RAKOTOMALALA, Bodo, Case Study Under The Social Sector Public Expenditure Review - 2014, Antananarivo: UNICEF Madagascar, 2014, 117 P.

Case study under the social sector
public expenditure review - 2014
In-depth analysis on the improvement of the efficiency and

sustainability (of funding) for community-based nutrition sites in
Madagascar.
Deliverable : Final version of the case study
March 2015
Nutrition Case Study for UNICEF-Final Report - Bodo Rakotomalala
Table of Contents
Executive Summary....................................................................................................................................... 4
Part 1: Overall Funding of Nutrition............................................................................................................ 11
1. Definition of nutrition ............................................................................................................................. 11
2. Reminder of the trends and conclusions highlighted in the 2007 PER ................................................... 11
3. Interim findings of the PER 2014 Team on nutrition .............................................................................. 12
4. The National Nutrition Action Plan (PNAN II) 2012- 2015 ...................................................................... 14
5. Analysis of budgetary resources to finance nutrition ............................................................................. 16
6. Review of ONNs expenditure ................................................................................................................. 17
Part 2: Findings of the comparative case study of community-based nutrition sites ................................ 22
1.
Aims of the case study .................................................................................................................... 22
2.
Summary of the methodology used for collecting and processing data ........................................ 23
3. Comparative analysis of the community-based nutrition sites in the regions of Boeny regions and
Amoroni Mania ...................................................................................................................................... 24
3.1. Structure/description of activities: ............................................................................................. 24
3.2. Trends and use of funding from 2012 to 2014............................................................................ 28
3.3. Changes in the underweight rate indicator ................................................................................ 32
3.4. Activities carried out by ACNs ..................................................................................................... 35
3.5. Changes in other indicators of the functioning of sites .............................................................. 36
3.6. ACNs resources........................................................................................................................... 38
3.7.
sites
4.
Procedures applicable to the implementation of funding for community-based nutrition

40
Strengths and weaknesses of the financial framework in terms of efficiency and sustainability .. 41
5. Practical recommendations for improving the predictability and sustainability of funding for sites
taking into account the local context ..................................................................................................... 42
Annexes ....................................................................................................................................................... 44
List of Tables
Table 1: Expenditure budgeted and implemented for nutrition and food security, 2009- 2013 ............... 13
Table 2: Expenditures implemented by the Ministry of Health on its nutrition program .......................... 13
Table 3: Estimated budget for the PNAN II, (in USD) .................................................................................. 15
Table 4 : Extract from the 2012 PNAN II implementation report ............................................................... 15
Table 5: Trends and situation of ONNs annual implementation budget as per the Budget Law (in MGA)
.................................................................................................................................................................... 16
Table 6: Trends in capital acquisitions - ONN (millions ariary) - 2006-2014............................................... 18
Table 7: Achievements of the ONN (millions ariary) 2006-2013 ................................................................ 18
Table 8: Expenditures implemented by ONN (in %) 2006-2013 ................................................................. 19
Table 9: Basic operating expenses of community-based nutrition sites (in million ariary) 2006-2013 ..... 20
Table 10: Basic operating expenses of community-based nutrition sites (in%) 2006-2013 ....................... 21
Table 11: ACNs compensation relative to ONNs expenditures implemented (in million ariary) - 20062013 ............................................................................................................................................................ 21
Table 12: ACNs compensation relative to ONNs expenditures implemented (in%) - 2006-2013 ............ 21
Table 13: Sampling ...................................................................................................................................... 23
Table 14: Comparison of structures and community-based nutrition activities ........................................ 24
Table 15: Earmarked funds and their use by the Boeny ORN - 2012-2014 ................................................ 28
Table 16: Region of Amoron'i Mania - Funding sources - 2012-2014......................................................... 29
Table 17: Earmarked funds in 2014 and use by the Amoron'i Mania ORN ................................................ 30
Table 18: Underweight rate ........................................................................................................................ 32
Table 19: Underweight rates ...................................................................................................................... 33
Table 20: Activities carried out as reported by the ACNs surveyed ........................................................... 35
Table 21: Other indicators of the functioning of sites ................................................................................ 37
Table 22: Changes in the site functioning indicators .................................................................................. 38
Table 23: Status of ACNs compensation payment..................................................................................... 38
Table 24: Support from communities to ACNs ........................................................................................... 39
Table 25: ACNs other sources of income ................................................................................................... 39
Table 26: Comparison of the funding implementation process ................................................................. 40
Table 27: Analysis of strengths and weaknesses of the financial framework ............................................ 41
List of Figures
Figure 1: Trends and situation of ONNs annual implementation budget as per the Budget Law ............. 17
Figure 2: Expenditures implemented by ONN - 2006-2013 ........................................................................ 20
Figure 3: ACNs compensation relative to ONNs expenditures implemented .......................................... 22
Figure 4: Earmarked funds and use by the Boeny ORN - 2012-2014 ......................................................... 29
Figure 5: Region Amoron'i Mania - Funding sources 2012-2014 ................................................................ 30
Figure 6: Earmarked funds in 2014 and use by the Amoron'i Mania ORN ................................................. 31
Figure 7: Region of Boeny - Monthly changes in the underweight rates from 2012 to 2014 .................... 32
Figure 8: Region of Boeny Changes in the underweight rates - 2012-2014 ............................................ 33
Figure 9: Region of Amoron'i Mania: Monthly changes in the underweight rate - 2012-2014.................. 34
Figure 10: Region of Amoron'i Mania: Changes in the underweight rate - 2012 to 2014 .......................... 34
Figure 11: Comparison of the activities carried out as reported by ACNs.................................................. 36
Figure 12: Functioning of sites in the two regions in 2014 ......................................................................... 37
Figure 13: Support to ACNs for the implementation of activities .............................................................. 39

Figure 14: ACNs other sources of income for their personal needs and the needs of their dependents . 40
Executive Summary
The case study on community-based nutrition sites was conducted to feed into the nutrition sector public
expenditure review with multiple goals:
Compare the effectiveness and functioning of community-based nutrition sites in two regions: one
of the regions, namely Boeny, receives no external funding but relies fully on the National Nutrition
Offices (ONN) internal resources (RPI) whereas the other, namely Amoroni 'Mania, benefits from
external funding through the PAUSENS project.
- Describe funding mechanisms for community-based nutrition sites and community-based nutrition
workers (ACNs), including the various funding steps and identify/quantify delays and bottlenecks at
various points in the process, and their consequences for NGOs and ACNs, namely in terms of late
payments.
- Determine whether the National Community-based Nutrition Programs current funding strategies
(internal/external/communities) are sustainable and effective.
- Analyze the strengths and weaknesses of the current funding framework.
- Suggest recommendations on practices to improve existing mechanisms to reduce payment delays
and to improve the predictability and sustainability of funding for the community-based nutrition
program.
These issues are addressed in the reports second part. The first part reviews the overall funding of
nutrition, taking into account the documents produced in previous studies on the sector, as well as
financial information provided by the sectors main public implementing agency, i.e. ONN.
The nutrition sector is a complex one as malnutrition reflects a set of multisectoral and multidisciplinary
determinants involved at different levels of society. Nutritional status is the result of immediate factors,
including proper diet and good health that are dependent on intertwined underlying factors such as care
for children and women within the family, economic and food security at the household level, and access
to health services, drinking water and a healthy environment. These underlying factors are in turn based
on deep factors, namely availability and control of potential human, economic and organizational
resources, and political, cultural, social and economic structures. Finally, the populations level of literacy
and education enables their use of information and resources available to improve their nutritional
status.1
Several sectors and actors are involved in the nutrition sector, including but not limited to the ministries
and partners of Health, Education, Agriculture, and the National Nutrition Office of Nutrition that reports
to the Prime Ministers Office.
Needless to say, this case study is limited in scope and looks into a limited part of the nutrition landscape.
The previous Public Expenditure Review (PER) in 2007 highlighted successes in nutritional prevention
activities in Madagascar from 2000 to 2006. Indeed, the implementation of a nutrition support program
has allowed for curbing the negative trends in underweight rates (UWR) in beneficiary regions and sites.
The proven program included a community-based nutrition component. The 2007 review also showed
that the shares of the National Nutrition Office and the Nutrition Unit (SNUT) in total expenditure in 2006
accounted for 81% of total public expenditure on nutrition.
National Nutrition and National Action Plan for Nutrition Policy.2004
ONN is the body in charge of ensuring overall technical coordination and monitoring of the
implementation of nutrition-related actions in the country and consolidating information from reports
prepared by its regional branches (Regional Nutrition Office) in the countrys 22 regions .
Taking as an assumption that current situation remains as in 2006, namely that over 80% of public
expenditure in the nutrition sector are managed by ONN and DSMER at the Ministry of Health, the first
part of this report provides data and information that complement the investigative work initiated by the
2014 PER team on the nutrition sector, reviewing resources available to ONN from 2006 to 2014 and the
allocation of resources.
National Nutrition Action Plan (PNAN II)
The PNAN II was developed for the 2012- 2015 period by a multidisciplinary team involving government
actors, NGOs and multilateral and bilateral partners. It provides a common framework of results to
achieve in malnutrition control as well as a framework for the development of sectoral action plans. The
PNAN II is built around five strategic focuses: malnutrition prevention; food and nutritional security of
vulnerable groups; malnutrition case management; emergency/rehabilitation for the malnutrition risk
reduction; and coordination and improving the enabling environment for the nutrition sector.
The PNAN IIs implementation budget was initially estimated at USD 137,951,692 though funding sources
are not clearly identified.
ONNs budgetary resources
The budget for nutrition (exclusive of IDA or World Bank funding) had been increasing from 2006 to 2009,
namely from MGA 12,855 million to MGA 19,904 million. However, it sharply decreased from 2010 to
2014, from MGA 23,851.5 million to MGA 6,528 million. In addition, the disbursement rate was
insignificant at only 0.33% in 2010, and still fairly low at 14.32% of a budget that was already limited in
2014.
The 2007 PER pointed out that the priority that should have been given to the activities described in the
annual work program activities (PTA) prepared by the ONN on the basis of the allocation entered in the
Finance Act was not always effective, due to issues of consistency between the activities in the annual
work plan and the availability of funds. This issue was even more acute during the 2010-2014 period, and
the non-availability of funds trickled down to the implementation of community-based nutrition programs
in the regions.
Review of ONNs expenditure
From 2006 to 2013, ONNs actual expenditures went from MGA 18,261. 8 million to MGA 8,707.8 million,
exclusive of capital expenditures that went from MGA 1264, 16 million to MGA 0.66 million over the same
period. The operating costs of sites, including steering of regions and expansion to new sites over the
same period, decreased from MGA 11,149.2 million to MGA 4,201.9 million, which corresponds only to
438.3% of the total expenditures in 2013. Moreover, expenditures for ACNs compensation no longer
appeared in the list of expenditures in 2013, thus accounting for 0% of ONNs expenditure.
Over this period, it became even more difficult to plan for activities as ONN had no guarantee as to the
timing of payment and the amount of cash theoretically available, as was the case in 2006, reflecting an
issue of lack of predictability as to when funds allocated to ONN can be available, particularly for the
functioning of community-based nutrition sites, which include ACNs compensation.
Comparative study of community sites in two regions differing by the availability of external
financial support
We selected two regions that differ in terms of funding of community-based nutrition sites: communitybased nutrition sites in the region Amoroni Mania funded under the World Bank-funded PAUSENS Project
and community-based nutrition sites in the Boeny region funded entirely by ONNs internal resources
(without external support credit).
To collect data from each of the two regions ORN, we visited the regional capitals to gather documents
and reports and to conduct interviews with Regional Coordinators (RC), the administrative and financial
officers (AFO) and the officers of the community-based nutrition program (C-PNNC). In addition, we
conducted focus groups with NGO leaders and program managers as well as with ORNs monitoring staff.
Furthermore, a questionnaire translated into Malagasy was administered to a sample of community
nutrition workers (ACNs) in both regions.
To compare the results of the Amoroni Mania and Boeny regions, we applied LQAS (Lot Quality Assurance
Sampling): we selected 25 community sites in both regions from the list of existing community sites. The
list of 25 sites selected in each region was submitted to their respective ORN that then grouped the ACNs
in charge of the sites to participate in the questionnaire.
Site visits
The collection of information from ORNs was supplemented by visits to two community-based nutrition
sites in each of the two regions. The sites were chosen by the community-based nutrition program officers
at the ORN, taking into account the time limitation for the field visits. The aim of the visits was mainly to
have a first-hand understanding of the sites functioning and also to exchange with community
representatives. The visits allowed us to see the conditions at the sites, to interact with ACNs, to review
the contents of registers and to assess the tools used by ACNs. Finally, we observed education sessions
for target groups (mothers with babies) and weighing sessions.
The activities that community sites are supposed to perform vary according to targets age groups but
include in general hygiene and health education sessions, growth monitoring by weighing or MUAC
measurement, counseling, and nutrition education illustrated with cooking demos.
We observed these activities during our visits to two sites in Amoroni Mania, except for the cooking
demos. Unfortunately, we were not able to observe any of these activities in the sites in Boeny as we
came on days where the sites were not open. However, we checked through the ACNs register that the
sites had been active in a recent past.
Difference in terms of funding between the Boeny and the Amoron'i Mania ORNs
The review of data on funding allocated to the ORNs showed a sharp fall for the Boeny ORN that is funded
solely through internal resources. The amount of funding for community-based nutrition activities
decreased from nearly MGA 120 million in 2012 to less than MGA 15 million in 2014.
In contrast, the Amoroni Mania ORN benefited from a very significant increase in funding for its
community-based nutrition program in the 2012-2014 period, from MGA 60 million to MGA 500 million,
thanks to funding from external sources, namely the PMPS II and PAUSENS projects.
Effects of funding:
The comparison of the activities described in the two regions yielded the following findings:
- For the Amoroni Mania ORN (benefiting enjoys external support): the community-based nutrition
sites activities are more intensive and varied, and the ACNs workload is heavy and steady. The
activities conducted by ACNs are in line with the community-based nutrition sites package of
activities: hygiene and nutrition education, child growth monitoring according to age groups,
counseling and cooking demos, home visits, annual census, home visits for Food Rationing
Counseling (FRC) for customized follow-up of malnourished children (since 2014), promotion of
vegetable garden activities in the context of household food security, support to food provision
activities under the school nutrition component in collaboration with the Education and Health
components of the PAUSENS project. Seventeen (17) NGOs are currently working with the Amoroni
Mania ORN.
- For the Boeny ORN (operating only on internal funds): the activities are also in line with the
community-based nutrition sites package of activities as defined previously and included the
following: nutrition education, growth monitoring by weighing, counseling, cooking demos, home
visits, identification of newborns and children. The low number of NGOs working (three or four))
implies that the activities of community-based nutrition sites are slow, with the involvement of the
weakness of supervision, control and monitoring of ACNs activities and activity reports from these
sites.
UWR trends:
UWR is the indicator most commonly used at the ONN for all its community-based nutrition sites in all
regions of Madagascar.
In the areas under the Boeny ORNs supervision, the UWR has increased from 12% in 2012 to over 20% in
2014 on average across all sites in the region. Trends in malnutrition are poor, and the rates are about to
exceed the 20% threshold set by the ONN for its regions.
As such, it appears that due to the lack of adequate internal funding, the program could not be effective
as reflected by the value of this indicator.
In the case of the Amoroni Mania ORN, UWR followed a downward trend from 16% in 2012 to 12% in
2013, but then an upward trend to 18% in 2014, accounting probably for the increase in the average UWR
in the medium term over the 2012 to 2014 period, though the rates remained below 18%. Detailed
explanations of this trend in 2014 were provided by program implementers and presented in annexes. In
summary, they point to that fact that the project's impact is still to be measured in the coming years. From
our point of view at this point in time, the trend may be due to the addition of 81 new sites that became
operational by December 2013, pulling upward the regional average UWR for Amoroni Mania sites in
2014. Indeed, the number of sites in the region of Amoroni Mania increased from 249 to 330 in 2013,
with the expansion of PNNC program to 81 new sites.
ACNs activities
Speaking about the package of activities set for ACNs, survey results showed that almost all ACNs in the
two regions performed growth monitoring for children under two; almost all ACNs in Amoroni Mania
ensured nutritional education for mothers and 90% of the ACNs in the Boeny region ensured nutrition
education for mothers. Similarly, almost all ACNs in the two regions conducted home visits.
Only half of the ACNs in Boeny conducted cooking demos, which however is a real feat as they did not
benefit from any funding to conduct this type of activity. ACNs indicated that they provide on their own
ingredients for the cooking demos, with mothers contributing in some cases. They also reported that
cooking demos are the most popular activity among mothers of children and constitute an incentive to
attend weighing and nutritional education sessions. Moreover, almost all ACNs in Boeny made a visit to a
basic health center (CSB), usually located in the communes capital. From our point of view, ongoing
collaboration with the public health facilities can be a source of monetary or non-monetary motivation
for the ACNs in Boeny who are looking to maintain their motivation in this function in a context of internal
funding failure. ACNs indicated that they were called to work with the CSB during expanded maternal and
child health campaigns, usually held twice a year, and that they receive financial incentives for their
support at these times.
In terms of operations from 2012 to 2014, the number of sites in the Boeny region reporting activities
clearly declined. This situation is due to a number of reasons: on ACNs side, there are cases of strikes
(such as one that concerns all ACNs in an entire commune), resignations resulting in vacancies that the
community could not fill; others say they do not have the means to make reports; but there is also a failure
in monitoring/supervision of their activities, or a lack of tools to record and report activities. The decrease
in the number of sites operational in the Boeny region is also the consequence of the failure of internal
funding. Indeed, it is reported that when funding fails, the functioning of sites is rapidly impacted.
Payment of ACNs allowances
Historically, ACNs received monthly allowances amounting to about MGA 50,000. It happened during
critical periods when funding lacked that the compensation was not paid, but later on arrears were
settled, at least in part (for instance, there were 6 months of arrears of allowances paid in 2002). It seems
that ACNs in Boeny continue to work in the hope of such settlement of arrears. Similarly, NGOs also hope
to benefit from a settlement of payment due to their program managers and animators based on
contracts entered between the NGOs and ORN.
The last time ACNs in Boeny were paid was in February 2014: they received a one-month allowance (plus
MGA 10,000 for a one-month cooking demo allowance), corresponding to arrears dating back to January
2013. In other words, ACNs in Boeny have not received compensation for 23 months.
ACNs in Amoroni Mania received their allowances for November 2014 in mid-December 2014, possibly
plus performance bonuses under their performance-based contracts (PBC).
Payment deadlines
As of February 2014, the payment deadline for the ACNs in Boeny was about one week after the
notification of their NGOs by ORNs Administrative and Financial Officer (AFO).
In Amoroni Mania, allowances for ACNs were received between the 12th and 20th days of the following
month. This delay is due to due to disbursement procedures.
ACNs resources /community support
Knowing that internal funding cannot ensure the payment of ACNs allowances, we were led to wonder
whether communities are the ones to take charge of ACNs. However, the surveys showed that ACNs in
Boeny did not receive any support from the community. Our findings also show that there is almost no
community support to ACNs in running the community-based nutrition sites.
In the case of ACNs in Amoroni Mania, the support reported consisted most often in the provision of
premises to host the sites or plots for vegetable garden sites.
This form of support also existed in Boeny during the initial installation of ACNs.
Other sources of income for ACNs include agriculture and livestock, and in parallel, 40% of the ACNs in
Boeny are involved in small trade. About 15% in Boeny and Amoroni Mania are involved in waged work.
Strengths and weaknesses of the funding frameworks in terms of effectiveness and sustainability
prospects
Internal funding:
ACNs in Boeny started feeling the impact of the lack of funding in early 2013 and had to pay from their
own resources the cooking demo costs. In this context, the bottleneck is not linked to the ORNs
settlement procedures but to the fact the funding for community sites activities is not prioritized, a
decision that is made at the central level. Indeed, ONNs central level is the one to decide, based on
availability, how much funding is to be allocated to ORNs and for which expenditure items. On its side,
ONN is subject to budget and cash availability restrictions after communicating its workplan funding
priorities to the Ministry of Finance and obtains only a portion of its funding requests.
As a result of internal funding failure on the medium term at the field level, ACNs have started giving up
cooking demo activities though it was acknowledged as the most attractive activity for target groups and
ORNs monitoring and supervision activities have been reduced, leading to less reliability and availability
of activity reports.
If internal funding is not ensured in the longer run, the number of operational ACNs will dwindle to a
worrying level over the next few years given the number of ACNs who already resigned from 2012 to 2014
and the difficulty of finding their replacements among communities.
External funding:
External funding is efficient and increases quality, integration and scope of activities.
However, ACNs workload is high, and these workers are discouraged from having other activities such as
community health workers or otherwise, which increases their dependence on external funding. From
what we have seen as regards funding, there has not yet been work done to establish those factors that
would ensure the sustainability of community-based nutrition sites operations. For example, there is a
need to investigate what would enable ACNs and communities to become less reliant on external funding
to continue operating: ACNs may need to have other sources of income beyond their monthly allowances
as ACNs but this would mean that they would have to divide their time between their work as ACNs and
other activities that would ensure their livelihood and resources for cooking demos.
Community funding
ACNs are elected by and live in their communities. They benefit from high social status and recognition.
However, there is no evidence so far that communities (Fokonolona, Fokontany or Communes) support
the functioning/survival of community-based nutrition sites beyond providing premises and land plots.
Madagascar has a National Community Health Policy (NCHP), established in 2009 under the leadership of
the Ministry of Health that defines the community level as an extension of the health system. This level
makes use of resource persons from the community, commonly called "community workers" (AC), to
provide services in the form of packages of activities whose effectiveness has been proven for the
communities welfare. Community workers activities include improving family practices in health and
welfare, nutrition, hygiene through group sensitization, interpersonal communication, and home visits.
Community workers are the centerpiece of community involvement, the national policy setting forth the
principle of community participation and defining it as active participation on the social, technical, and
financial aspects to the success and sustainability of health interventions targeting community members.
An implementation guide associated with the NCHP was developed in 2013 after health committees at
the fokontany and commune level were formalized through regulations in 2009. The guide offers a range
of financial and non-financial incentives for ACs, taking into account the diversity of program partners
while providing for some harmonization mechanisms to implement. However, it has not clearly defined
the practical application of in-kind or financial participation for the functioning of community-based
nutrition sites. The NCHP states that one thing remains to be put in place for the actual implementation
of this policy that directly affects the lives of people by ensuring their well-being, namely the effectiveness
of an efficient and sustainable steering with satisfactory mobilization of all resources required.
As it came out of field interviews, communities do not currently have the structure or the means required
to take over the running of community sites. There is still a needed to devise an agreed scheme for
communities to be in charge of the implementation of the NCHP, would it be only in part, and partners of
the community health sector, communities and central and decentralized institutions are to be involved
in this discussion. In practical terms, application remains to be piloted in our regions.
Practical recommendations for improving the predictability and sustainability of funding for sites
taking into account the local context

