and health of women and young children, priority targets.

In Madagascar, two complementary and adapted approaches have been implemented: firstly, support for the health system in disseminating advice on good feeding practices to complement breast milk, particularly in the preparation of balanced meals; and secondly, support for the local private sector in the production and marketing of high-quality infant flours that are financially and geographically accessible to as many people as possible.

GRET has carried out at least fifty projects and provided expertise in nutrition in Madagascar. Here are a few examples.

In the 2000s, Nutrimad projects led to the development of a range of fortified infant flours, which are still on sale today: Koba Aina for the prevention of malnutrition, PECMAM flour for the treatment of children with moderate acute malnutrition, and Koba Tsinjo for a fortified snack for school-age children.

In the south of the country, GRET has been running food aid and social safety net projects for several years, to help cope with food crises during lean periods. They comprise a package of activities including awareness-raising, in-kind food aid for vulnerable households, care for malnourished children and the provision of improved seeds to strengthen the population’s resilience.

To address the issue of micronutrient deficiencies, a food fortification project for vulnerable urban populations was carried out from 2017 to 2021. It helped develop an innovative, multichannel awareness approach to promote more impactful behavior changes in favor of nutrition, as well as to develop and improve the availability of quality products for vulnerable groups and enhance regulatory frameworks for food fortification and standardization.

Currently, Gret is primarily leading an integrated project to combat malnutrition, called "Tambatra," in alignment with the national multisectoral action plan for nutrition. It is also running a project called "Aintsoa" to fight malnutrition and social and health inequalities in urban areas of Madagascar through a gender approach and social entrepreneurship, while developing various nutrition-sensitive activities such as urban agriculture and social services.

Focus 2030 :  Focus 2030: In March 2025, France will host the Nutrition for Growth summit, which aims to strengthen global commitment in the fight against malnutrition. As a field actor, what are your expectations for this event? What commitments do you think are essential to enhance the effectiveness of the fight against malnutrition worldwide?

Andrimampionona Razakandrainy : Commitments often remain at the level of speeches made by countries and stay political. However, field stakeholders are essential for the implementation of actions aimed at achieving these commitments.

My expectations regarding the N4G summit are based on :

• The adoption of achievable and realistic commitments that address priority issues in line with the local contexts.
• The consideration, from the outset of the commitments, of the absolute need to regularly monitor their progress;
• Actions to give more space to field actors in the fight against malnutrition, both for their innovative and impactful actions and for their involvement in monitoring the commitments made by countries.

In the case of Madagascar, the only programmatic commitment linked to the roadmap for the transformation of food systems, which includes a goal for diversified, healthy, and nutritious food, needs to be strengthened to meet the already ambitious impact commitments.

Therefore, I propose placing greater emphasis on nutritious, safe, affordable, and sustainable diets, on local production, and on the contributions of public and private sector actors to advocate for policies, practices, and food products (whether commercial or not) that guarantee optimal nutrition for all children, all adolescents, and all women, in all contexts.

In my opinion, to strengthen the effectiveness of the fight against malnutrition worldwide, the essential commitments are: first, domestic financing, which, if effective, demonstrates a genuine commitment from the state; and second, commitments to concrete actions with long-term impacts, as well as local and innovative initiatives.

One of the key challenges of the event is also the commitment of donors to mobilize funds for the fight against malnutrition. It is crucial to give as much importance to development actors as to United Nations agencies and to fund actions that have proven their effectiveness, are realistic, and sustainable. It is equally important to address the strong challenges posed by climate change, its impacts on food and nutrition security, especially for vulnerable populations, which are becoming increasingly visible and significant.

NB : The opinions expressed in this interview do not necessarily reflect the positions of Focus 2030.