It seems that bottlenecks in the payment of ACNs compensation do not lie in the procedures governing
the pipeline from ONN to ORN, then to NGOs and to ACNs. Rather, the problem results from the drastic
cuts in internal funding available and the decision or lack of decision to prioritize the activities of
community-based nutrition sites. The first solution to ensure sustainability would then be to make the
right decision at the central level. The other solution would be to adapt minimal costs that can be
considered and sustained to improve the viability of community-based nutrition sites.
Minimal costs:
According to the contract agreed between the ONN/ORN and an implementing NGO2, the annual amount
proposed by the NGO to oversee 40 community-based nutrition sites in Boeny amounts to MGA
41,507,200 for 40 sites, i.e. an annual average cost per site of 1,037,680. This includes the compensation
for the various workers (including ACNs), the costs of management and supervision, and the cost of
cooking demo activities. When this cost is divided by the number of 200 children supervised per site, the
annual cost per child is estimated at MGA 5,188. The costs of key tools such as registers and cards are to
be added to these costs.
It is necessary to work based on minimal funding to maintain the activities of community-based nutrition
sites and to avoid a deterioration of nutrition indicators in regions that do not benefit from external
support.
Program steering, supervision and extension:
The third solution would be to review, restructure or rebalance the organization of these functions and
the associated costs as part of the thinking on the sustainability of community-based nutrition sites
activities, given the scarcity of funding for some regions. Needless to say, the design will have to be based
on an assessment of the local organization to allow for jointly developing a needs-tailored management
and supervision structure for activities and coordination in keeping with the financial resources available.
A copy of the contract is annexed to this report.
10
Part 1: Overall Funding of Nutrition

1. Definition of nutrition
As an introduction of this report, the definition of nutrition in the 2007 Public Expenditure Review is
reminded.
Nutrition and food security
Nutrition encompasses all processes involved in the absorption and utilization of food substances that
allow for the development, repair and maintenance of activities of the body or any part thereof. The
nutritional status of each household member is dependent on the availability of products, quality of food,
and health status of household members.
Malnutrition is the result of the lack of food (in terms of quantity and quality) and diseases. There is a
cycle relationship between malnutrition and diseases: malnutrition exacerbates diseases while diseases
aggravate malnutrition. Cognitive functions are also impaired by malnutrition, which often compromises
childrens education and future productivity.
There are several levels of malnutrition: protein and calorie malnutrition is the first form of malnutrition
and its seriousness can be assessed by the level of stunting, wasting (or leanness) and underweight.
Stunting is characterized by low height for age in a child and is an indicator of chronic malnutrition.
It usually results from inadequate nutrition and/or diseases that occurred repeatedly over fairly long
periods of time.
- Wasting or leanness reflects the current nutritional status and may be strongly influenced by the
season or various crises. Wasting is measured as a ratio between the childs weight and height.
- Underweight or undernutrition is characterized by low weight for age and can result both from
wasting and stunting.
As such, underweight is used as a key monitoring indicator by many nutrition programs.
Micronutrient deficiencies, particularly vitamin A, iron and iodine deficiencies also characterize
malnutrition. They often results from unbalanced diet, but may also result from disease or infection. They
significantly increase the risk of mortality and morbidity.
While the confusion between nutrition and diet is widespread, there is also a tendency to limit the
causes of malnutrition to food insecurity only. Yet, the causes of malnutrition are multiple and
multisectoral, some acting directly, others indirectly. The underlying causes of malnutrition are (i)
inadequate care and inappropriate feeding habits, (ii) inadequate access to health services and unhealthy
environment, as well as (iii) food insecurity at the household level.
Food security refers to the populations ability to access food in sufficient quantity to cover their
physiological needs, lead an active life, and be healthy. At the household level, food security is defined by
the ability to obtain an adequate amount of healthy and diverse food throughout the year to cover the
dietary needs of all family members, either from individual production or through purchases. A person
can be malnourished even in context of adequate food supply and adequate access to food, for example
when he/she eats an unbalanced diet, or because of diseases or various infections.
2. Reminder of the trends and conclusions highlighted in the 2007 PER

The review of nutrition public expenditure over the 2000-2006 period under the 2007 PER report
highlighted the following key information:
11
Successes in preventing malnutrition from 2000 to 2006: the negative trends in malnutrition were
reversed with the annual rates of underweight decreasing in the regions and sites beneficiaries of
the nutrition support program. This effective program included a community-based nutrition
component.
- Share of prevention in the funding of nutrition: 70% of total expenditures implemented in 2005 went
to prevention programs, namely the community-based nutrition program and the school nutrition
and feeding programs.
- ONN's share of spending in 2006: about 81% of total public expenditure on nutrition programs were
allocated to ONN and the Nutrition Service (SNUT).
- Issues of availability of analytical data at the Ministry of Finance (PFMIS): it was difficult to get an
accurate picture of the Governments financial commitment to the nutrition sector in Madagascar.
The review of expenditure on nutrition stumbled upon the lack of data from the Ministry and Finance
and Budgets information system. For instance, (i) nutrition expenditure is classified as capital
expenditure due to weaknesses in the functional classification, (ii) the analysis of expenditures by
category does not allow for a detailed review of expenditures on nutrition activities, such as
identifying whether there was a greater use of micronutrients or a nutritional emergency).
- Trends highlighted by the 2007 PER for years running from 2008 to 2011: over the 2000-2005 period,
the World Bank, the World Food Program (WFP) and UNICEF were the nutrition sectors main donors,
contributing to more than 90% of all allocations. However, the decline in the level of internal
resources allocated in 2006 compared to 2005 combined with reduced contributions from donors
(especially the World Bank) raised the issue of the sectors funding sustainability although ONN
benefited from additional credit from the World Bank in 2007-2008.
ONN has three funding sources, namely (i) external funding, including from the World Bank and the World
Food Program (WFP), in support of community-based nutrition activities, (ii) funds from the Heavily
Indebted Poor Countries (HIPC) initiative that funds the Nutritional Prevention and Security program and
(iii) internal resources supporting the operation of community-based nutrition sites and other activities of
ONN. Since 2004, about 52% of ONN/PNNC Seecalines total budget is financed with Governments
internal resources. The supplemental credit granted by the World Bank in the amount of USD 10 million
is expected to support the process of institutionalizing and regionalizing nutrition, communication
activities, and capacity building and the operation of the PNNC/SEECALINE operational unit. The NGOs
and operation of community-based nutrition sites are expected to be financed with internal resources.
Prevention programs such as the community-based nutrition, school nutrition or micronutrients
fortification programs rank among priority strategies. The cost for the implementation of these programs
nationwide is estimated at USD 99 million for 2007-2011. Food security activities are also budgeted at
about USD 29.1 million for the 2007-2011 period. Given the leading position ONN has in the funding of
nutrition-related activities and the governments commitment to fund all the activities of ONN starting in
2009, it was unlikely that an additional substantial funding in the range of USD 30 to 44 million could be
mobilized from donors in the years beyond 2008.
PNANs funding sources (2005- 2009) at the time were not yet clarified.
3. Interim findings of the PER 2014 Team on nutrition

The team responsible for the 2014 Public Expenditure Review (PER) collected information from the Public
Finance Management Information System (PFMIS) on nutrition public expenditure. Table 1 shows data for
the 2009- 2013 period:
12
Table 1: Expenditure budgeted and implemented for nutrition and food security, 2009- 2013
Budgeted
Implemented
Budgeted
Implemented
Budgeted
Implemented
2013
Implemented
2012
Budgeted
2011
Implemented
2010
Budgeted
2009
31100
10544
9469
78
36880
16800
29270
11270
4700
4700
18600
1505
4300
18000
16000
11000
11000
4700
4700
60%
14%
45%
49%
95%
38%
98%
100%
100%
Of which transfers (%)
100%
100%
100%
100%
100%
100%
100%
100%
100%
Investment program (PIP)
12500
9039
5169
78
18880
800
18270
270
40%
86%
34%
12%
34%
5%
39%
2%
100%
100%
4%
100%
4%
100%
1%
100%
5601
581
18334
564
18067
244
8205
204
Budgeted=Amended credit;
Implemented= Liquidated amount
ONN - PNNC (Million Ar)
Operational Expenditures (excl. salaries)
In percent of ONN-PNNC
In percent of ONN-PNNC
Of which, internally financed
FID IV (Million Ar)
Investment program (PIP)
Investment program in %
Of which, Internally financed
Total in Million Ar
31100
10544
5601
581
18334
564
18067
244
8205
204
100%
100%
100%
100%
100%
100%
100%
100%
11%
100%
2%
37%
1%
63%
3%
17%
15070
659
55214
17364
47337
11514
12905
4904
Source: MFB, PFMIS
Table 2 shows the expenditure on nutrition implemented by the Ministry of Health as part of the maternal
and child health program.
Table 2: Expenditures implemented by the Ministry of Health on its nutrition program
Total MoH expenditures (Mission=health) in Million Ar

Expenditures in the MCH program in million Ar
MCH expenditures related to nutrition programs in million Ar
Expenditures related to nutrition programs in % of MCH expenditures
2009
2010
2011
2012
2013
158195
121937
156807
145414
157687
2719
2083
3153
4856
7663
111
101
123
98
21
4.07%
4.86%
3.90%
2.01%
0.27%
Source: MoF, PFMIS
These tables show how the nutrition budget is structured in the public finance information system:
nutrition does not appear as a separate item in the expenditures reported in the PFMIS. This is one of the
main challenges faced by the 2014 PER team when they wanted to collect data on nutrition, and in
particular to determine the distribution between the payroll and other expenses lines which would have
been useful to know, for instance, the budget and actual expenditures on the item of compensation for
the 5,500 community-based nutrition agents (ACNs) who manage a same number of community-based
nutrition sites throughout the country.
This challenge associated with the information system was already mentioned in the review and
recommendations of the 2007 PER, which stated:
13
The analysis of public expenditure on nutrition is limited due to insufficient information. Data from the
MEFB information system are limited as the system contains only data on the budget and its
implementation and does not include all the external aid in support of projects. Identification of nutrition
expenditure is limited to capital expenditure data (and is based on the conventions listed in the Budget
Law). Furthermore, the functional classification does not consider nutrition as a specific sector and
expenditure data in the conventions do not allow for a detailed analysis of expenditure by type of nutrition
activities, namely fortification with micronutrients, nutritional emergencies or training of senior nutrition
technicians.
Associated recommendation under the 2007 PER:
Establish mechanisms for monitoring the sector, including by adapting the functional classification to
provide improved and detailed accounting of nutrition expenditures. The functional classification
currently used does not allow for identifying the various activities in the area of nutrition. Given that
nutrition is a priority sector for the Government, it is important to improve the integration of nutrition in
budget monitoring. Better monitoring will allow for: (i) identifying expenditures on nutrition-related
budget and (ii) collecting data so as to make comparison with other sectors.
Tables 1 and 2 also highlight significant differences between the amounts budgeted and the amounts
implemented. From 2009 to 2013, budget cuts were due to the significant cuts in external funding as well
as domestic budgetary constraints (less public funds available over the years). As a result, requests for
funding allocation (to the Ministry of Finance) for ONNs activities were less prioritized.
4. The National Nutrition Action Plan (PNAN II) 2012- 2015

Madagascar has adopted a National Nutrition Policy (2005-2015) through the governmental Decree No.
2004-496 dated on 20 April 2004. The policys objectives is first to ensure the Malagasy populations right
to adequate nutrition in order to improve childrens survival and full development of their physical and
intellectual potentialities; and second, to promote the health and well-being of mothers and adults. The
National Policy was translated into National Nutrition Action Plans (PNAN), namely PNAN I (2005-2009)
followed by PNAN II (2012-2015). The implementation of PNAN I, hampered by the political and
socioeconomic crisis that started in 2009, was extended until 2011.
PNAN II was developed by a multidisciplinary team involving government actors, NGOs and multilateral
and bilateral partners. It provides a common framework of results to achieve in malnutrition control as
well as a framework for the development of sectoral action plans. PNAN II aims to reduce the prevalence
of underweight and acute malnutrition among children under 5; to reduce the prevalence of low birth
weight; to increase the rate of exclusive breastfeeding until 6 months; and to reduce the proportion of
people living in food insecurity. PNAN II is built around five strategic focuses: malnutrition prevention;
food and nutritional security for vulnerable groups; malnutrition case management;
emergency/rehabilitation for malnutrition risk reduction; and coordination and improving the enabling
environment for the nutrition sector.
The budget for the implementation of PNAN II was initially estimated at USD 692,137,951.
14
Table 3: Estimated budget for the PNAN II, (in USD)

STRATEGIES
MALNUTRITION
PREVENTION
FOOD SECURITY
MALNUTRITION CASE
MANAGEMENT
EMERGENCY,
REHABILITATION AND
DEVELOPMENT
COORDINATION
TOTAL
2012
2013
2014
2015
TOTAL
17394
17458
15713
18158
68722
5242
7711
10686
13496
37135
3868
4401
4937
9930
23136
1101
1131
1226
1269
4727
868
771
1334
1257
4230
28473
31472
33896
44109
137952
Source: ONN
This budget table for the implementation of PNAN has the benefit of existing though the funding sources
are not clearly identified. As for the previous PNAN I (2005-2009), with its 14 strategies, there was no
estimate of the funding needed to implement the program.
Results under strategic focus # 1: malnutrition prevention in 2012
Table 4 shows indicators, baselines, targets and levels of expenditures implemented under strategic
focus 1 of PNAN2 in 2012.
Table 4 : Extract from the 2012 PNAN II implementation report
Indicator
Underweight prevalence in children under
5 years at community sites
Underweight prevalence in children under
2 years at community sites
Number of children aged 6 to 59 months
who received vitamin A supplementation
during MCHW
Percentage of children 12 to 59 months
dewormed
Percentage of pregnant women
dewormed (routine and MCHW)
Percentage of children of school age (6-14
years) dewormed
Baseline data
Value
Year
Objectives
2015
2012
Implementation
2012
19.70%
2011
19%
18.7%
18.47%
2011
18%
18.50%
3279000
2011
95.00%
2011
95.00%
95%
95%
49.70%
2011
60%
45%
48%
53.00%
2010
70%
57%
17%
Number of functional PNAN schools
1670
2012
4730
2210
2218
Drinking water access rate
36.48
2004
65%
54.80%
47.00%
Utilization rate of latrines
53%
2004
72.00%
70%
46%
3464152
Source: ONN
15
The National Nutrition Office, which ensures overall technical coordination and monitoring of the
implementation of nutrition actions in the country, collects some of this information from the reports
prepared by the Regional Nutrition Offices based in the 22 regions.
Interestingly, this allows for obtaining, through the ORNs, data on 22 regions, including information on
the growth monitoring of children seen at community-based nutrition sites in the regions.
A quick look at Table 4 shows good performance as regards child growth indicators at community-based
nutrition sites but poorer performance when it comes to children deworming targets.
However, with the current understanding of the determinants of malnutrition, the 22 ORN regions should
not be the only source of data. Other sources include actors in the sectors of health, food security and
WASH.
5. Analysis of budgetary resources to finance nutrition

Table 5 shows the evolution of budgetary resources from 2005 to 2014, as well as disbursement rates.
Table 5: Trends and situation of ONNs annual implementation budget as per the Budget Law (in MGA)
IMPLEMENTATION BUDGET EXECUTION AS PER THE BUDGET LAW
INTERNAL
RESOURCES AS
PER BUDGET LAW
Year
2005
28,303,838,400
2006
835,5863,000
2007
1,098,5190,000
2008
1,332,4343,000
2009
1,990,4000,000
2010
2,385,1561,000
2011
1,905,7296,000
2012
1,627,2906,000
2013
1,479,2110,000
2014
652,8089,000
TOTAL
161,375,196,400
IDA
TOTAL
CREDIT
DISBURSEMENT
ALLOCATED
(IDA not
included)
(IDA not included)
HIPC
DISBURSEMENT
RATE
(INTERNAL
RESOURCES
28,300,3838,400
2,830,3838,400
100.00%
4,500,000,000
1,285,5863,000
1,285,5863,000
100.00%
892,950,0000
4,500,000,000
1,548,5190,000
1,548,5190,000
100.00%
8,000,000,000
3,172,387,000
1,649,6730,000
1,649,6730,000
100.00%
1,990,4000,000
1,809,1265,000
90.89%
601,851,000
2,385,1561,000
7,7600,000
0.33%
6,936,645,000
1,905,7296,000
1,086,9,808,,076
57.04%
16,27,2906,,000
11193,054,955
68.78%
4,186,330,442
1,479,2110,000
4651,155,000
31.44%
10,007,619,388
652,8089,000
934,901,161
14.32%
173,547,583,400
1,189,5940,5592
68.55%
38,661,945,830
1,217,2387,000
Source: ONN
16
Figure 1 reflects the changes in the amounts over time.

Figure 1: Trends and situation of ONNs annual implementation budget as per the Budget Law
The 2007 PER provided a detailed review of the budget allocated and programs implemented from 2005
to 2007 as well as funding trends from 2008 and the foreseeable funding difficulties beyond 2011.
Figure 1 shows that the budget for nutrition increased from 2006 to 2010, which was followed by a drastic
decrease from 2010 to 2014. Table 5 shows that the disbursement rate was ridiculously low in 2010 and
remained very low compared to budget that is itself small in 2014.
The low disbursement rates observed from 2010 to 2014 reflect the fact that though ONN planned its
resource requirements to carry out the programs defined in its Annual Work Plans, the financial resources
for such programs were not available at the Ministry of Finance.
The 2007 PER pointed out that the priority that should have been given to the activities described in the
annual work program activities (PTA) prepared by the ONN on the basis of the allocation entered in the
Finance Act was not always effective, due to issues of consistency between the activities in the annual
work plan and the availability of funds. This issue was even more acute during the 2010-2014 period, and
the non-availability of funds trickled down to the implementation of community-based nutrition programs
in the regions.
6. Review of ONNs expenditure

Acquisition of fixed assets
Table 6 shows the changes in the amounts used from 2006 to 2014 for the acquisition of fixed assets at
ONN, per sources of funding.
It should be noted that since 2004, since the program budget system (as opposed to the input-based
budgets used in the past) was adopted for public budget implementation, donor funding (World Bank,
European Union, etc.) has been deposited in the Governments pooled account at the Central Bank and
considered by the Budget Law as internal resources with the relating expenditure implemented as such.
Thus, the nutrition sector funding as well as the funding of other sectors such as the environment,
17
education, etc. fell under what was called CARP (Poverty Reduction Support Credit). Funding for nutrition
was part of CARP 1 in 2004 and CARP 6 in 2009 and were recorded as internal resources.
While reading the following table, one should keep in mind that internal resources over this period (2004
to 2009) included external funding.
Table 6: Trends in capital acquisitions - ONN (millions ariary) - 2006-2014
Year
2006
2007
2008
2009
2010
2011
2012
2013
2014
Source: ONN
HIPC
124.00
377.16
46.17
RPI
1 140.15
280.93
2 361.01
150.00
7.04
7.33
6.10
0.66
0.00
9.8%
57.3%
1.9%
0.0%
0.0%
0.0%
0.0%
0.0%
0.0%
Total
90.2%
42.7%
98.1%
100.0%
100.0%
100.0%
100.0%
100.0%
100.0%
1 264.16
658.09
2 407.18
150.00
7.04
7.33
6.10
0.66
0.00
Other expenditures implemented by ONN

Table 7 shows expenditures implemented by ONN in 2006 and 2013 ONN, grouped into broad categories
of expenditure.
Table 7: Achievements of the ONN (millions ariary) 2006-2013
Year
Construction works for food security
2006
2007
2008
2009
1,464.5
1,734.2
1,477.7 2,748.9
2010
2011
2012
2013
114.7
64.5
289.1
153.8
Capacity building and monitoring &

evaluation
Communication
Inputs and equipment for sites
Other: surveys and technical
assistance
61.4
163.6
257.5
321.9
165.1
135.9
267.9
1,242.9
2 132.8
753.5
592.8
722.7 1,143.1
326.4
635.6 1,591.9 1,003.6
156.7
58.6
590.7
1.2
296.7
0.8
918.1
2,118.0
1,738.6 2,746.6 3,117.3
2,928.9 4,217.3
3 781.8
Sites operation, including steering of

regions and expansion to new sites
11,149.2
7 ,619.5
6,639.3 7,519.8 5,327.6
4,815.2 6,306.2
4 201.9
1,233.6
1,420.4
1,251.6
874.0
477.7
15.4
2.8
0.3
Nutritional emergencies/nutritional
rehabilitation centers (intensive and
ambulatory)
Equipment - FBE
Total expenditures implemented
59.3
10.5
18,261.8
Source: ONNs table on expenditures implemented
14,412.4
765.8
12,738.4 17,392.8 10,689.5
262.3
110.4
0.2
0.0
8.5
4.9
8,451.2 11,659.4
8,707.8
Table 8 shows implementation of same expenditure items from 2006 to 2013, as a percentage of total
expenditures.
18
Table 8: Expenditures implemented by ONN (in %) 2006-2013

Year
Construction works for food
security
Capacity building and monitoring
& evaluation
Communication
Inputs and equipment for sites
Other: surveys and technical
assistance
Sites operation, including
steering of regions and
expansion to new sites
Nutritional
emergencies/nutritional
rehabilitation centers (intensive
and ambulatory)
Equipment - FBE
Total expenditures
implemented
2006
2007
2008
2009
2010
2011
2012
2013
8.019%
12.033%
11,600%
15.805%
1.073%
0.763%
2.479%
1.766%
0.336%
1.135%
2.021%
4.403%
3.011%
1.953%
1.166%
3.076%
6.806%
11.679%
5.228%
4.113%
5.674%
4.989%
6.572%
9.153%
3.054%
9.389%
1.854%
0.693%
5.066%
0.010%
3,407%
0.009%
5.028%
14.695%
13.648%
15.791%
29.162%
34.656%
36.171%
43.429%
61.052%
52.867%
52.120%
43.235%
49.839%
56.977%
54.087%
48.254%
6.755%
9.855%
9.826%
5.025%
4.469%
3,104%
0.947%
0.002%
0.325%
0.073%
0.121%
0.016%
0.003%
0.000%
0.073%
0.056%
100%
100%
100%
100%
100%
100%
100%
100%
Figure 2 shows the make-up of the expenditures implemented by ONN, according to these main headings
and years.
19
Figure 2: Expenditures implemented by ONN - 2006-2013
Table 9 shows what can be considered as basic operating costs of community-based nutrition sites which
includes allowances for ACNs, the cost of cooking demos and vegetable gardens as well as headings
related to the activities of the sites, such as the provision of registers, forms, and health cards.
Table 9: Basic operating expenses of community-based nutrition sites (in million ariary) 2006-2013
Year
ACNs compensation
Cooking demos
Vegetable garden
Growth card
Register
Health card
Total
2006
4 281.82
1 328.63
0.00
11.29
40.85
212.02
5 874.6
2007
3 176.35
810.53
0.00
0.00
0.00
291.56
4 278.4
2008
2009
2010
2011
2012
2013
6 152.45 3 577.30 3 291.43 3 270.89 2 545.73
0.00
552.01
569.27
571.14
639.57
518.10 350.50
0.00
0.00
1.69
27,51
10.58
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
7.70
0.00
3.30
0.00
0.00
0.00
0.00
0.00
6 707.8 4 146.6 3 864.3 3 938.0 3 082.1 350.5
20
Table 10: Basic operating expenses of community-based nutrition sites (in%) 2006-2013
2006
Year
ACNs compensation
Cooking demos
Vegetable garden
Growth card
Register
Health card
Total
2007
72.89%
74.24%
22.62%
18.94%
0.00%
0.00%
0.19%
0.00%
0.70%
0.00%
3.61%
6.81%
100.00% 100.00%
2008
2009
2010
2011
2012
2013
91.72%
8.23%
0.00%
0.00%
0.00%
0.05%
100.00%
86.27%
13.73%
0.00%
0.00%
0.00%
0.00%
100.00%
85.18%
14.78%
0.04%
0.00%
0.00%
0.00%
100.00%
83.06%
16.24%
0.70%
0.00%
0.00%
0.00%
100.00%
82.60%
16.81%
0.34%
0.00%
0.25%
0.00%
100.00%
0.00%
100.00%
0.00%
0.00%
0.00%
0.00%
100.00%
Table 11: ACNs compensation relative to ONNs expenditures implemented (in million ariary) - 2006-
2013
2006
Year
ACNs compensation
Total of other
expenditures
implemented
Total expenditures
implemented
2007
2008
2009
2010
2011
2012
2013
4,282
3,176
6,152
3,577
3,291
3,271
2,546
13,980
11,236
6,586
13,815
7,398
5,180
9,114
8,708
18,262
14,412
12,738
17,393
10,690
8,451
11,659
8,708
Table 12: ACNs compensation relative to ONNs expenditures implemented (in %) - 2006-2013
2009
2010
2011
2012
ACNs compensation
2006
23.4%
22.0%
48.3%
20.6%
30.8%
38.7%
21.8%
0.0%
Total of other expenditures implemented
76.6%
78.0%
51.7%
79.4%
69.2%
61.3%
78.2%
100.0%
100.0%
100.0%
100.0%
100.0%
100.0%
100.0%
100.0%
100.0%
Year
2007
2008
2013
21
Figure 3: ACNs compensation relative to ONNs expenditures implemented
Over this period, it became even more difficult for ONN to plan its activities as it had no guarantee as the
amount of cash that would be made available for its operation (as seen in 2006) and the timing of such
payments. This aggravated the issue of predictability of the effective provision of funding to ONN,
especially for the operation of community-based nutrition sites, including ACNs allowances.
Part 2: Findings of the comparative case study of community-based

nutrition sites
1. Aims of the case study
The case study on community-based nutrition sites was conducted to document the nutrition sector
public expenditure review. It has several aims:
- Compare the effectiveness and functioning of community-based nutrition sites in two regions:
one of the regions, namely Boeny, receives no external funding but relies fully on the National
Nutrition Offices (ONN) internal resources (RPI) whereas the other, namely Amoroni Mania
benefits from external funding through the project PAUSENS. The comparison would allow for
identifying the effects of funding or lack of funding on the sites operation and more specifically
to answer the question: Which of the community-based nutrition sites activities are reduced or
cancelled when funding is lacking?
- Describe funding mechanisms for community-based nutrition sites and community-based
nutrition workers (ACNs), including the various funding steps and identify/quantify delays and
bottlenecks at various points in the process, and their consequences for NGOs and ACNs, namely
in terms of late payments.
- Determine whether the National Community-based nutrition programs current funding
strategies (internal/external/communities) are sustainable and effective.
22
Analyze the strengths and weaknesses of the current funding framework.

Suggest recommendations on practices to improve existing mechanisms to reduce payment
delays and to improve the predictability and sustainability of funding for the community-based
nutrition program.
2. Summary of the methodology used for collecting and processing data

Selection of the two regions based on funding characteristics
The Boeny region, representing community-based nutrition sites funded solely by internal resources and
the Amoroni Mania region representing community-based nutrition sites benefiting from external
funding were selected for the study following the recommendations of program implementing agencies
and/or donors.
Mission Plan:
The field missions terms of reference were drafted, specifying the information to be collected from the
ORNs, using an interview guide for Regional Coordinators (RC), Administrative and Financial Officers
(AFO), community-based nutrition Program Officers (C-PNNC), as well as focus groups with animators,
NGOs Program Officers (PO), ORNs monitoring staff (MS) and a questionnaire in Malagasy to be
completed a selection of ACNs.
The mission agenda was developed in consultation with the ORNs Regional Coordinators.
Method for selecting ACNs representatives
The respective lists of community-based nutrition sites and ACNs in these two regions have been
previously requested and obtained from the ONN
Table 13: Sampling
Regions
Number of
districts
Number of
communities
reached
Number of
sites
Number of
ACNs
ACNs to
select
Amoroni Mania
54
331
331
25
Boeny
28
176
176
25
Source: ONN
Lot Quality Assurance Sampling (LQAS) was used to select the community-based nutrition sites that would
represent each region in the comparative study, sampling 25 sites/ACNs per region.
Organization of the ACNs gathering
The list of sites/ACNs thus selected was sent to the ORN Coordinators via the central ONN, and they were
requested to gather ACNs in the respective regional capitals. It took half a day to administer the
questionnaire to ACNs who completed the questionnaire in Malagasy on their own after the consultant
explained each question.
23
Site visits
The information collected at the ORNs was supplemented with visits to two community-based nutrition
sites in each region. The sites to visit were selected by ORN/C-PNNC based on accessibility criteria since
the time allotted for the visits was only half-day, the goal being to get an overall picture of how well the
sites operated.
The two sites visited in Amoroni Mania (1- site of Zanaposa, Commune of Tsarasaotra, District of
Ambositra, ACN Jeannie, and 2- site of Soavina, Commune of Ilaka Centre, District of Ambositra), had
activities running at the time of our visit (cf. annex for documentation on those sites).
Both sites visited in Boeny (1 site of Ambohimandamina, Commune of Mahajanga I, ACN Augustine, 2site of Mahabibokely, Commune of Mahajanga I, ACN Charifa), were not in business on the day of our visit
(cf. annex on the activities of these sites). However, the deputy head of the fokontany of Mahabibokely
was present during our visit and was willing to discuss the contribution and expectations of the community
in relationship with community-based nutrition sites.
Entering ACNs questionnaires and data processing according to the LQAS methodology
The data from the questionnaires were entered in an Excel spreadsheet. The standards were defined in
reference either to the average of respondents' answers (e.g. the ACN's average age was calculated to be
7 years), or to objective data known (e.g. amount of ACNs compensation set at MGA 50,000). Responses
were then counted and interpreted according to the LQAS data processing tool to determine the
percentages of the responses estimated against standards.
3. Comparative analysis of the community-based nutrition sites in the regions of Boeny

regions and Amoroni Mania
3.1. Structure/description of activities:
Table 14: Comparison of structures and community-based nutrition activities
ORN
criteria
Structure/Personnel
District/community
sites
Implementing
partners NGOs
Activity package of
community-based
nutrition sites
(according to
interviews and
documents
forwarded by the
CPNNC)
Boeny
-
Amoroni Mania
5 supervision staff: RC, AFO, RAF,

PCCB, NHPR, CSR.
15 support staff
5 districts/communes reached 28
176 community sites/ACNs
4
5 supervision staff: CR, RAF, PCCB, NHPR,

CSR.
13 support staff
4 districts/communes reached 54
330 community sites/ACNs
17
This is a set of activities undertaken by

ACNs such as
Weighing (good technique
learned and mastered by each
ACNs)
Nutritional education (NE), using
materials
Cooking demos
1) Weighing + Counseling + NE monitoring

cooking demos
Once per month: 0 to 2 years
Pregnant women
Once per quarter: 2 to 5 years
ACNs plans: 28 half days per month,
Six times for 0 to 2 years
Once for pregnant women
24
Counseling
Home visits
Census of new born and children
1) Weighing
Performed once or twice per
week
Tracking babies weight curves
Recording all activities in a
register or a notebook
2) NE is provided by age group:
from 0 to 6 months (EBF)
from 6 to 8 months
from 8 to 11 months
and 11 months and on
Topics addressed include:
the amount of food to be given to
babies per each age
Consistency (thick or fluid)
Pace in nychthemeron
Quality of food (rich in nutrients)
Techniques (hygiene, cooking,
how to give to babies: with
confidence, love)
3) Cooking demos
Session most popular among
mothers
With a recipe book in support
Ingredients provided by ACNs
themselves, lack of funding
Activity conducted in a small
room of the center for sites that
have a stand-alone premise.
Otherwise, done at the ANCs
home
4) Counseling
EBF
Nutrition of pregnant and
lactating women, complications in
the breast
Immunization
Hygiene of food, body and
environment
Prevention of common and
endemic diseases
5) Home visits
Whenever required: generally
once a week
6) Annual census
Last such activity in 2012
Four times for 2 to 5 years

or MUAC measurement for
Pregnant woman
Children 2 to 5 years)
2) Annual census
Every new year: addition of new Fokontany
(changing register)
3) Home visits
With numerical targets
Discussion with mothers and
encouraging them for good behavior
In 2014: with new materials (CORAL kit
and CORAL kit for home visits)
ACNs and mothers work together to
draft the CORAL it menu (counseling
and food rationing)
with a diet book (Diary Sakafo) to fill
for three successive days to monitor,
check the progress and effectiveness of
menus
Trying to diversify menus (use at least
4 of the 7 colors)
Once the CORAL approach mastered,
increasing the number of home visits
CORAL home visits: 3 visits per target
at most and 2at least: same person,
same target. It is a household approach
Under the PAUSENS project, the CORAL
approach is included in NE, cooking
demos and home visits.
4) Animation on vegetable garden activities
Snack with Nutrition and Health Education
Activities of the three projects
Distribution of deworming medicine: 2
times per year
The Education sector gives money
Meals are prepared by ACNs as part of
cooking demos
A committee (PO and ACNs) keeps
funds and decides about the improved
menu
Snack -cost per student: MGA 500
25
new objectives of
ACNs in the
PAUSENS
Time requested from ACN: 28 half days per

month
Quantitative targets: 97 children from 0 to 2
years (330 enrolled in Fokontany)
151 children aged 2 to 5 years per quarter;
58 pregnant women in the year
To achieve these objectives, ACNs must
expand their geographical coverage (villages
and fokontany).
18-22 home visits per month (November
2014) including CORAL home visits: approach
to customized monitoring of children who
are malnourished children or have problems,
including 2-3 home visits for monitoring the
same child; ACNs and mothers work
together to define the CORAL kit menu
Responsibilities of
monitoring staff
(MS) (ORN staff)
Control and monitor ACNs

activities
Provide guidance and know-how
Put ACNs in contact with doctors
and staff of the CSB, with the
head and staff of fokontany, with
the Mayor and staff at the
municipality
Organize groupings
Supervise animators plans
Control monthly reports
Responsibilities of
animators
(NGO staff)
One animator per 10 sites or per

two communes cities: closer to
ACNs
Visit sites: twice a month
Control and track records, advises
Collect reports in the registers
In charge of 130 sites: three MS for 330

ACNs
Follow the functioning of sites
Prepare plan and survey mothers
Monitor the different activities
Field visit once per 4 months to check
scales
Once a month to collect data from
animators
with the PO:
audit of records
support and advise on site activities
check proper record keeping
Communication with the authorities for
possible district activities
Control and monitor vegetable gardens
New perspectives with "Fokonolona"
with the participation of the head of
Fokontany (Review UWR), goals in the
next 6 months
Facilitate work with the NGO in the
commune
One animator per 10 ACNs
Monitor their work
Help solve various problems
Field visits 2 times a month:
1st visit, early in the month,
assistance and support in various
26
-sending to NGO registry collected

reports
-Checks working hardware
(functional status, sufficiency) and
makes reports
-resolution local problems
-help to the tasks
-made ACNs grouping schedule
-Coordinates with head FKT and CSB
Responsibilities of
PO
(NGO staff)
Visit sites: once a month

Detect problems
Report to the president of the
NGO
Meet with ACNs and animators
every three months to develop
preparation of action programs
Prepare financial reports
activities (weighing techniques, NE,

cooking demos ...)
2nd visit, data collection,
verification of registers, observation
and reporting on work completed
At the beginning of the month:
gathering ACNs
* Readjust and share new goals
* Report on the new experiences of
each ACNs
* Facilitate sharing and mutual
assistance between the ACNs
2 Times a year and meeting new
prospects with "Fokonolona"
1 PO per NGO
Represent the NGO in operations
Monitor ACNs activities (performance
of their work)
Survey directly mothers
2 times a month: supervise facilitators
(support and monitoring, collection of
reports)
Visit sites
Distribute materials and allowances
Collect all supporting documents for
cooking demos expenses
In relation with communities and sites,
educates communities
Prepare the Messages Dissemination
Campaign, an annual community
evaluation
Once every 3 months: distribute seeds
whose production is intended for
cooking demos
Source: CPNNC interviews, focus group ES, Animators, and PO.
The table comparing the activities in the two regions shows that:
At the ORN benefiting from external support: the activities of community-based nutrition sites are
more intensive and varied. In this particular case, they include household food security activities,
namely vegetable gardens. ACNs have a heavier workload, including customized nutritional
monitoring of children with nutritional issues.
At the ORN that operate only on internal resources: the low number of operational NGOs means that
activities at the community-based nutrition sites have slowed down, leading to less supervision,
control and monitoring of the ACNs activities as well as less reporting from the sites.
First standard results from data processing:

Further to the processing of the ACNs questionnaires in the two regions, we obtained the following data:
27
Average seniority of ACNs: 7 years

Number of children under 5 years monitored per site: 214
Average travel time from the community-based nutrition site to the communes capital: about
2h20mn
3.2. Trends and use of funding from 2012 to 2014

ORN in Boeny:
Table 15: Earmarked funds and their use by the Boeny ORN - 2012-2014
2012
Year
2013
2014
ACNs compensation
73,850,000
55,223,000
9,000,000
cooking demos allowance
12,301,200
5,527,600
1,371,900
ANMs compensation
14,910,000
13,273,000
1,475,000
POs compensation
5,455,000
4,681,440
1,050,000
Supervision fees
9,749,240
8,453,360
1,529,398
Fuel for ANM
2,998,376
87,158,400
14,426,298
Fuel for PO
Total budget (MGA)
Source: Boeny ORN
500,000
119,763,816
28
Figure 4: Earmarked funds and use by the Boeny ORN - 2012-2014
ORN in Amoroni Mania

Table 16: Region of Amoron'i Mania - Funding sources - 2012-2014
Funding sources
ONN (PNNC)
PMPS II PROJECT (U-PNNC)
PAUSENS PROJECT (U-PNNC)
TOTAL
2012
(MGA)
60,029,700
100.0%
60,029,700
100.0%
2013
(MGA)
35,408,000
20,968,280
123,259,912
179,636,192
%
19.7%
11.7%
68.6%
100.0%
2014
(MGA)
20,848,800
143,585,380
355,833,920
520,268,100
Source: Amoroni Mania ORN
29
%
4.0%
27.6%
68.4%
100.0%
Figure 5: Region Amoron'i Mania - Funding sources 2012-2014
Table 17: Earmarked funds in 2014 and use by the Amoron'i Mania ORN
Topics
ACNs compensation
Cooking demos(cooking demos)
Animators compensation
PO compensation
Supervision fees
Fuel for Animators
Seeds and inputs
Bonus for actors
Fuel for PO
Motorcycle maintenance
Cost of traveling to bank
Bank charges
Other
TOTAL
Amount (MGA)
146,800,000
46,012,000
34,970,,000
18,200,000
42,505,252
31,568,400
16,900,000
17,258,940
16,940,400
15,100,000
850,000
997,008
132,166,100
520,268,100
30
Figure 6: Earmarked funds in 2014 and use by the Amoron'i Mania ORN
Earmarked funds in 2014 and use by the Amoron'i Mania ORN
cost of travel to bank

0.16%
Other
25.40%
ACNs' compensation
28.22%
Bank fees
0.19%
Maingenance
of motorcycle
2.90%
Fueld for PO
3.26%
Cookding demos
8.84%
Bonus for actors

3.32%
Seeds and inputs

3.25%
Fuel for
animators
6.07%
Animators'
compensation
Supervision fees PO's compensation 6.72%
8.17%
3.50%
Comments on earmarked funds:

Figure 4 shows the drastic drop in the funding for community-based nutrition activities at the ORN in
Boeny over the 2012-2014 period, from almost MGA 120 million to MGA 15 million. The ORNs activities
were solely funded with internal resources.
In contrast, Figure 5 shows a very significant increase in the funding obtained by the Amoroni Mania ORN,
from MGA 60 million to over MGA 500 million, the activities being externally supported through the PMPS
II and PAUSENS projects.
Use of funds by the ORNs:
In the region of Boeny, the funding of ORN went to community-based nutrition activities with the payment
of ACNs compensation being the largest item.
In the region of Amoroni Mania, community-based nutrition activities absorbed almost 75% of the
funding (in 2014), with more than 28% going to ACNs compensation, about 9% to cooking demos, and
more than 30% to the operation of the supervision structure. It should be noted that actors, including
ACNs, receive performance bonuses amounting to a little over 3% of all the funding.
31
3.3. Changes in the underweight rate indicator

ORN in Boeny
Table 18: Underweight rate
Year January February March April
2012 13.01
14.56
2013 14.27
16.71
2014 19.24
20.19
Source: Boeny ORN
May
June
July
14.33 13.55 14.2 14.54 13.85

17.11 16.83 17.09 16.54 17.01
19.73 19.51 18.54 18.19 17.32
August Seven October November December

14.43
16.91
17.72
14.99
16.86
20.76
14.73
17.55
20.93
14.1
17.67
Figure 7: Region of Boeny - Monthly changes in the underweight rates from 2012 to 2014
32
15.12
17.26
Figure 8: Region of Boeny Changes in the underweight rates - 2012-2014
ORN in Amoroni Mania

Table 19: Underweight rates
Year
April
May
June
July
2012
January February March

16.24
16.38
15.92
15.33
14.78
15.22
14.34
August Seven October November December

13.95
14.02
13.8
14.36
2013
17.27
17.21
16.61
15.18
15.22
15.13
14.83
14.37
16
15.87
12.57
2014
16.97
17.71
16.25
19.09
18.77
17.32
17.81
17.62
17.36
17.91
18.35
14.35
33
Figure 9: Region of Amoron'i Mania: Monthly changes in the underweight rate - 2012-2014
Figure 10: Region of Amoron'i Mania: Changes in the underweight rate - 2012 to 2014
Comments on the UWR trends from 2012 to 2014:

UWR is the indicator most commonly used by ONN for all its community-based nutrition sites in all regions
of Madagascar.
34
Figures 7 and 9 show the changes in this indicator over the years, allowing for assessing the seasonality of
malnutrition: the three curves relating to the Boeny ORN clearly illustrate this trend, the UWR peak being
observed in February and March, i.e. the lean period, and the rates decreasing in July and August. This
trend is not as clear when it comes to Amoroni Mania.
Figures 8 and 10 show the continuous changes in UWR over three years, which may allow for assessing
the programs effectiveness in the medium term.
In the case of the Boeny ORN, we see that the UWR increased on average from 12% in 2012 to over 20%
in 2014 across all sites in the region. As such, the trends in malnutrition were negative, and the rate was
about to exceed the 20% threshold set by the ONN for its regions. Based on this indicator, one would say
that the program could not be effective due to the lack of consistent internal funding.
In the case of the Amoroni Mania ORN, as shown in Figure 12, there was a downward trend of UWR in
2012 and 2013, but an upward trend in 2014, which probably led to a rising trend of UWR in the medium
term from 2012 to 2014, though the ceiling remains below 18%. Explanations provided by program
managers (Amoroni Mania ORN) are detailed in the annexes. In summary, given the national target of
19% for the UWR, program managers are satisfied, all the more so as at the beginning of the program (in
1999), the sites showed UWRs of up to 40% to 50%. However, their conclusion is that the projects impact
is yet to be measured in the coming years. From our point of view, the increase in UWR in 2014 also results
from the addition of 81 new sites that became operational by December 2013, which pulled the average
UWR upward. As a reminder, the number of sites in the Amoroni Mania region increased from 249 to 330
sites in 2013.
3.4. Activities carried out by ACNs

The findings from the ACNs questionnaires are shown in of Table 20 below.
Table 20: Activities carried out as reported by the ACNs surveyed
Activities carried out in the previous month (November

2014)
Cooking demos
Growth monitoring of children under 2 years
Growth monitoring of children 2 to 5 years
Home visit
Visit to the CSB
Nutritional education for Mothers
Nutritional education for Girls
Estimated
percentage in
Amoroni Mania
95
95
40
95
70
95
20
Estimated
percentage in
Boeny
55
95
80
95
95
90
35
Source: Processing of survey questionnaires
35
Figure 11: Comparison of the activities carried out as reported by ACNs
Comments:
Almost all ACNs in the two regions performed growth monitoring of children under 2 years as well as
home visits.
Almost all ACNs in Amoroni Mania conducted cooking demo activities, which can be seen as normal given
the availability of external funding. However, only half of the ACNs in Boeny conducted cooking demos,
which is still a feat given that they did not receive any internal funding for this type of activity. These ACNs
reported paying in advance the ingredients used for cooking demonstration, with mothers contributing in
some cases. The ACNs in Boeny have the leaders in their fokontany sign supporting documents evidencing
the completion of cooking demo sessions with the hope that that they would be reimbursed at a rate of
MGA 10 000 per cooking demo session later on. ACNs also indicated that cooking demos are the most
popular activity among mothers, motivating them to attend weighing and nutritional education sessions
or to send their eldest child bring the babies to weighing sessions if they cannot attend themselves.
Moreover, almost all of ACNs in Boeny made a visit to a basic health center (CSB), usually located in the
communes capital. From our point of view, ongoing collaboration with the public health facilities can be
a source of monetary or non-monetary motivation for the ACNs in Boeny who are looking to maintain
their motivation in this function in a context of internal funding failure.
3.5. Changes in other indicators of the functioning of sites

Table 21 shows the outcomes of the ACNs questionnaires after processing.
36
Table 21: Other indicators of the functioning of sites
Indicators
Had a stand-alone premise
Was opened last month
Reported activity carried out in the month preceding the survey
Received compensation last month
Time dedicated by the ACNs to site work up to standard (Amoroni Mania:
7 - Boeny: 4 half days/week)
Estimated
percentage
in Amoroni
Mania
45
95
95
85
Estimated
percentage
in Boeny
40
95
85
10
65
95
Source: Survey questionnaires

Figure 12: Functioning of sites in the two regions in 2014
Comments:
In each of the two regions, less than 50% of the community sites have stand-alone premises. The rest of
the sites are hosted at the fokontany offices, in one room at private houses or even at the ACNs own
homes.
It appears that both in Boeny and Amoroni Mania, almost all of the sites were open last month, but for
Boeny, only 85% indicated reporting their activities.
37
Table 22: Changes in the site functioning indicators
Indicators
Number of sites
Number of ACNs operational
Number of ACNs resigning/ nonperforming
Under 2 year child coverage rate
Number of sites sending reports
2012
176
168
Boeny
2013
176
161
2014
176
158
2012
249
249
Amoron'i Mania
2013
2014
330
330
330
330
8
75.03%
172
15
74.44%
151
18
73.58%
136
94.40%
249
89.75%
235
85%
330
Source: ORNs activity reports
Table 22 also illustrates changes in the functioning of sites in the two regions from 2012 to 2014. The last
row in the table shows that the number of sites reporting their activities in the Boeny region is in clear
decline as a result of non-performance on the ACNs side, failures or weaknesses in supervision and
monitoring, or the lack of recording and reporting tools. This trend of decrease in the number of
operational sites in Boeny is also the consequence of internal funding failure. Indeed, it is reported that
when funding fails, the functioning of sites is rapidly impacted.
3.6. ACNs resources

Historically, ACNs received monthly compensation amounting to about MGA 50,000. It happened during
critical periods when funding lacked that the compensation was not paid, but later on arrears were
settled, at least in part (for instance, there were 6 months of arrears of allowances paid in 2002). It seems
that ACNs in Boeny continue to work in the hope the hope of such settlement of arrears. Similarly, NGOs
also hope to benefit from as settlement of payment due to their program managers and animators based
on contracts entered between the NGOs and ORN.
Table 23: Status of ACNs compensation payment
ORN
Last payment of
ACNs
compensation
Boeny
February 2014: payment of the
compensation in January 2013 (+
amount for cooking demos MGA
10,000)
50000Ar per month
Amount of ACNs
compensation
Source: ORNs AFOs and NGOs POs
Amoroni Mania
Compensation for November 2014: settled in
December 2014
50,000Ar per month + possibly bonuses (from 010,000 Ar/month)
Table 23 indicates that ACNs in Boeny were last paid in February 2014 and received at that time a one
month allowance (plus 1 month allowance for cooking demos amounting to MGA 10,000) corresponding
to arrears of January 2013. In other words, ACNs in Boeny have not received compensation for 23 months.
38
ACNs in Amoroni Mania received their allowances for November 2014 in mid-December 2014.This
amount was increased with performance bonuses (performance-based contract) if the regular survey with
eight mothers of their localities was conclusive.
Table 24: Support from communities to ACNs
Support to ACNs for the implementation of activities

Support from mayors of communes and/or heads of fokontany
Support received from private individuals
% estimated for
Amoroni Mania
50
85
% estimated for
Boeny
10
10

Figure 13: Support to ACNs for the implementation of activities
Given that it was clear that internal funding could not meet needs for the payment of ACNs
compensation, the Terms of Reference of this case study called for determining whether the community
took charge of ACNs. The surveys with ACNs showed (Table 21) that those in Boeny did not receive any
support from communities. As shown in Figure 13, support from communities in the operation of the
ACNs is almost nil.
In Amoroni Mania, the support provided consisted mostly in the provision of premises for the site or land
plots for vegetable gardens.
Table 25: ACNs other sources of income
ACNs other sources of income for their personal needs

and the needs of their dependents
Waged work
Agriculture
Estimated
percentage in
Amoroni Mania
15
95
Estimated
percentage in
Boeny
15
85
39
Livestock
Trade
95
20
60
40
Figure 14: ACNs other sources of income for their personal needs and the needs of their dependents
Other sources of income for ACNs include agriculture and livestock, and in parallel, 40% of the ACNs in
Boeny are involved in small trade. About 15% in Boeny and Amoroni Mania are involved in waged work.
3.7.
Procedures applicable to the implementation of funding for community-based

nutrition sites
Table 26: Comparison of the funding implementation process

ORN
From Ministry of
Finance to ONN
From ONN to
ORNs
Boeny
Amoroni Mania
Internal resources: ONN establishes its annual work program and defines its priorities for
the activities to be financed from the Ministry of Finance.
The Ministry of Finance forwards to ONN the appropriation in the Budget Law/or
amended Budget Law for its activities.
However, the actual disbursement depends more on tax revenues achieved by the
Government rather than on the priorities defined by ONN.
Internal resources: ORN
Note: The Amoroni Mania ORN is funded by
establishes its annual work
Internal resources for charges relating to its

plan for the coming year and
operations
forwards it to the ONN in
U-PNNC PAUSENS for community-based

September.
nutrition activities
ORN maintains 3 bank
accounts corresponding
respectively to PSN
40
From ORN to ACNs

Procedure and
delay for payment
to ACNs
operations, ORN operation

and PNNC operations.
ONN wires funds to ORNs
bank account, specifying the
intended use of funds wired.
The AFO in Boeny informs the
NGOs when funds are made
available in the NGOs bank
accounts.
The NGO sends sms to ACNs
and convene them at the
commune to pay them.
The delay for the payment of
ACNs was about on week in
February 2014, once the
NGOs are notified by the AFO.
Payment of compensation in month M: from the 12th

to 20th day of the following month (M + 1)
Funds are made available to NGOs through their bank
accounts.
The following procedures are then applied:
- Animators collect reports every 20th day of the
month.
- There is a delay of 5 days to collect ACNs reports up
to the PO (gathering and verification)
- Reports are checked by the monitoring staff for
completeness and reliability: 2 or 3 days
Recording
Reading (CR, PCCB)
Verification by the NCPC in conjunction with
the financial reports
Entering the grassroots NGOs
- Grouping every 29th day of the month
- The financial reports of October and the technical
reports of November are reviewed together for the
payment of November (there are deductions in
some cases).
- Payments are made with other disbursements:
seeds, performance-based contract premiums.
Source: Interviews with AFO, CPNNC, POs
4. Strengths and weaknesses of the financial framework in terms of efficiency and

sustainability
Using all the information and results available, the current funding framework is reviewed in Table 27
below.
Table 27: Analysis of strengths and weaknesses of the financial framework
Funding
Internal
Strengths
Weaknesses
ACNs have tried to

address the impact of the
lack/insufficient funding in
early 2013, providing on
their own as advances the
resources needed for
cooking demos.
As a result of internal funding

failure on the medium term
at the field level, ACNs have
started giving up cooking
demo activities though it was
the most attractive activity
for target groups and ORNs
monitoring and supervision
Efficiency/sustainability
prospects
If the failure of internal
funding remains, there will
be no more ACNs will in the
next one or two years (cf.
signs in Table 22).
41
The bottleneck is not

linked to the ACNs
payment procedures but
to the fact the funding for
community sites activities
is not prioritized.
External
External funding is
efficient and increases
quality, integration and
scope of activities.
Community ACN are elected by and

live in their communities
They benefit from high
social status and
recognition.
activities have been reduced,

leading to less reliability and
availability of activity reports.
ACNs workload is heavy, and

these workers are
discouraged from having
other activities such as
community health workers or
otherwise, which increases
their dependence on external
funding.
The factors of continuity of

the operation of community
sites are not visible or
prepared.
There is no evidence so far

that communities
(Fokonolona, Fokontany or
Communes) support the
operation/survival of
community-based nutrition
sites.
There is still a needed to

devise an agreed scheme
for communities to be in
charge of the
implementation, would it be
only in part, and by
involving partners of the
community health sector,
communities and central
and decentralized
institutions.
Communities do not currently

have the structure or the
means required to take over
the running of community
sites.
It can be considered to
implement a pilot program
in some regions in line with
the terms of the National
Community Health Policy
and its Implementation
Guide, under the operation
of community-based
nutrition sites and in
consensus with agencies
and partners working in
community-based nutrition
5. Practical recommendations for improving the predictability and sustainability of

funding for sites taking into account the local context
42
It seems that bottlenecks in the payment of ACNs compensation do not lie in the procedures governing
the pipeline from ONN, to ORN, to NGOs and to ACNs (cf. Table 26). Rather, the problem results from the
drastic cuts in internal funding available (cf. Figure 5) and the decision or lack of decision to prioritize the
activities of community-based nutrition sites.
The first solution to ensure sustainability would then be to make the right decision at the central level.
The other solution would be to adapt minimal costs that can be considered and sustained to improve the
viability of community-based nutrition sites.
Minimal costs:
According to the contract agreed between the ONN/ORN and an implementing NGO3, the annual amount
proposed by the NGO to oversee 40 community-based nutrition sites in Boeny amounts to MGA
41,507,200 for 40 sites, i.e. an annual average cost per site of 1,037,680. This includes the compensation
for the various workers (including ACNs), the costs of management and supervision, and the cost of
cooking demo activities. When this cost is divided by the standard number of 200 children supervised per
site, the annual cost per child is estimated at MGA 5,188. The costs of key tools such as registers and cards
are to be added to these costs.
It is necessary to work based on minimal funding to maintain the activities of community-based nutrition
sites and to avoid a deterioration of nutrition indicators in regions that do not benefit from external
support.
Program steering, supervision and extension:
The third solution would be to review, restructure or rebalance the organization of these functions and
the associated costs as part of the thinking on the sustainability of community-based nutrition sites
activities, given the scarcity of funding for some regions. Needless to say, the design will have to be based
on an assessment of the local organization to allow for jointly developing a management and supervision
structure sized to the needs for activities and coordination in keeping with the financial resources
available.
A copy is provided in Annex.
43
ANNEXES
List of annexes:
Expenditures implemented by ONN

Detailed description of the methodological approach of collecting and processing data
Raw results from the processing of questionnaires
Terms of reference for field data collection
ACNs questionnaire
Data on the sites visited (Amoroni Mania)
Explanatory details provided by the Amoroni Mania ORN on changes in UWR and
coverage rates
History of community-based nutrition sites
Other documents in PDF format

- Costs of supervision as estimated by ORN
- Boeny ORNs 2015 annual workplan
- Models of NGO contracts
- Data on the sites visited (Boeny)
- Organizational chart of the Boeny ORN
- Organizational chart of the Amoroni Mania ORN
- Amount of ONN internal resources in 2014
- LQAS methodology standards (To be added)
44
PRIME MINISTER OFFICE

NATIONAL NUTRITION OFFICE
EXPENDITURES IMPLEMENTED BY ONN
2006
HIPC
2007
INTERNAL
RESOURCES
HIPC
2008
INTERNAL
RESOURCES
HIPC
INTERNAL
RESOURCES
ACQUISITIONS OF FIXED ASSETS

TECHNICAL EQUIPMENT
AUDIO VISUAL EQUIPMENT
IT HARDWARE
13 061 800.00
7060 273.00
36 817 411.20
3776 000.00
10 201 100.00
0.00
32 054 080,00
185 118 713.65
100 300.00
64 839 305,55
34 219 000.00
7915 839.10
EQUIPMENT AND OFFICE FURNITURE
119 000.00
79 713 772.80
16 018 800.00
25 307 473.50
10 186 591.00
5171 600.00
OTHER MATERIALS
263 700.00
1441 200.00
1454 262.00
1393 220.00
1760 850.00
91 568 000.00
857 043 273.35
325 771 042.40
172 130 000.00
VEHICLES
LAYOUT - FACILITIES AND INSTALLATIONS
33 818 400.00
124 004 780.00
TOTAL FIXED ASSETS
1140154 759.80
0.00
2310665 000.00
443 841.20
377 162 804.40
280 931 372.05
0.00
0.00
46 166 441.00
2361013 691.50
Expenditures implemented
LAND DEVELOPMENT
PUBLIC GARDENS
0.00
10 911 354.00
LI WORKS FOR PUBLIC GARDENS.
8471 654.00
EQUIPMENT FOR PUBLIC GARDENS
1263 500.00
MATERIALS FOR PUBLIC GARDENS
285 000.00
SUPERVISION FOR PUBLIC GARDENS
891 200.00
PLAY GROUNDS
1 000,00
0.00
1 000,00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
13 292 070,00
0.00
MATERIAL FOR PLAY GROUNDS

LEISURE SPACES
LI WORKS FOR LEISURE SPACE
11 044 130,00
EQUIPMENT FOR LEISURE SPACE
1702 340.00
SUPERVISION FOR LEISURE SPACE
545 600.00
OUTDOORS
LI WORKS FOR OUTDOORS.
36 365 673.00
203 765 599.00
99 685 591.74
5248 097.00
5248 097.00
61 158 870.00
599 625.00
31 587 568.00
165 295 361.00
69 189 511.74
37 688 722,00
387 625.00
EQUIPMENT FOR OUTDOORS
562 705.00
13 603 070,00
1647 560.00
2160 200.00
0.00
MATERIALS FOR MATERIALS
1367 400.00
13 277 480.00
17 376 420.00
12 951 860.00
212 000.00
SUPERVISION FOR OUTDOORS
2848 000.00
11 589 688.00
11 472 100.00
8358 088.00
0.00
IRRIGATION WORKS
IRRIGATION CHANNEL
LI WORKS FOR IRRIGATION CHANNELS.
EQUIPMENT FOR IRRIGATION CHANNELS
394 933 756.97
0.00
817 116 486.19
26 571 515.00
681 024 360.00
308 943 063.40
629 631 089.19
22 104 715.00
564 846 320.00
9187 817.65
34 710 264.00
902 000.00
28 082 950.00
MATERIALS FOR IRRIGATION CHANNELS
26 003 656.92
34 519 476.00
0.00
19 308 942,00
SUPERVISION FOR IRRIGATION CHANNELS
50 799 219.00
118 255 657.00
3564 800.00
DRAINS
LI WORKS FOR DRAINS.
EQUIPMENT FOR DRAINS
MATERIALS FOR DRAINS
SUPERVISION FOR DRAINS
165 757 317.00
66 530 797.00
343 094 481.99
140 349 127.00
62 391 246.00
284 593 167.00
5124 860.00
1016 160.00
15 497 604.00
9382 200.00
9382 200.00
68 786 148.00
251 266 803.12
205 405 037.12
10 020 670.00
3534 050.00
220 850.00
6371 349.99
4419 460.00
16 749 280.00
2902 541.00
36 632 361.00
31 421 636.00
0.00
45
0.00
HYDRAULIC STRUCTURES (Tarpaulin, flush

valve, siphon)
0.00
0.00
949 000.00
LI WORKS FOR HYDRAULIC STRUCTURES
143 000.00
EQUIPMENT FOR HYDRAULIC STRUCTURES
806 000.00
0.00
15 356 460.00
414 400.00
MATERIALS FOR HYDRAULIC STRUCTURES
10 821 530.00
SUPERVISION FOR HYDRAULIC STRUCTURES

DAM
1589 280.00
0.00
0.00
13 056 985.00
LI WORKS FOR DAMS
6325 500.00
EQUIPMENT FOR DAMS
1190 060.00
MATERIALS FOR DAMS
3956 150.00
SUPERVISION FOR DAMS

URBAN DEVELOPMENT
0.00
0.00
0.00
6191 700.00
2532 632.00
0.00
1585 275.00
0.00
LI WORKS FOR URBAN DEVELOPMENT
15 175 400.00
6506 918.00
10 164 750.00
5872 893.00
2187 000.00
EQUIPMENT FOR URBAN DEVELOPMENT
455 000.00
227 500.00
4000 000.00
MATERIALS FOR URBAN DEVELOPMENT
4254 400.00
387 500.00
0.00
301 250.00
19 025.00
4 700.00
SUPERVISION FOR URBAN DEVELOPMENT

BUFFER BASINS (marsh)
0.00
2531 250.00
0.00
0.00
1373 100.00
2532 632.00
0.00
0.00
0.00
0.00
591 000.00
0.00
LI WORKS FOR BUFFER BASINS

EQUIPMENT FOR BUFFER BASINS
569 000.00
MATERIALS FOR BUFFER BASINS
211 400.00
SUPERVISION FOR BUFFER BASINS

BUFFER BASIN (Lake)
592 700.00
0.00

REFORESTATION
0.00
38 984 538.00
37 082 354.00
28 503 943.00
32 113 254.00
5322 295.00
2434 000.00
109 000.00
150 000.00
279 500.00
234 000.00
5008 300.00
2255 600.00
0.00
LI WORKS FOR REFORESTATION
4694 100.00
248 000.00
0.00
3877 500.00
EQUIPMENT FOR REFORESTATION
920 000.00
0.00
810 000.00
816 600.00
MATERIALS FOR REFORESTATION

SUPERVISION FOR REFORESTATION
EMERGENCY WORKS
LI WORKS FOR EMERGENCY WORKS
110 000.00
2354 420.00
0.00
25 920.00
61 717 294.00
0.00
60 941 248.00
42 504 189.00
49 654 498.00
EQUIPMENT FOR EMERGENCY WORKS
468 500.00
683 300.00
1963 700.00
MATERIALS FOR EMERGENCY WORKS
1760 000.00
3010 560.00
146 800.00
SUPERVISION FOR EMERGENCY WORKS

LATRINES
LI WORKS FOR LATRINES
100 000.00
26 928 832,00
15 519 245.00
0.00
7297 500.00
EQUIPMENT FOR LATRINES

MATERIALS FOR LATRINES
SUPERVISION FOR LATRINES
VILLAGE COMMUNITY GRANARIES
LI WORKS FOR VILL. COMM. GRANARIES
EQUIPMENT FOR VILL. COMM. GRANARIES
MATERIALS FOR VILL. COMM. GRANARIES
SUPERVISION FOR VCG/LATRINES
749 770.00
9176 250.00
0.00
72 000.00
28 134 621.00
823 300.00
0.00
4 800,00
320 000.00
17 141 900.00
0.00
357 770.00
0.00
17 746 648.00
1042 500.00
2378 750.00
0.00
41 651 725.00
5269 500.00
125 000.00
325 700.00
14 344 748.00
31 847 245.00
2234 400.00
4209 280.00
SUPERVISION FOR VCG

CONSTRUCTION OR REHABILITATION:
THOROUGHFARES
0.00
8609 171.00
15 951 520.00
2856 512.00
0.00
46
0.00
RURAL ROADS
LI WORKS FOR RURAL ROADS
EQUIPMENT FOR RURAL ROADS
MATERIALS FOR RURAL ROADS
SUPERVISION FOR RURAL ROADS
LANES
LI WORKS FOR LANES
EQUIPMENT FOR LANES
56 514 670.00
18 843 407.00
32 110 530.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
1245 000.00
627 000.00
0.00
69 335 039.00
0.00
31 954 870.00
8447 250.00
24 152 250.00
416 000.00
1537 560.00
2065 360.00
19 413 200.00
8631 500.00
2341 700.00
4730 600.00
227 097,00
3551 220.00
2083 200.00
1211 500.00
1282 500.00
1072 500.00
366 000.00
139 000.00
MATERIALS FOR LANES
0.00
SUPERVISION FOR LANES

PUBLIC RIGHT-OF-WAY
LI WORKS FOR PUBLIC RIGHT-OF-WAY
EQUIPMENT FOR PUBLIC RIGHT-OF-WAY
MATERIALS FOR PUBLIC RIGHT-OF-WAY
SUPERVISION FOR PUBLIC RIGHT-OF-WAY
DIKES
434 700.00
2352 500.00
312 000.00
25 000.00
27 000.00
1988 500.00
0.00
LI WORKS FOR DIKES
1245 000.00
627 000.00
55 463 977,00
EQUIPMENT FOR DIKES
4855 712.00
MATERIALS FOR DIKES
2031 450.00
SUPERVISION FOR DIKES
6983 900.00
PUBLIC ROADS LARGER THAN3 m
0.00
0.00
LI WORKS FOR PUBLIC ROADS LARGER < 3M

EMERGENCY WORKS
7104 750.00
0.00
0.00
0.00
0.00
7557 890.00
0.00
7104 750.00
0.00
0.00
8597 350.00
6374 250.00
6221 250.00
1033 100.00
14 500.00
1190 000.00
89 500.00

WATER CAPTURE
1232 640.00
0.00
0.00
LI WORKS FOR WATER CAPTURE.

WELLS
LI WORKS FOR WELLS
270 000.00
0.00
0.00
0.00
0.00
4612 140.00
0.00
270 000.00
3861 300.00
311 250.00
1916 200.00
112 500.00
25 065 389.00
3647 839.00
978 000.00
EQUIPMENT FOR WELLS
121 000.00
6 000.00
730 000.00
164 300.00
MATERIALS FOR WELLS
1468 700.00
1304 000.00
18 162 750.00
1826 000.00
SUPERVISION FOR WELLS
1960 350.00
493 700.00
2524 800.00
1643 840.00
GRAVITY WATER SUPPLY
0.00
LI WORKS FOR GRAVITY WATER SUPPLY
1906 261.00
1036 500.00
3664 590.00
0.00
0.00
0.00
0.00
0.00
-150 400,00
3253 940.00
EQUIPMENT FOR GRAVITY WATER SUPPLY
376 511.00
3 700.00
MATERIALS FOR GRAVITY WATER SUPPLY
493 250.00
406 950.00
SUPERVISION FOR GRAVITY WATER SUPPLY

DRAINAGE CHANNELS
0.00
LI WORKS FOR DRAINAGE CHANNELS
33 600.00
426 250.00
33 600.00
-150 400,00
EQUIPMENT FOR DRAINAGE CHANNELS

MATERIALS FOR DRAINAGE CHANNELS
SUPERVISION FOR DRAINAGE CHANNELS
CROSSING STRUCTURES
LI WORKS FOR CROSSING STRUCTURES
EQUIPMENT FOR CROSSING STRUCTURES
426 250.00
7831 837.00
4918 200.00
2 000,00
847 800.00
847 800.00
1353 195.00
0.00
0.00
416 250.00
500.00
47
0.00
MATERIALS FOR CROSSING STRUCTURES

SUPERVISION FOR CROSSING STRUCTURES
PROTECTIVE STRUCTURES (retaining wall)
943 200.00
478 300.00
1968 437.00
458 145.00
0.00
0.00
LI WORKS FOR PROTECTIVE STRUCTURES
40 500.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
222 964 475,20
25 614 735.00
204 496 552.44
0.00
40 500.00
EQUIPMENT FOR PROTECTIVE STRUCTURES

MATERIALS FOR PROTECTIVE STRUCTURES
SUPERVISION FOR PROTECTIVE STRUCTURES
SANITATION STRUCTURES
0.00
1064 250.00
LI WORKS FOR SANITATION STRUCTURES
984 250.00
EQUIPMENT FOR SANITATION STRUCTURES

IRRIGATION CHANNELS
LI WORKS FOR IRRIGATION CHANNELS
80 000.00
295 057 872.80
42 978 666.80
223 069 135.80
36 581 116.80
199 340 383.60
22 862 935.00
150 577 035.22
9534 666.00
1147 000.00
5181 810.00
0.00
11 032 613.50
15 467 030.00
1203 750.00
11 065 664.00
0.00
12 707 400.00
46 987 041,00
4046 800.00
7376 617.60
2751 800.00
DRAINS
LI WORKS FOR DRAINS
41 214 814.00
38 372 014,00

HYDRAULIC STRUCTURES (tarpaulin, flush
valve, siphon)
9426 000.00
9426 000.00
4134 919.40
3661 119.40
810 000.00
9426 000.00
9426 000.00
0.00
30 179 503.72
21 519 153.00
1027 020.00
21 000.00
0.00
209 700.00
2011 800.00
473 800.00
1206 550.00
7927 250.00
0.00
6443 250.00
8472 801.00
0.00
3495 700.00
988 500.00
2 000,00
61 000.00
0.00
807 950.00
3838 351.00
316 600.00
674 050.00
1077 750.00
300 400.00
DAM
2266 000.00
0.00
0.00
0.00
2266 000.00
11 850 130,00
686 000.00
MATERIALS FOR DAMS
3163 680.00
1576 100.00
205 200.00
LABOR INTENSIVE WORKS

EQUIPMENT AND MATERIALS
0.00
6424 350.00
EQUIPMENT FOR DAMS
OTHER
0.00
371 500.00
LI WORKS FOR DAMS
0.00
19 075 883.00
0.00
1755 000.00
3052 350.00
1502 600.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
205 200.00
SUPERVISION
0.00
SOCIAL SUPPORT ACTIONS

EMERGENCY WORKS
0.00
943 006,00
2766 750.00

OTHER EMERGENCY OPERATIONS
HOUSEHOLD FOOD SECURITY (HFS)
1755 000.00
285 600.00
943 006,00
0.00
1502 600.00
0.00
0.00
HFS: LI WORKS.
HFS: TRANSPORT EQUIPMENT
HFS:-MATERIALS-SEED-TRANSPORT
HFS: SUPERVISION
HFS: MISCELLANEOUS
HFS: LAYING HENS
HFS: HEN
48
HFS: LAYING HENS: FEED

HFS: LAYING HENS: TREATMENT
HFS: - HEN - COACHING & TRAINING
HFS: - HEN - MISCELLANEOUS
HFS: VLP
HFS: VPL: AWARENESS, COACHING, TRAINING
HFS: VPL: ALLOWANCES OF ACTORS
HFS: VPL - COOKING DEMOS
HFS: VPL: INPUTS AND SMALL EQUIPMENT
HFS: VPL: MISCELLANEOUS
SUPPORT
531 600.00
21 514 050.00
DATABASE
CAPACITY-BUILDING
16 774 600.00
STAFF TRAINING
M&E AND SUPERVISION
27 249 160.00
63 341 559.00
9823 940.00
1416 000.00
0.00
3498 150.00
7523 107.00
1001 200.00
444 000.00
13 263 800.00
52 285 174.00
19 107 700.00
38 776 300.00
ARM ACTIVITY
TECHNICAL AND FINANCIAL AUDITS
16 282 430.00
27 761 715.00
99 556 949.00
FOOD AND NUTRITIONAL MONITORING
1077 700.00
MATERIALS FOR NUTRITIONAL STATUS Monit

OTHER
540 000.00
257 004,00
0.00
-477 000.00
25 636 083.00
ACCELERATING MALNUTRITION REDUCTION

COMMUNICATION STRATEGY
42 281 318.00
913 150.00
152 596 950.60
3224 444.00
325 091 586.63
251 900.00
284 137 142.67
PERIODIC JOURNAL
27 864 922,00
24 262 618.00
8235 932.00
TEE SHIRT - VISOR - CAP
43 825 986.40
39 312 880,00
45 220 104.00
FLAG SMALL FLAG - BASE

BANNER
362 307.20
913 150.00
LOGO
5451 305.00
3214 444.00
1469 100.00
CALENDAR
9303 790.00
112 600.00
4409 124.00
2111 960.00
100 000.00
2894 000.00
120 000.00
59 798 860.00
PRODUCTION OF VIDEO "HETSORO"
1932 840.00
545 000.00
56 330 722,00
10 000.00
112 179 189.00
55 058 360,00
39 300.00
115 085 900.00
CONTEST AND INCENTIVES "HETSORO"
28 051 880,00
PERIODIC JOURNAL "HETSORO"
36 145 066,00
8052 900.00
80 170 124.30
20 511 566.00
7000 456.67
4998 256.67
OTHER
4520 680.00
CHANGES IN "COMMUNICATIONS" STOCKS
19 126 000.00
BEHAVIOUR CHANGE COMMUNICATION

COMMUNICATION MATERIALS
WORKSHOP - SEMINAR -COLLOQUIUMS
WORKSHOP
1165 519.00
1165 519.00
5926 500.00
5926 500.00
SEMINAR
27 216 247.00
27 216 247.00
58 134 559.00
80 000.00
80 000.00
54 912 250.00
754 500.00
754 500.00
181 343 124.16
84 000.00
0.00
84 000.00
39 790 814.00
39 022 291.00
54 422 250,01
105 998 990.08
37 033 144.00
334 800.00
489 999.99
55 200.00
32 000.00
SYMPOSIUM
203 384 985.00

97 375 843.00
380 000.00
2724 900.00
NATIONAL NUTRITION DAY

RADIO BROADCAST
18 777 468.00
911 364.00
13 717 350.00
75 288 934.08
253 000.00
22 367 330.00
2725 670.00
205 000.00
49
102 904 242.00

17 716 475.00
MUSICAL GROUP
250 000.00
RADIO BROADCAST
661 364.00
MEDIA TRAINING
TRAINING MATERIALS FOR PARTNERS
2740 400.00
28 400.00
13 717 350.00
947 272.00
253 000.00
3155 000.00
239 248.00
22 367 330.00
205 000.00
17 716 475.00
3957 428.00
0.00
4113 700.00
2 732 200.00
761 300.00
TRAINING MATERIALS FOR ACNs/PNNC

TRAINING MATERIALS FOR LEADERS/PNNC
TRAINING MATERIALS FOR NGO/ACC;/PNNC
SUPPORT TRAINING OF MAYORS,PCC, NGOs,
ACCOUNTANTS
INTERNAL STAFF TRAINING
2768 800.00
2625 000.00
IEC MATERIALS FOR TRAINERS

OPERATIONAL RESEARCH
906 200.00
OTHER MATERIALS
708 024.00
SENSITIZATION
SENSITIZATION OF PARTNERS
39 621 090.01
8193 510.01
SENSITIZATION OF NGOs
SENSITIZATION OF LOCAL SUPERVISORS
SENSITIZATION OF TRAINERS
SENSITIZATION, ANIMATION AND
IDENTIFICATION
TRAINING
31 427 580.00
1569 600.00
TRAINING OF PARTNERS
37 234 754.96
530 000.00
6597 176.00
319 028,00
9316 782.00
3352 400.00
48 742 407.00
7860 579.00
7584 514.96
1481 520.00
173 500.00
55 200.00
0.00
816 700.00
210 800.00
0.00
754 800.00
25 050 090,00
0.00
0.00
4334 150.00
451 307 472.20
6597 176.00
12 392 664.00
7835 262.00
51 923 742.75
48 742 407.00
0.00
6115 579.00
32 738 332.80
344 116 760.27
47 212 949.75
TRAINING OF TECHNICAL OFFICERS
19 359 000.00
512 693.00
TRAINING OF LOCAL SUPERVISORS
80 168 312.00
1361 600.00
288 000.00
0.00
0.00
2836 500.00
200 000.00
TRAINING OF TRAINERS
INTERNAL TRAINING FOR STAFF
1569 600.00
EXTERNAL TRAINING FOR STAFF

PROFESSIONAL DEVELOPMENT (PD)
6875 399.93
12 392 664.00
500 000.00
0.00
DEVELOPMENT OF LOCAL SUPERVISORS

DEVELOPMENT OF SCHOOL PRINCIPALS
CAPACITY BUILDING IN ENA
423 992 656.13
55 000.00
0.00
0.00
5920 000.00
61 245 835.13
920 000.00
35 470 618.00
0.00
242 654 901.00
0.00
1502 000.00
0.00
19 631 400.00
5000 000.00
DEVELOPMENT OF ACNs
848 904.00
0.00
DEVELOPMENT OF NGOS
62 438 998.00
0.00
CONTEST AND INCENTIVES
32 483 332.80
DEWORMING
0.00
0.00
98 200.00
0.00
OTHER IEC
1343 700.00
1245 500.00
200 000.00
MINISTRY OF HEALTH
0.00
THEME DAYS
14 958 909.00
0.00
14 857 709.00
24 425 493.00
0.00
22 295 493.00
33 197 889.80
13 987 051.80
MONITORING AND EVALUATION

OTHER
101 200.00
MINISTRY OF EDUCATION
0.00
77 700.00
2130 000.00
0.00
SCHOOL MEALS
3410 104.00
19 210 838,00
0.00
8229 450.00
660 980.00
42 700.00
2749 124.00
8126 750.00
PNAS
60 000.00
OTHER
77 700.00
MINISTRY OF AGRICULTURE AND LIVESTOCK
0.00
2852 369.00
0.00
14 340 250.00
0.00
MAEP/GRAAM
50
4351 056.00
FOOD SECURITY
2852 369.00
WORLD FOOD DAY

WORLD RURAL WOMEN DAY
MINISTRY OF POPULATION
1042 450.00
1046 000.00
11 407 800.00
518 000.00
1890 000.00
0.00
THEME DAY
7291 540.00
0.00
16 448 030.00
2787 056.00
0.00
8266 088.00
6509 540.00
16 465 630.00
3134 328.00
782 000.00
-17 600.00
5131 760.00
SOCIAL PROTECTION
OTHER
PRIME MINISTERS OFFICE/MINISTR OF
FINANCE
0.00
JOINT MISSION
5181 762.91
0.00
5181 762.91
OTHER
PRIME MINISTERS OFFICE
MINISTRY OF DECENTRALIZATION AND
OTHER PARTNERS
0.00
0.00
OTHER
4590 920.00
4590 920.00
FOOD
0.00
0.00
110 000.00
6653 975.00
0.00
2178 000.00
350 850.40
6174 864.00
2311 476.00
0.00
19 974 500.00
35 000 000.00
5000 000.00
2311 476.00
263 829.00
FOOD
19 974 500.00
35 000 000.00
TRANSPORT OF FOOD COMMODITIES

DRUGS
110 000.00
0.00
745 268 306.65
0.00
8352 864.00
6303 124.60
5000 000.00
263 829.00
179 718 863.90
0.00
IRON FOLATE
403 828 570.00

148 900 000.00
MEBENDAZOLE
5973 728.00
DRUG
SPIRULINE
741 874 526.75
0.00
3393 779.90
11 979 718.10
180 000 000.00
TRANSPORT OF DRUGS
750 200.00
CHANGES IN DRUG STOCKS

EQUIPMENT FOR NGOs/SITES/COMMUNES
197 672 310.00

0.00
MOTORCYCLE
1387545 888.54
0.00
728 532 000.00
772 139 172.20
74 178 370.00
0.00
191 730 305.62
1023296 000.00
0.00
219 314 338.62
3898 461.38
BICYCLE
SALTER SCALE
HANGING TROUSERS/ BABY SCALE
45 735 030.00
0.00
GROWTH CARD
11 292 600.00
0.00
0.00
REGISTER
40 854 408.40
0.00
0.00
HEALTH CARD
212 024 288.00
291 558 176.00
3304 000.00
MATERIALS AND TOOLS FOR SITES
337 107 147.14
0.00
25 716 420.00
46 622 331.00
58 573 296.66
79 722 000.00
11 113 114.00
867 933 549.08
69 429 424.24
1115 620.00
9660 000.00
480 260.00
0.00
MATERIALS AND TOOLS FOR SCHOOLS

CHANGES IN EQUIPEMENT STOCK FOR/NGOSITES-COMMUNITIES
TRANSPORT OF EQUIPMENT FOR
NGOs/SITES/COMMUNITIES
OTHER
SURVEYS
0.00
7058 210.00
DIETARY SURVEY
1504 000.00
ANTHROPOMETRIC SURVEY
4474 210.00
EVALUATION SURVEY
1080 000.00
0.00
10 196 800.00
0.00
30 443 283.60
5884 683.60
SMART SURVEY
10 196 800.00
24 558 600.00
NGO QUANTITATIVE SURVEY

TECHNICAL ASSISTANCE
426 259 808.07
PERMANENT NATIONAL ASSISTANT

TEMPORARY ASSISTANT NATIONAL
426 259 808.07
484 807 767.88

484 732 767.88
997 750 753.15
1110026 248.07
997 750 753.15 1110026 248.07
642 311 154.00

642 311 154.00
75 000.00
1065680 722.37
140 000.00
OPERATING ACTIVITIES
1065820 722.37
51
A. GRADUAL TRANSFORMATION OF OLD

SITES
0.00
9337457 615.30
0.00
4624874 833.91
0.00
5573158 467.05
COMPENSATION FOR POS
361 663 266.14
259 085 858.45
COMPENSATION FOR ACCOUNTANTS
209 464 395.09
190 000.00
255 784 000.00

-20 000.00
COMPENSATION FOR ANIMATORS

COMPENSATION FOR MONITORING STAFF
912 787 542.40
397 658 809.35
547 372 300.00
COMPENSATION FOR ACNS
3682830 871.51
2004940 869,49
2791685 000.00
COOKING DEMOS
1225502 912.01
507 591 048.05
482 909 708.00
204 962 126.52
159 550 918.96
99 294 884,00
935 382 808.62
470 037 564.27
561 165 631.30
129 853 580.02
2320 723.30
244 413 431.71
19 647 974.04
-961 919.60
SUPERVISION
1041927 973.10
574 976 788.01
707 928 547.40
MISCELLANEOUS
237 659 820.85
227 945 235.99
127 960 315.95
81 321 643.00
-57 485.00
5905 240.00
0.00
VEGETABLE GARDEN
TRAVEL EXPENSES FOR PO
COMPENSATION FOR PILOT NGO PO
COMPENSATION FOR PILOT NGO ACCOUNT;
FUEL AND LUBRICANTS FOR ACCOUNTANT
FUEL FOR MONITORING STAFF
40 000.00
TRAVEL EXPENSES FOR ACCOUNTANT

TRAVEL EXPENSES FOR MONITORING STAFF
MOTORCYCLE MAINTENANCE
MONITORING STAFFS MOTO MAINTENANCE
DEVELOPMENT OF ACNs
DEVELOPMENT OF ANIMATORS
DEVELOPMENT OF NGOs/PO /ACCOUNTANT
COMMUNICATION ACTIVITIES
TRANSPORT OF SEVERELY MALNOURISHED
CHILDREN
B. STEERING OF REGIONS
TRAINING OF STEERING COMMITTEE SPOT
MAP (CCD-Relay-Facilitator-Supervisor)
DATA COLLECTION - OPERATION WRITING
OF DRAFT
INTERPRETATION
58 967 956.40
0.00
4742 150.00
100 000.00
71 897.93
0.00
247 425 966.11
886 529.00
0.00
220 063 107,88
0.00
255 745 386.79
5775 179.00
420 000.00
2009 330.00
466 500.00
DEVELOPMENT OF SPOT MAP
12 380 627.40
-87 570.00
OFFICIAL PILOT SITE LAUNCH
74 734 987.59
28 673 810.08
12 250 000.00
24 500 000.00
23 940 000.00
24 310 000.00
49 610 000.00
48 234 000.00
1140 000.00
2134 000.00
2206 000.00
NGOs
COMPENSATION OF SUPERVISOR
COMPENSATION OF ANIMATOR
COMPENSATION OF ACCOUNTANT
COMPENSATION OF FACILITATOR
TRAVEL EXPENSES OF SUPERVISOR
TRAVEL EXPENSES OF ANIMATOR
TRAVEL EXPENSES OF FACILITATOR
4292 000.00
7038 000.00
7703 900.00
SUPERVISION FEES
5512 600.00
12 220 100.00
11 951 590.00
MISCELLANEOUS
1501 337.98
5454 939.75
6090 581.68
COMMUNE
BASIC TRAINING (Relay-FacilitatorSupervisor-NGO Nutrition Officer)
COMPENSATION FOR NUTRITION OFFICER
COMPENSATION FOR ACCOUNTANT
COMPENSATION FOR RELAY
22 020 823.00
0.00
6740 000.00
12 250 000.00
13 200 000.00
4170 000.00
7474 600.00
7890 000.00
49 424 000.00
87 936 000.00
87 310 000.00
TRAVEL EXPENSES FOR ACNs
52
TRAVEL EXPENSES FOR RELAY
850 000.00
1856 000.00
2576 000.00
TRAVEL EXPENSES FOR NUTRITION OFFICER

COOKING DEMOS
12 584 000.00
27 706 700.00
28 208 380.00
SUPERVISION FEES
3755 500.00
6558 740.00
6583 205.00
MISCELLANEOUS
ADDITIONAL TRAINING ON SPOT MAP FOR
STEERING COMMITTEE
DEVELOPMENT OF ACTORS (RELAYFACILITATORS- ...)
3132 081.14
3618 908.21
4320 830.11
64 000.00
0.00
32 700.00
0.00
5498 200.00
359 500.00

COMPENSATION FOR ANIMATOR
COOKING DEMOS
TRAVEL EXPENSES FOR ANIMATOR
SUPERVISION
SUPERVISION FEES FOR COMMUNES
SUPERVISION FEES FIR FOKONTANY
C. EXPANSION TO NEW SITES
0.00
TRAINING OF ACNs
1564331 072.86
0.00
142 352 857.75
TRAINING PO/NGO/ANIMATOR
COMPENSATION FOR PO
2774513 713.30
0.00
810 398 157.83
180 000.00
42 848 925.00
0.00
107 207 595.99
218 904 308.85
2032 238.07
845 600.00
51 059 320.00
114 624 476.40
236 654 322.56
81 166 800.00
COMPENSATION FOR ACNs
598 989 362.49
1171406 922.84
405 390 000.00
COOKING DEMOS
103 125 258.74
302 940 635.28
69 104 630.00
56 473 953.67
123 180 727.73
8654 000.00
116 415 455.68
260 344 391.74
77 462 582.48
1821 196.81
206 139.00
19 644 937.46
488 638.39
-150 000.00
165 200 579.49
343 189 179.61
99 554 458.62
45 689 035.31
116 054 167.30
18 156 366.73
FUEL AND LUBRICANTS FOR PO

FUEL AND LUBRICANTS FOR ANIMATOR
SUPERVISION FEES
MISCELLANEOUS
DEVELOPMENT OF ACNs
118 680.00
DEVELOPMENT OF NGOs/PO/ACCOUNTANT
NUTRITIONAL EMERGENCIES
47 905 200.00
0.00
190 507 069.55
0.00
0.00
63 110 673.00
0.00
121 119 395.12

FOOD
95 619 838.35
0.00
EMERGENCY EQUIPMENT
11 180 000.00
0.00
NON-FOOD ITEMS
20 401 406.20
0.00
LOCAL TRANSPORT
32 921 800.00
22 100 310.00
NATIONAL SUPPORT STAFF
24 422 885.00
29 231 373.00
7697 600.00
5961 140.00
11 778 990.00
28 135 396.60
28 546 549.72
56 739 848.80
CRENA/CRENI
CRENA
0.00
10 643 530.00
0.00
FOOD
REHABILITATION
81 521 600.00
0.00
75 947 400.00
10 543 530.00
0.00
53
104 800.00
TRAINING AND REFRESHERS
100 000.00
5574 200.00
104 800.00
CRENA TRAINING
CRENI
0.00
7703 375.00
0.00
EQUIPMENT - MATERIAL-FOOD
FOOD
406 413 145.22
0.00
650 077 027.50
641 800.00
6 000.00
320 988 715.71
594 301 803.50
FOOD TRANSPORT
6025 275.00
28 230 970.00
23 413 616.00
DRUGS
1190 100.00
0.00
20 790 284.00
488 000.00
8 750,00
211 700.00
REHABILITATION
CRENI OPERATION
56 542 909.51
0.00
1024741 284.99
0.00
869 350 044.93
11 353 624.00
0.00
480 342 033.70
PERSONNEL COSTS
186 569 766.43
219 829 579.07
302 228 934,00
MANAGEMENT FEES
172 244 899.32
134 408 914.50
59 495 180.00
93 819 645.00
55 985 002.00
688 420.00
22 102 300.00
SUPERVISION FEES
REFERRAL/COUNTER REFERRAL COSTS
44 060 453.00
30 233 800.00
DRUG
144 492 542.90
109 762 328.09
84 949 390.77
FOOD
315 713 568.00
274 215 849.00
114 413 739.00
27 078 497.00
22 369 828.00
24 992 876.00
5749 773.00
4890 020.00
6078 640.00
CLEANNESS OF CRENI
IEC & GARDENING
SOCIAL MOBILIZATION
FUEL
OTHER
9 308 070,00
12 494 400.00
217 000.00
25 899 890.00
26 447 550,00
21 339 900.00
-195 819.66
17 040 260.00
159 839.00
38 327 485.73
156 324 185.07
SMALL EQUIPMENT
SUPPLIES FOR LIGHTING
POTABLE WATER
CHANGE IN CRENI EQUIPMENT FOOD STOCKS
EQUIPMENT - FBE - REHABILITATION
SITES/SCHOOLS/COMMUNES
EQUIPMENT
0.00
EQUIPMENT FOR PNC SITES
1283 280.00
0.00
0.00
0.00
0.00
0.00
8993 400.00
0.00
15 400 000.00
1283 280.00
EQUIPMENT FOR PSN

FBE
0.00
FBE FOR PNC SITES

FBE FOR SCHOOLS PNS
49 699 750.00
13 829 570.00
2646 000.00
7354 480.00
3063 400.00
SPOT MAP
11 696 900.00
0.00
FBE FOR COMMUNES/REGIONS
16 818 800.00
3284 000.00
15 400 000.00
FBE - Region Haute Matsiatra

FBE Region Analanjirofo
REHABILITATION
0.00
REHABILITATION PNC SITES

TOTAL OF EXPENDITURES IMPLEMENTED
8314 785.00
0.00
8314 785.00
1520224 279.85
16,741,567 957.48
2009
Internal
resources
2010
Internal
resources
2868269 844.67
2011
Internal
resources
1526 900.00
1526 900.00
11,544,151
195.15
2012
Internal
resources
0.00
0.00
2263167 168.56
10,475,223
333.85
2013
Internal
resources
54
2014
Internal
resources
ACQUISITIONS OF FIXED ASSETS

TECHNICAL EQUIPMENT
3030 286.00
0.00
AUDIO VISUAL EQUIPMENT
4569 000.00
0.00
202 800.00
676 000.00
IT HARDWARE
38 506 739.10
2469 136.00
5217 600.00
3776 317.30
0.00
EQUIPMENT AND OFFICE FURNITURE
93 827 132.76
4566 661.98
1738 200.00
1643 500.00
150 000.00
7351 580.40
0.00
173 888.00
650 000.00
0.00
280 000.00
2067 900.00
0.00
200 000.00
150 002 638.26
7035 797.98
OTHER MATERIALS
VEHICLES
LAYOUT - FACILITIES AND INSTALLATIONS
TOTAL FIXED ASSETS
0.00
7332 488.00
34 000.00
0.00
6095 817.30
664 000.00
0.00
Expenditures implemented
LAND DEVELOPMENT
PUBLIC GARDENS
LI WORKS FOR PUBLIC GARDENS.
51 627 404.00
645 000.00
271 500.00
42 943 720.00
0.00
EQUIPMENT FOR PUBLIC GARDENS
3328 184.00
540 000.00
0.00
MATERIALS FOR PUBLIC GARDENS
2366 500.00
0.00
271 500.00
SUPERVISION FOR PUBLIC GARDENS
2989 000.00
105 000.00
0.00
PLAY GROUNDS
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
42 000.00
0.00
0.00
0.00
0.00
0.00
4369 800.00
0.00
0.00
0.00
0.00
0.00
0.00
MATERIAL FOR PLAY GROUNDS

LEISURE SPACES
LI WORKS FOR LEISURE SPACE
EQUIPMENT FOR LEISURE SPACE
SUPERVISION FOR LEISURE SPACE
OUTDOORS
LI WORKS FOR OUTDOORS.
EQUIPMENT FOR OUTDOORS
42 000.00
146 053 092.40
93 068 568.00
2158 000.00
5199 674.40
1510 800.00
MATERIALS FOR MATERIALS
37 371 300.00
120 000.00
SUPERVISION FOR OUTDOORS
10 413 550,00
581 000.00
IRRIGATION WORKS
IRRIGATION CHANNEL
LI WORKS FOR IRRIGATION CHANNELS.
1056061 732.16
0.00
722 600.00
1915 900.00
905 543 082.00
0.00
0.00
58 662 753.16
1261 900.00
1915 900.00
21 062 061.00
1984 500.00
0.00
70 793 836,00
0.00
DRAINS
LI WORKS FOR DRAINS.
212 599 820.60
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
186 256 093.60

3970 090.00
7218 590.00

HYDRAULIC STRUCTURES (Tarpaulin, flush
valve, siphon)
15 155 047,00
19 344 720.00
1260 000.00
1493 500.00
13 593 720.00
2997 500.00
55
DAM
LI WORKS FOR DAMS
4104 254.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
9636 600.00
6656 000.00
0.00
0.00
0.00
0.00
4844 370.00
18 375 658.00
0.00
0.00
1347 154.00
EQUIPMENT FOR DAMS
370 000.00
MATERIALS FOR DAMS
1802 300.00

URBAN DEVELOPMENT
LI WORKS FOR URBAN DEVELOPMENT
584 800.00
41 807 660.00
33 857 000.00
EQUIPMENT FOR URBAN DEVELOPMENT
1066 960.00
MATERIALS FOR URBAN DEVELOPMENT
6329 700.00
SUPERVISION FOR URBAN DEVELOPMENT

BUFFER BASINS (marsh)
BUFFER BASIN (Lake)
554 000.00
11 357 021,00
9668 971.00
120 000.00
131 050.00
1437 000.00

REFORESTATION
LI WORKS FOR REFORESTATION
8661 000.00
6556 000.00
EQUIPMENT FOR REFORESTATION
321 500.00
0.00
MATERIALS FOR REFORESTATION
568 100.00
100 000.00
SUPERVISION FOR REFORESTATION

EMERGENCY WORKS
86 000.00
102 232 572.00
0.00
0.00
87 352 772.00
2756 750.00
10 728 608.00
3020 900.00
0.00
436 200.00
1882 000.00
289 100.00
386 150.00
1798 520.00
6824 700.00

LATRINES
LI WORKS FOR LATRINES
9976 900.00
3402 873.00
0.00
0.00
0.00
0.00
0.00
5200 494.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
755 473.00
EQUIPMENT FOR LATRINES

MATERIALS FOR LATRINES
SUPERVISION FOR LATRINES
VILLAGE COMMUNITY GRANARIES
LI WORKS FOR VILL. COMM. GRANARIES
1883 400.00
764 000.00
5583 300.00
892 000.00
4336 700.00
EQUIPMENT FOR VILL. COMM. GRANARIES
472 000.00
-922 700,00
MATERIALS FOR VILL. COMM. GRANARIES
3142 100.00
530 494.00
SUPERVISION FOR VCG/LATRINES
481 000.00
840 000.00
SUPERVISION FOR VCG

CONSTRUCTION OR REHABILITATION:
THOROUGHFARES
596 200.00
416 000.00
RURAL ROADS
LI WORKS FOR RURAL ROADS
46 098 594.00
0.00
35 257 740.00
EQUIPMENT FOR RURAL ROADS
3706 604.00
MATERIALS FOR RURAL ROADS
1593 700.00
SUPERVISION FOR RURAL ROADS
5540 550.00
56
LANES
LI WORKS FOR LANES
22 139 700.00
0.00
0.00
5529 700.00
18 239 380.00
EQUIPMENT FOR LANES
969 520.00
0.00
MATERIALS FOR LANES
1904 800.00
4197 200.00
SUPERVISION FOR LANES
1026 000.00
PUBLIC RIGHT-OF-WAY
0.00
0.00
1267 500.00
65 000.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
56 578 030.00
11 727 303.00
210 000.00
0.00
11 228 246.00
0.00
LI WORKS FOR PUBLIC RIGHT-OF-WAY

EQUIPMENT FOR PUBLIC RIGHT-OF-WAY
MATERIALS FOR PUBLIC RIGHT-OF-WAY
SUPERVISION FOR PUBLIC RIGHT-OF-WAY
DIKE
DIKE LI WORKS.
DIKE MATERIALS
DIKE MATERIALS
DYKE MANAGEMENT
PUBLIC ROADS WHICH WIDTH <3 m
PUBLIC ROADS <LI 3M
EMERGENCY WORKS
42 484 990.00
0.00
0.00
5740 046.00
9888 020.00
5300 000.00
0.00
496 000.00
5039 160.00
210 000.00

WATER CAPTURE
4205 020.00
0.00
1388 143.00
4992 200.00
0.00
0.00
0.00
0.00
0.00
0.00
-457 589.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
48 665 961.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
LI WORKS FOR WATER CAPTURE.

WELLS
LI WORKS FOR WELLS
-164 089,00
EQUIPMENT FOR WELLS

MATERIALS FOR WELLS
-293 500,00
SUPERVISION FOR WELLS

GRAVITY WATER SUPPLY
LI WORKS FOR GRAVITY WATER SUPPLY
EQUIPMENT FOR GRAVITY WATER SUPPLY
MATERIALS FOR GRAVITY WATER SUPPLY
SUPERVISION FOR GRAVITY WATER SUPPLY
DRAINAGE CHANNELS
LI WORKS FOR DRAINAGE CHANNELS
EQUIPMENT FOR DRAINAGE CHANNELS
MATERIALS FOR DRAINAGE CHANNELS
SUPERVISION FOR DRAINAGE CHANNELS
CROSSING STRUCTURES
LI WORKS FOR CROSSING STRUCTURES
40 441 661.00
5848 300.00
275 300.00
2100 700.00
341 000.00
30 000.00
EQUIPMENT FOR CROSSING STRUCTURES
21 000.00
MATERIALS FOR CROSSING STRUCTURES
290 000.00
SUPERVISION FOR CROSSING STRUCTURES

PROTECTIVE STRUCTURES (retaining wall)
LI WORKS FOR PROTECTIVE STRUCTURES
EQUIPMENT FOR PROTECTIVE STRUCTURES
MATERIALS FOR PROTECTIVE STRUCTURES
4035 600.00
2565 000.00
30 000.00
1239 000.00
57
SUPERVISION FOR PROTECTIVE STRUCTURES

SANITATION STRUCTURES
201 600.00
0.00
0.00
0.00
0.00
0.00
0.00
675 546 603.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
48 826 819.00
0.00
0.00
2202 500.00
0.00
0.00
142 546 781.00
0.00
LI WORKS FOR SANITATION STRUCTURES

EQUIPMENT FOR SANITATION STRUCTURES
IRRIGATION CHANNELS
LI WORKS FOR IRRIGATION CHANNELS
545 785 039.00
31 584 090,00
20 010 704.00

DRAINS
LI WORKS FOR DRAINS
78 166 770.00
108 824 527.00
99 360 367.00
1251 000.00
1266 100.00

HYDRAULIC STRUCTURES (tarpaulin, flush
valve, siphon)
6947 060.00

DAM
LI WORKS FOR DAMS
17 388 551.00
10 310 450.00
63 000.00
4962 901.00
2052 200.00
45 575 730.00
26 486 140,00
EQUIPMENT FOR DAMS
1073 200.00
MATERIALS FOR DAMS
11 092 440.00

OTHER
6923 950.00
LABOR INTENSIVE WORKS

EQUIPMENT AND MATERIALS
SUPERVISION
SOCIAL SUPPORT ACTIONS
EMERGENCY WORKS
45 010 179.00
1495 000.00
2134 200.00
1682 440.00
140 000.00
3 500,00

HOUSEHOLD FOOD SECURITY (HFS)
564 000.00
11 497 950.00
86 070 368.00
58 425 990.86
261 031 007,00
HFS: LI WORKS.
7955 050.00
38 041 385.00
14 448 250.00
33 942 208.00
2172 150.00
HFS: TRANSPORT EQUIPMENT
1153 500.00
5373 723.00
7962 751.86
4835 250.00
3542 000.00
HFS:-MATERIALS-SEED-TRANSPORT
792 000.00
21 229 150.00
11 107 600.00
23 343 760.00
7047 260.00
1568 400.00
19 346 160.00
24 283 589.00
46 838 564.00
28 085 690.00
29 000.00
2079 950.00
623 800.00
3298 150.00
292 000.00
31 973 000.00
5829 000.00
HFS: LAYING HENS: FEED
2350 040.00
4709 963.00
HFS: LAYING HENS: TREATMENT
1113 600.00
76 000.00
13 133 575.00
15 101 223.00
72 000.00
514 100.00
42 672 700.00
38 711 780.00
HFS: SUPERVISION
HFS: MISCELLANEOUS
HFS: LAYING HENS
HFS: HEN
HFS: - HEN - COACHING & TRAINING

HFS: - HEN - MISCELLANEOUS
HFS: VLP
HFS: VPL: AWARENESS, COACHING, TRAINING
58
HFS: VPL: ALLOWANCES OF ACTORS
8640 000.00
8160 000.00
HFS: VPL - COOKING DEMOS
31 803 780.00
25 364 680.00
10 608 960.00
1815 160.00
SUPPORT
6405 420.00
1125 775.00
43 454 925.00
11 878 950.00
DATABASE
CAPACITY-BUILDING
149 673 070.80
18 422 220.00
15 264 050.00
382 100.00
0.00
0.00
0.00
0.00
STAFF TRAINING
28 789 863.00
1828 170.00
2906 000.00
7820 820.00
8692 100.00
M&E AND SUPERVISION
131 012 969.00
3321 140.00
6980 800.00
10 000.00
42 000.00
ARM ACTIVITY
253 008 074,00
152 495 447.00
50 635 485.00
83 330 870.29
TECHNICAL AND FINANCIAL AUDITS

FOOD AND NUTRITIONAL MONITORING
12 967 300.00
131 675 026.80
166 857 740.00
146 801 100.00
83 519 247.00
950 000.00
102 605 000.00
1656 400.00
0.00
5763 550.00
369 600.00
0.00
MATERIALS FOR NUTRITIONAL STATUS Monit

OTHER
ACCELERATING MALNUTRITION REDUCTION
140 000.00
34 294 500.00
-961 350,00
2 000,00

COMMUNICATION STRATEGY
PERIODIC JOURNAL
TEE SHIRT - VISOR - CAP
123 092 261.00
47 430 608.52
6195 827.12
25 654 008.88
0.00
20 000.00
0.00
0.00
680 400.00
825 000.00
650 000.00
4507 500.00
22 320 000.00
0.00
FLAG SMALL FLAG - BASE
1408 536.00
503 200.00
0.00
78 000.00
20 400.00
BANNER
1418 200.00
7680 000.00
0.00
710 000.00
160 000.00
LOGO
2376 600.00
1 646 916.52
0.00
0.00
0.00
0.00
12 158 400.00
0.00
0.00
0.00
PRODUCTION OF VIDEO "HETSORO"
68 675 928.00
4707 000.00
1596 000.00
0.00
0.00
CONTEST AND INCENTIVES "HETSORO"
14 283 105.00
2137 000.00
0.00
0.00
400 000.00
PERIODIC JOURNAL "HETSORO"
34 542 000.00
0.00
0.00
0.00
0.00
OTHER
16 303 060.00
80 000.00
134 060.00
1610 000.00
100 000.00
CHANGES IN "COMMUNICATIONS" STOCKS
16 740 168.00
17 848 092,00
-41 732.88
936 008.88
0.00
CALENDAR
0.00
0.00
BEHAVIOUR CHANGE COMMUNICATION

WORKSHOP - SEMINAR -COLLOQUIUMS
WORKSHOP
SEMINAR
SYMPOSIUM
NATIONAL NUTRITION DAY
RADIO BROADCAST
1345 800.00
1345 800.00
324 189 332.88
194 500.00
194 500.00
197 517 927.00
700 000.00
9642 656.00
147 151 822.80
403 398 701.00
99 584 755.00
263 170 513.80
77 117 460.00
0.00
0.00
1241 175.00
0.00
7877 200.00
240 000.00
0.00
0.00
0.00
0.00
58 614 815.00
46 325 892.80
140 228 187.20
127 184 748.00
2462 020.00
TRAINING MATERIALS FOR PARTNERS

TRAINING MATERIALS FOR ACNs/PNNC
60 960 832,00
817 200.00
301 000.00
817 200.00
7886 520.00
301 000.00
945 000.00
303 924.00
268 000.00
0.00
303 924.00
13 257 800.00
7928 820.00
0.00
12 887 800.00
40 000.00
0.00
70 000.00
0.00
0.00
292 650.00
0.00
0.00
0.00
0.00
0.00
0.00
517 500.00
0.00
0.00
0.00
INTERNAL STAFF TRAINING
0.00
0.00
300 000.00
IEC MATERIALS FOR TRAINERS
0.00
875 000.00
0.00
0.00
268 000.00
332 650.00
49 600.00
3435 180.00
0.00
0.00
56 858 552.00
TRAINING MATERIALS FOR LEADERS/PNNC

TRAINING MATERIALS FOR NGO/ACC;/PNNC
SUPPORT TRAINING OF MAYORS,PCC, NGOs,
ACCOUNTANTS
212 179 408.00
108 749 444.00

2462 020.00
0.00
90 000.00
138 903 112.00
0.00
MEDIA TRAINING
90 000.00
215 199 888.88
MUSICAL GROUP
RADIO BROADCAST
9642 656.00
700 000.00
59
0.00
OPERATIONAL RESEARCH
OTHER MATERIALS
0.00
42 300.00
0.00
70 000.00
100 000.00
SENSITIZATION
140 721 474.00
0.00
15 268 285.00
1750 716.00
3214 700.00
3431 000.00
SENSITIZATION OF PARTNERS
9801 340.00
4715 020.00
106 800.00
886 850.00
2606 000.00
SENSITIZATION OF NGOs
9126 925.00
944 700.00
-464 700,00
102 500.00
353 000.00
SENSITIZATION OF LOCAL SUPERVISORS
0.00
0.00
0.00
0.00
0.00
SENSITIZATION OF TRAINERS
SENSITIZATION, ANIMATION AND
IDENTIFICATION
0.00
0.00
0.00
0.00
0.00
TRAINING
TRAINING OF PARTNERS
121 793 209.00

126 942 577.68
9608 565.00
2681 000.00
2108 616.00
9465 920.00
2225 350.00
28 812 335.00
108 860 025.80
2681 000.00
9465 920.00
28 812 335.00
TRAINING OF TECHNICAL OFFICERS
3969 470.00
0.00
0.00
0.00
TRAINING OF LOCAL SUPERVISORS
7208 975.00
0.00
472 000.00
41 789 000.00
0.00
41 789 000.00
0.00
INTERNAL TRAINING FOR STAFF

EXTERNAL TRAINING FOR STAFF
PROFESSIONAL DEVELOPMENT (PD)
6904 106.88
2807 000.00
DEVELOPMENT OF LOCAL SUPERVISORS
917 300.00
0.00
0.00
597 925.00
0.00
97 000.00
DEVELOPMENT OF SCHOOL PRINCIPALS
0.00
25 000.00
CAPACITY BUILDING IN ENA

CONTEST AND INCENTIVES
336 500.00
1926 000.00
123 800.00
DEVELOPMENT OF ACNs
0.00
DEVELOPMENT OF NGOS
0.00
0.00
335 000.00
525 425.00
DEWORMING
881 000.00
OTHER IEC
72 500.00
0.00
MINISTRY OF HEALTH
13 561 166.00
THEME DAYS
3571 040.00
MONITORING AND EVALUATION

OTHER
MINISTRY OF EDUCATION
SCHOOL MEALS
16 565 368.00
3186 450.00
76 382 892.80
4421 080.00
3186 450.00
1195 780.00
0.00
0.00
0.00
8794 346.00
12 144 288.00
0.00
687 100.00
9673 035.00
936 600.00
0.00
0.00
75 695 792.80
8218 250.00
7930 250.00
4254 750.00
9917 710.00
9517 140.00
PNAS
4434 697.00
896 600.00
0.00
0.00
OTHER
5238 338.00
40 000.00
288 000.00
400 570.00
MINISTRY OF AGRICULTURE AND LIVESTOCK
2053 800.00
0.00
1418 630.00
MAEP/GRAAM
FOOD SECURITY
WORLD FOOD DAY
2053 800.00
THEME DAY
SOCIAL PROTECTION
OTHER
PRIME MINISTERS OFFICE/MINISTR OF
FINANCE
105 000.00
0.00
119 000.00
76 000.00
0.00
80 400.00
60 000.00
0.00
0.00
0.00
19 674 000.00
1181 000.00
383 360.00
6900 175.00
1195 800.00
4643 200.00
809 600.00
383 360.00
6900 175.00
210 000.00
15 000 000.00
0.00
0.00
0.00
0.00
30 800.00
371 400.00
0.00
0.00
985 800.00
311 192 207.00
JOINT MISSION
OTHER
136 000.00
1418 630.00
WORLD RURAL WOMEN DAY

MINISTRY OF POPULATION
304 400.00
0.00
4254 750.00
50 222 533.00
3360 000.00
6457 200.00
0.00
0.00
1404 000.00
6523 398.00
1842 000.00
0.00
0.00
304 668 809.00
48 380 533.00
3360 000.00
5053 200.00
14 028 930.00
14 028 930.00
60
0.00
0.00
MINISTRY OF DECENTRALIZATION AND

OTHER PARTNERS
OTHER
4411 600.00
4411 600.00
FOOD
FOOD
158 430 200.00

53 655 200.00
TRANSPORT OF FOOD COMMODITIES

DRUGS
IRON FOLATE
104 775 000.00

238 357 700.00
595 916.00
595 916.00
3336 542.67
2688 000.00
648 542.67
236 086 510.00
112 663 760.00
225 000 000.00
2200 000.00
11 086 510.00
780 700.00
780 700.00
5264 112.31
8152 800.00
8152 800.00
7776 425.00
0.00
7776 425.00
0.00
0.00
0.00
144 780.00
0.00
0.00
798 000.00
0.00
1598 000.00
3666 112.31
701 220.00
MEBENDAZOLE
DRUG
SPIRULINE
TRANSPORT OF DRUGS
CHANGES IN DRUG STOCKS
EQUIPMENT FOR NGOs/SITES/COMMUNES
123 493 940.00

1195093 609.88
MOTORCYCLE
764 212 391.42
822 000.00
24 000.00
-120 780,00
120 780.00
52 597 370.00
1031 501.78
0.00
0.00
0.00
0.00
0.00
0.00
SALTER SCALE
0.00
0.00
0.00
HANGING TROUSERS/ BABY SCALE
0.00
0.00
0.00
GROWTH CARD
0.00
0.00
0.00
4 000.00
0.00
7700 000.00
0.00
0.00
0.00
678 600.00
0.00
0.00
0.00
680 000.00
0.00
1207 169.88
740 974 231.42
50 040 970.00
6808 898.22
119 394 040,00
22 396 760.00
1876 400.00
140 400.00
90 000.00
158 800.00
0.00
0.00
BICYCLE
600 000.00
REGISTER
HEALTH CARD
MATERIALS AND TOOLS FOR SITES
MATERIALS AND TOOLS FOR SCHOOLS
CHANGES IN EQUIPEMENT STOCK FOR/NGOSITES-COMMUNITIES
TRANSPORT OF EQUIPMENT FOR
NGOs/SITES/COMMUNITIES
OTHER
SURVEYS
1073802 400.00
4647 000.00
6000 000.00
DIETARY SURVEY
ANTHROPOMETRIC SURVEY
EVALUATION SURVEY
2408 300.00
6000 000.00
SMART SURVEY
NGO QUANTITATIVE SURVEY
2238 700.00
TECHNICAL ASSISTANCE
2741925 862.17
PERMANENT NATIONAL ASSISTANT
2730655 862.17
3058558 444.16
TEMPORARY ASSISTANT NATIONAL
11 270 000.00
52 757 166.67
OPERATING ACTIVITIES
A. GRADUAL TRANSFORMATION OF OLD
SITES
COMPENSATION FOR POS
6680016 948.91
3111315 610.83
5322069 474.92
20 750.00
242 355 594.00
0.00
0.00
48 000.00
750 000.00
0.00
0.00
0.00
0.00
242 355 594.00
20 750.00
0.00
0.00
0.00
0.00
0.00
3974986
921.13
3781766 633.70
2927043 548.67 3970306 134.87
3778934 984.56
2928843 548.67
1800 000.00
4680 786.26
4815225 406.14
6305933
580.50
2831 649.14
4154615 467,50
337 497 500.00
1400 000.00
118 185 000.00
288 940 000.00
240 000.00
80 000.00
0.00
0.00
COMPENSATION FOR ANIMATORS

COMPENSATION FOR MONITORING STAFF
589 600 950.00
533 175 000.00
285 797 500.00
685 888 720.00
150 920 000.00
3664 000.00
4800 000.00
4522 000.00
2955370 000.00
3297810 000.00
3290172 500.00 3270890 000.00
2545730 000.00
COOKING DEMOS
520 462 118.00
570 684 060.00
639 565 409.00
518 098 209.00
350 500 110.00
1687 500.00
27 513 800.00
10 582 100.00
331 996 952.60
0.00
34 422 500.00
193 789 449.60
1880 000.00
9700 000.00
100 000.00
0.00
COMPENSATION FOR ACCOUNTANTS
VEGETABLE GARDEN
TRAVEL EXPENSES FOR PO
COMPENSATION FOR PILOT NGO PO
204 585 000.00

476 725 000.00
23 484 300.00
61
0.00
COMPENSATION FOR PILOT NGO ACCOUNT;

FUEL AND LUBRICANTS FOR ACCOUNTANT
1640 000.00
0.00
0.00
0.00
696 318 197.00
563 736 792.00
135 989 399.00
589 246 289.00
162 959 762.00
80 332 543.01
3675 120.00
4441 100.00
12 969 580.00
0.00
0.00
0.00
FUEL FOR MONITORING STAFF

800 000
TRAVEL EXPENSES FOR MONITORING STAFF

133 051 871.67
MONITORING STAFFS MOTO MAINTENANCE
36 598 579.00
180 000.00
0.00
70 731 049.63
2125 200.00
57 030 820,00
141 500.00
0.00
0.00
-661 000.00
SUPERVISION
829 204 117.74
462 195.75
261 808 075.14
669 370 845.04
373 453 794.61
MISCELLANEOUS
282 747 241.90
346 920.89
3821 255.53
1344 090.00
12 452 047.86
DEVELOPMENT OF ACNs
187 000.00
0.00
0.00
DEVELOPMENT OF ANIMATORS
602 000.00
10 522 813.00
404 000.00
DEVELOPMENT OF NGOs/PO /ACCOUNTANT
0.00
160 000.00
0.00
TRANSPORT OF SEVERELY MALNOURISHED
CHILDREN
0.00
0.00
0.00
B. STEERING OF REGIONS
TRAINING OF STEERING COMMITTEE SPOT
MAP (CCD-Relay-Facilitator-Supervisor)
DATA COLLECTION - OPERATION WRITING
OF DRAFT
0.00
152 220 706.05
2983 193.00
0.00
0.00
0.00
0.00
0.00
INTERPRETATION
DEVELOPMENT OF SPOT MAP
OFFICIAL PILOT SITE LAUNCH
NGOs
COMPENSATION OF SUPERVISOR
7460 000.00
0.00
COMPENSATION OF ANIMATOR
360 000.00
0.00
COMPENSATION OF ACCOUNTANT
360 000.00
0.00
14 870 000.00
40 000.00
TRAVEL EXPENSES OF SUPERVISOR
1392 000.00
0.00
TRAVEL EXPENSES OF ANIMATOR
672 000.00
0.00
TRAVEL EXPENSES OF FACILITATOR
2672 000.00
0.00
SUPERVISION FEES
8575 300.00
0.00
MISCELLANEOUS
2187 100.51
150 193.00
COMPENSATION OF FACILITATOR
COMMUNE
BASIC TRAINING (Relay-FacilitatorSupervisor-NGO Nutrition Officer)
3679 440.00
0.00
10 280 000.00
520 000.00
6760 000.00
360 000.00
COMPENSATION FOR RELAY
39 822 000.00
680 000.00
TRAVEL EXPENSES FOR ACNs
10 290 000.00
0.00
1828 000.00
108 000.00
747 000.00
0.00
TRAVEL EXPENSES FOR RELAY

COOKING DEMOS
17 549 976.76
0.00
SUPERVISION FEES
15 486 642.00
1125 000.00
3340 807.08
0.00
MISCELLANEOUS
ADDITIONAL TRAINING ON SPOT MAP FOR
STEERING COMMITTEE
DEVELOPMENT OF ACTORS (RELAYFACILITATORS- ...)
0.00
0.00
0.00
360 000.00
62
0.00
360 000.00
360 000.00
1350 000.00
COOKING DEMOS
387 500.00
108 000.00
TRAVEL EXPENSES FOR ANIMATOR
108 000.00
SUPERVISION
765 000.00
SUPERVISION FEES FOR COMMUNES
89 939.70
SUPERVISION FEES FIR FOKONTANY

C. EXPANSION TO NEW SITES
TRAINING OF ACNs
TRAINING PO/NGO/ANIMATOR
COMPENSATION FOR PO
COMPENSATION FOR ACNs
687 531 750.43
2512 021.25
11 878 040,00
0.00
209 500.00
0.00
43 600 000.00
0.00
360 000.00
0.00
55 960 000.00
240 000.00
0.00
307 646.40
47 301 012,00
278 142 500.00
1260 000.00
COOKING DEMOS
48 805 000.00
455 000.00
FUEL AND LUBRICANTS FOR PO
43 819 781.60
0.00
22 891 087,00
FUEL AND LUBRICANTS FOR ANIMATOR
67 067 967.20
72 000.00
24 409 925.00
0.00
0.00
16 967 927.26
0.00
SUPERVISION FEES
82 306 209.32
395 021.25
MISCELLANEOUS
38 414 825.05
90 000.00
DEVELOPMENT OF ACNs
0.00
307 646.40
0.00
DEVELOPMENT OF NGOs/PO/ACCOUNTANT
NUTRITIONAL EMERGENCIES
0.00
41 619 760.00
38 712 300.00

FOOD
EMERGENCY EQUIPMENT
NON-FOOD ITEMS
LOCAL TRANSPORT
NATIONAL SUPPORT STAFF
100 000.00
23 696 981,00
50 000.00
0.00
21 040 130,00
20 946 800.00
0.00
0.00
0.00
592 500.00
0.00
0.00
150 000.00
5830 800.00
50 000.00
0.00
0.00
51 500.00
0.00
0.00
128 800.00
0.00
0.00
163 350.00
20 300 830.00
11 290 700.00
164 400.00
0.00
164 400.00
23 533 631.00
CRENA/CRENI
CRENA
FOOD
9841 740.00
4449 000.00
201 200.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
262 026 449,02
86 738 001.04
0.00
0.00
30 800.00
30 000.00
201 200.00
0.00
0.00
0.00
7006 400.00
4419 000.00
0.00
CRENA TRAINING
2804 540.00
0.00
REHABILITATION
CRENI
20 428 165,35
EQUIPMENT - MATERIAL-FOOD
1920 695.68
144 900.00
FOOD
4615 065.35
1301 795.68
FOOD TRANSPORT
1105 100.00
474 000.00
DRUGS
0.00
REHABILITATION
0.00

CRENI OPERATION
PERSONNEL COSTS
0.00
14 708 000.00
802 069 038.89
324 491 993.60
432 654 427.00

238 172 829.93
177 034 048,00
42 106 313.00
63
MANAGEMENT FEES
51 354 096.74
44 352 795.10
32 420 021.14
5283 857.38
111 500.00
2847 743.37
2071 678.71
457 476.72
REFERRAL/COUNTER REFERRAL COSTS
21 178 463.00
12 116 100.00
6614 080.00
2091 600.00
DRUG
80 802 254.00
45 939 986.00
17 653 630.00
2580 818.00
FOOD
86 920 910.00
51 886 688.25
25 063 415.00
8818 334.00
CLEANNESS OF CRENI
25 608 577.00
6854 255.00
3692 006.00
916 610.00
5595 228.00
3281 999.00
1387 750.00
2652 600.00
49 500.00
164 700.00
175 950.00
5 600,00
17 982 790.00
8617 500.00
4257 750.00
1051 100.00
3544 800.00
11 626 086.00
2198 450.00
9893 272.00
SUPERVISION FEES
IEC & GARDENING

SOCIAL MOBILIZATION
FUEL
OTHER
SMALL EQUIPMENT
0.00
SUPPLIES FOR LIGHTING
0.00
POTABLE WATER
0.00
CHANGE IN CRENI EQUIPMENT FOOD STOCKS

EQUIPMENT - FBE - REHABILITATION
SITES/SCHOOLS/COMMUNES
EQUIPMENT
184 428 926.55
99 950.00
6793 744.35
0.00
10 542 329.83
10 880 419.94
0.00
0.00
0.00
0.00
0.00
0.00
4886 500.00
0.00
EQUIPMENT FOR PNC SITES

EQUIPMENT FOR PSN
99 950.00
FBE
2679 300.00
267 700.00
FBE FOR PNC SITES
0.00
FBE FOR SCHOOLS PNS
4886 500.00
8 500,00
SPOT MAP
0.00
FBE FOR COMMUNES/REGIONS
0.00
FBE - Region Haute Matsiatra

FBE Region Analanjirofo
REHABILITATION
0.00
2679 300.00
0.00
259 200.00
0.00
0.00
REHABILITATION OF PNC SITES

TOTAL OF EXPENDITURES IMPLEMENTED
17,392,778
079.20
10,689,537 276.29
8451231 234.92
8489 200.00
8489 200.00
11,659,375
028.82
0.00
0.00
8707847 415.00
0.00
64
Detailed description of the methodological approach for data collection and processing
Choice of the two regions based on funding characteristics
The region of Boeny was selected by the PER team among the regions where community-based nutrition
sites are supported only with internal resources. Community sites in two districts of the region, namely
Mitsinjo and Soalala that benefit from support from the USAID-funded Mahefa program, were excluded
from the selection of sites/ACNs to survey.
However, in practice, no funding for activities in these two districts go through the Boeny Regional
Nutrition Office (ORN).
The Amoroni Mania region was recommended by the U-PNNC among the five regions currently supported
by the PAUSENS project to represent community-based nutrition sites benefiting from external support
under the case study.
The lists of community-based nutrition sites and ACNs in these two regions were requested and obtained
from ONN.
Mission plan:
The terms of reference for the field mission to collect information from the ORNs in the two regions were
drafted and approved (see Annex). They set forth the information to be collected from the ORNs and
included the development of corresponding tools, namely interview guides for the Regional Coordinators,
the Administrative and Financial Officers (AFO), the Community-based nutrition program Officer (CPNNC), animators (in focus groups), NGOs Program Manager (PO) NGOs, monitoring staff (ES) of the ORNs
as well as a questionnaire in Malagasy to be completed by the ACNs selected.
The mission schedule was set and agreed with the CR of each ORN.
Method for selecting representatives of ACNs
Table 13: Sampling
Regions
Number of
districts
Number of
communities
reached
Number of
sites
Number of
ACNs
ACNs to
select
Amoroni Mania
54
331
331
25
Boeny
28
176
176
25
Source: ONN
Lot Quality Assurance Sampling (LQAS) was used to select community sites to represent each region in
the comparative study. When using LQAS to compare two lots (two regions in our study), a selection of
19 units (community sites) to survey is required to achieve representativeness.
In each of the two regions, we selected 25 community sites,4 thus providing for a margin, and the
corresponding ACNs to participate in survey questionnaires. The selection was made respectively from
the list of sites/ACNs: we first randomly selected a number ranging from 1 to n (n being the total number
or community-based nutrition sites per region) to be the first element selected then calculated the
LQAS allows for processing a sample of 12 to 30 elements in a lot.
65
increment by dividing the total number on the list by 25. The remaining sites were selected by applying
the increment until we got 25 sites/CAN taking part in the study.
The list of sites/ACNs thus selected was forwarded to the ORN Coordinator via the central ONN, for them
to organize the gathering of ACNs in the region capitals.
Organizing the gathering of ANCs
ACNs from the selected sites were gathered at the regional capitals to complete the questionnaires
designed to collect information on them, their sites and their work. Half a day was sufficient to administer
the questionnaire to ACNs. ACNs completed the questionnaire themselves in Malagasy after the
consultant explained each question.
ORNs compliance with the sampling of sites/ACNs:
ORN in Boeny: out of the 25 sites/ACNs initially selected in the Boeny region, four (4) were absent and
were replaced upon a proposal by the RC.
ORN of Amoroni Mania: out of the 25 sites/ACNs initially selected in Amoroni Mania region, two (2) were
absent and the remaining 23 sites were those that appeared in the original selection list.
Site visits
The collection of information from the ORNs was supplemented with visits to two community-based
nutrition sites in each region. The sites visited were selected by the ORN/C-PNNC based on accessibility
criteria since the time allotted for the visit was only half a day, the goal being to have an overall assessment
of how well the sites operate. We were able to observe education sessions for target groups (mothers
with infants), weighing sessions, registers and planning tools, communication activities, and monitoring
of ACNs.
The two sites visited in Amoroni Mania (1- site of Zanaposa, Commune of Tsarasaotra, District of
Ambositra, with Jeannie as ACN, 2- site of Soavina, Commune of Ilaka Centre, District of Ambositra), were
conducting activities at the time of our visit. See annex for documentation on these sites.
The two sites visited in Boeny (1 - site of Ambohimandamina, Commune of Mahajanga I with Augustine
as ACN, 2- site of Mahabibokely, Commune of Mahajanga I with Charifa as ACN), were not conducting
activities on the day of our visit. However, the deputy head of the Fokontany of Mahabibokely was present
during our visit and discussed with us on the communities contribution and expectations as regards
community-based nutrition sites.
Entering ACNs questionnaires and data processing according to the LQAS methodology
In all, 25 questionnaires were completed by ACNs in Boeny and 23 by ACNs in Amoroni Mania. The data
in the questionnaires were entered in an Excel spreadsheet. The standards were defined in reference
either to the average of respondents' answers (e.g. the ACNs average age was calculated to be 7 years),
or to objective data known (e.g. amount of ACNs compensation set at MGA 50,000). Responses were
then counted and interpreted according to the LQAS data processing tool to determine the percentages
of the responses estimated against standards.
66
Raw results from the processing of questionnaires

Number in
Amoroni
Mania
ACNs in service for at least 7 years (average
years)
14
Estimated %
in Amoroni
Mania
Estimated %
in Boeny
17
75
80
13
70
45
15
7
23
23
19
10
7
13
23
21
75
45
95
95
90
21
11
95
55
40
65
95
95
10
55
23
24
95
95
6
22
13
22
1
17
24
21
20
5
40
95
70
95
20
80
95
95
90
35
23
19
95
85
Amount of ACNs monthly compensation

compliant with standard
Received compensation last month
23
17
25
0
95
85
95
10
Received support from the communes mayor

municipality and/or the head of fokontany
Received support from a private individual
8
17
0
0
50
85
10
10
Time dedicated by ACNs to the activities of the

nutrition site up to standard
12
22
65
95
ACNs other income to pay their personal needs

and dependents needs
Waged work
Agriculture
Livestock
Trade
0
23
20
1
1
19
12
7
15
95
95
20
15
85
60
40
Walking distance to the communes capital

(duration in hours) equal or above average (2.4)
Number of children under 5 years monitored at
the site equal or above average (214)
Had a stand-alone premise
Had at least one room
Was opened last month
Was opened last week
Activities in the previous month
Cooking demonstration
Growth monitoring for children
under 2
Growth monitoring for children 2 to
5
Home visits
Visit to the CSB
Nutritional education for mothers
Nutritional education for girls
Reported activities carried out in the month
before the survey
Number in
Boeny
67
Terms of reference for the field data collection mission

Case Study on nutrition/public expenditure: In-depth analysis on improving the efficiency and
sustainability of funding for community-based nutrition sites in Madagascar.
Terms of reference of field missions
Purpose: Collect information from two regions differing by the type of funding for their community-based
nutrition sites: one region is funded under the PAUSENS project and one is entirely funded with internal
resources (i.e. without external support credit).
Field activities:
- At the regional region:
Visit ORN, conduct interviews ORN Coordinators, Administrative and Financial Officers, Nutrition
Officer,
Collect reports on ORNs implemented expenditure (2012, 2013, 2014), and the specific reports
of the sites to visit (2014).
Collect copies of the latest funds allocation operations and uses of funds
Conduct focus group discussions with monitoring staff, facilitators, and program managers (NGOs
PO)
Gather ACNs representing the community-based nutrition sites from the region
Administer to ACNs a questionnaire on the functioning of community-based nutrition sites and
their resources
-
Visit some community-based nutrition sites

Condition of the site, most recent activities
Communities contribution/involvement of the head of fokontany
ACNs resources.
Selection of regions to visit:

- 1 ORN funded by the PAUSENS project: Amoron'i Mania (as recommended by the U-PNNCs AFO):
the ORN is among the 5 regions benefiting from PAUSENS funding, as well as from additional funding
to implement the Household Food Security (HFS) promotion at the sites.
- 1 ORN funded entirely with internal resources without external support credit to be selected from
the identify which of the 3 regions: Boeny (except districts Soalala and Mitsinjo), Sofia and Betsiboka
Date of trips: To be coordinated with ORNs (need to convene representatives of ACNs at the regional
capital), some time from December 8 to 15, 2014.
Duration of mission: estimated at 3 days per region.
Transportation:
to Amoron'i Mania by car
to Boeny by plane
Cash requirements for partners: 2 * 25 ACNs for inter-district trips
68
Table 1: Sites planned to visit (highlighted) and number of ACNs to select per session
Regions
Amoroni Mania
Betsiboka
or SOFIA
Boeny
Number of
Number of communities Number of Number of
districts
reached
sites
ACNs
4
54
331
331
3
25
122
122
7
58
342
342
5
28
176
176
ACNs to
select
25
25
25
25
Interviews guide for ORNs:

- Organizational chart of the ORN and number of employees
- Details on the structure that supervises community-based nutrition sites
- Review of ORNs reports on community-based nutrition sites: month/year, indicators, expenditure
implemented
- Review of the ORNs financial report (if available)
- Amount of funds allocated to the ORN including those for community-based nutrition sites
activities according to the various expenditure lines: years 2007 to 2014.
- Illustration of the funds receipt mechanisms in 2014: number of occurrences, procedures and
deadlines.
- Illustration of the fund use mechanism for community sites in 2013 and 2014: number of
occurrences, procedures and deadlines.
- Payment of compensation: NGOs PO, monitoring staff, Animators, ACNs
- Through NGOs or administered directly by ORN
- Assessment of the functioning of sites under ORNs supervision
- Identification of sites to visit under the case study
Information to be collected from ACNs: a questionnaire in Malagasy will be administered to ACNs.
- ACNs name, site, district,
- ACNs seniority
- Features of their sites : location, access, number of children under 5 years monitored at the sites,
physical description of premises, functioning (last opened)
- Activities carried out in the previous month (October 2014)
- Activity report prepared and forwarded for previous month
- Amount of ACNs compensation, month of last payment.
- Value or quantity of inputs by type of activities carried out, source of the inputs
- Other activities that do not require input: frequency/number performed last month
- Support from the head of fokontany in 2013 and 2014: head of fokontanys name, date/month,
description, quantity or value
- Support from the communes mayor in 2013 and 2014: the mayors name, date/month, description
or value, value
- Support from the community: date/month, description, quantity or value
- Other support received by an organization: date/month, description, quantity or value
- Time regularly dedicated by ACNs to nutrition site activities: number of half-days per week
69
ACNs other income for their personal needs and dependents needs: waged work, agricultural
work for self-consumption.
70
Fanadihadiana atao aminny ACN : Fanontaniana aminny teny malagasy hofenoinny ACN.
1. Anaranny ACN :
2. Toby :
3. Fokontany :
4. Kaominina :
5. Distrika :
6. Firy taona no naha-ACN anao ? :

7. Ny mombamomba ny Toby :
7.1. Halaviranny Toby miala eo aminny kaominina (faharetanny dia - ora) :
7.2. Isanny ankizy latsaky ny 5 taona arahi-maso ao aminny toby :
7.3. Ny mombamomba ny trano iasana :

7.3.1. Trano mitokana Eny
Tsia
7.3.2. Firy ny efitrano iasna: .
7.3.3. Daty voalohany nisokafanny toby : ..
7.3.4. Daty farany nisokafanny toby : .
8. Inona avy ny asa notanterahinao taminny volana lasa (Novambra 2014) :
8.1. Dmonstration culinaire
8.2. Fanaraha-maso ny fitombonny zaza latsaky ny 2 taona
8.3. Fanaraha-maso ny fitombonny zaza 2 hatraminny 5 taona
8.4. VAD
8.5. Mandeha eny aminny CSB
8.6. Fanabeazana ara-tsakafo ny renin-jaza
8.7. Fanabeazana ara-tsakafo ny tovovavy
8.8. Hafa :
9. Volana farany nanaovana sy nandefasana tatitra isam-bolana momba ny asa vita :
10. Ohatrinona ny tambikarama raisinny ACN isam-bolana : Ariary

11. Volana farany nandraisana tambikarama : Volana Taona
12. Ohatrinona (sarany) na fatrany (quantit) mikasika ny akora ilaina voaray isaky ny
karazanasa natao sy ny fiavianireo akora :
Sarany
Karazanireo akora
Fatrany
Fiavianireo akora
(Ariary)
71
1
2
3
4
5
6
7
8
9
10
11
12
13
14
15
13. Karazanasa notanterahina tsy mila akora :

Fisehoany isanKarazanasa
kerinandro
1
Isanny vita taminny volana lasa

(novambra 2014)
2
3
4
5
72
14. Fanampiana azo avy aminny Filohanny Fokontany taminny taona 2013 sy 2014 :
Anaranny filohanny
Filazalazana momba ny
Fatra na sarany
Daty
fokontany
fanampiana
(Ariary)
1
2
3
4
5
6
15. Fanampiana azo avy aminny Benny Tanna (Maire) taminny taona 2013 sy 2014 :
Anaranny Benny
Fatra na sarany
Daty
Tanna (Maire)
fanampiana
(Ariary)
1
2
3
4
5
6
16. Fanampiana azo avy aminny fokonolona taminny taona 2013 sy 2014 :
Fokonolona
Daty
fanampiana
1
Fatra na sarany
(Ariary)
2
3
4
5
6
73
17. Fanampiana hafa azo avy aminny fikambanana taminny taona 2013 sy 2014 :
Fatra na sarany
Anaranny fikambanana
Daty
fanampiana
(Ariary)
1
2
3
4
5
6
18. Fotoana lany isan-kerinandro aminny fanatanterahana ny asa maha-ACN : Tapakandro firy
no iasana isan-kerinandro
19. Misy Fidiram-bola hafa ve fivelomanny ACN :
19.1. Asa andraisam-bola (lazao) : . Vola miditra isam-bolana: .
Ariary
19.2. Asa fambolena sy fiompiana :
Vola miditra isan-taona
Asa fambolena sy fiompiana
(Ariary)
1
2
3
4
5
6
Daty namenoana fanadihadiana :
Misaotra Tompoko !
74
Information to be collected from ACNs: a questionnaire in Malagasy will be administered to ACNs.

1. ACNs Name:
2. Site: .
3. Fokontany: ...........
4. Commune:
5. District:
6. How many years have you been an ACN? ....................................................................................
7. Features of the site:
7.1. Walking distance from the communes capital (duration in hours): ................................
7.2. Number of children under 5 years monitored at the site: ................................................
7.3. Physical description of premises:
7.3.1. Stand-alone premises Yes
No , Number of rooms: ........................................
7.3.2. Opening Date: .................................... Date last opened: .........................................
8. What were the activities carried out in the previous month (November 2014):
8.1. Cooking demonstration
8.2. Growth monitoring of children under 2 years
8.3. Growth monitoring of children 2 to 5 years
8.4. Home visits
8.5. Visit to the CSB
8.6. Nutritional education for mothers
8.7. Nutritional education for girls
8.8. Other:
9. Last month when an activity report completed and forwarded: ...................................................
10. Amount of ACNs monthly compensation: ......................................... ariary
11. Last month when payment was received: month of .. Year........................................
75
12. Value or quantity inputs by type of activities, source of the inputs :

Types of inputs
Amount
Value (MGA)
Source
1
2
3
4
5
6
7
8
9
10
11
12
13
14
15
13. Other activities that do not require input:

Types of activities
weekly
Number made during the previous

month (November 2014)
1
2
3
4
5
14.
76
15. Support from the head of fokontany in 2013 and 2014:

Name of head of fokontany
Date
Description of support
Quantity or value
(in MGA)
1
2
3
4
5
6
15. Support received from the communes mayor in 2013 and 2014:
Mayors name
Date
Quantity or value
(in MGA)
Quantity or value
(in MGA)
1
2
3
4
5
6
16. Support received from the community:

Communitys name
Date
1
2
3
4
5
6
77
17. Other support received from an organization:

Organizations name
Date
Quantity or value
(in MGA)
1
2
3
4
5
6
18. Time regularly dedicated by ACN to nutrition site activities: number of half-days per week
19. ACN' other income for his/her personal needs and dependents needs:
19.1. Waged work: ...................................... Monthly income: ...............................ariary
19.2. Agricultural work:
Agricultural work
Annual income (MGA)
1
2
3
4
5
6
78
Data on the sites visited

Name of the site
District
Commune
NGO
President of the NGO
Animator:
PO
ACN
Name of sites intervention fokontany
Zanaposa
Ambositra
Tsarasaotra
NY Antsiva
Razafimaharo Benjamin
HERILALAINA Hoyme Ador
Simone RAZAFINDRAVELO
Jeannie RAHAJASOA
Zanaposa
Number of inhabitants
Number of households
Distance from the road
Distance from the town of Ambositra
Distance to communes capital
Date of site opening
Date activities started
Community involvement
1,738
355
0
7 km
13 km
oct-13
oct-13
Support group existing
Community Garden existing
Household
Basic health centers
Public primary school

Collaboration with local authorities
Collaboration with technical services
Farmers (rice), small animal-raising

Tsarasaotra and Vatovory
In collaboration with the site:
Referral of children and pregnant women
800m
With the head of fokontany and the mayor
Health (referral to MCHW, DMM education, snacks)
Water and sanitation

Last community commitment:
Profile of the ACN
Provide a temporary premise for the site
In her forties
Jeannie RAHAJASOA
Obtained end-of-junior high school certificate
Worked as volunteer health worker for ADRA before 2013
79
TECHNICAL DATA ON THE ZANAPOSA SITE

PAUSENS EXTENSION SITE
Year 2014
NUTRITIONAL
SITUATION
Children identified <2
years
Children monitored <2
years
Jan
Feb.
March
April
May
June
July
Aug.
Sept.
October
Nov.
98
98
81
80
78
80
90
88
84
94
97
72
73
66
64
59
60
74
72
73
79
84
Children <2 years Z: -2
10
10
Children with GPMMA
19
16
25
11
22
26
17
19
19
0.00
0.00
28.79
25.00
42.37
18.33
29.73
36.11
23.29
24.05
22.62
CR children 0-2 years
GPMMA rate
73.47
74.49
81.48
80.00
75.64
75.00
82.22
81.82
86.90
84.04
86.60
UWR children 0-2 years

years
years
22.22
20.55
16.67
17.19
13.56
16.67
10.81
9.72
9.59
8.86
8.33
52.38
# DIV/0!
# DIV/0!
147
147
82
77
Children MUAC <125 mm

CR children <5 years
Rate <5 years
Preg. women identified
Preg. women monitored
Rate of preg. women seen
in NE
Mothers identified <2
years
Mother NE <2 years
Mothers rate NE <2 years
#
DIV/0!
#
DIV/0!
#
#
#
#
#
DIV/0! DIV/0! DIV/0! DIV/0! 55.78 DIV/0!
#
#
#
#
#
DIV/0! DIV/0! DIV/0! DIV/0! 0.00 DIV/0!
0.00
# DIV/0!
# DIV/0!
13
13
100.00
100
100
42.8571
57.14
62.50
71.43
100.00
42.86
33.33
85.71
98
98
81
80
78
80
90
88
84
94
96
72
73
66
64
59
60
74
72
73
75
75
73.47%
74.49%
81.48%
80.00%
75.64%
75.00%
82.22%
81.82%
86.90%
79.79%
78.13%
Mother identified <5 years
142
Mother NE <5 years

Mothers rate NE <5 years
Newborns
New born birth weight
2,500
Women delivering at CSB
Referral of children to
CSB
CORAL Home Visits
#
DIV/0!
#
DIV/0!
138
82
#
DIV/0!
#
DIV/0!
#
DIV/0!
4
4
15
#
DIV/0!
2
2
18
77
57.75
#
DIV/0!
# DIV/0!
55.80
# DIV/0!
# DIV/0!
18
#
DIV/0!
Census period
4- Changes in the coverage rates and the underweight rate (UWR) among children under <2
Children <2 years
Jan
Feb.
March
April
May
June
CR
73.47
74.49
81.48
80,00
75.64 75,00
UWR
22.22
20.55
16.67
17.19
13.56 16.67
July
August
Sept.
82.22
81.82
86.90
84.04
86.60
10.81
9.72
9.59
8.86
8.33
October November
80

NATIONAL NUTRITION OFFICE
U-PNNC SEECALINE
CHARACTERISTICS OF THE PMPS II SITE SOAVINA

Distance Tana - Soavina:
name of the site
District
Commune
NGO
President of the NGO
Animator:
PO
CAN
Name of the sites intervention fokontany
227 km
Soavina
AMBOSITRA
Ilaka Centre
TSIRY
RAKOTOZANDRINDRAINY Raphael
RANDRIANASOLO Hajanaina
RASOANINDRINA Zafimalala
RASOAMAHAFALY Marie Angeline
Soavina
Number of inhabitants
Number of households
Distance from the road
Distance from the town of Ambositra
Distance to the communes capital
Date of site opening
Date activities started
Community involvement
2,086
351
0 km
260 km
2 km
nov-01
Jan-02
Support group existing: 6 women
Community garden existing
Households
Basic health center
Public primary school

Collaboration with local authorities
Collaboration with technical services
Water and sanitation
Last commitment of the community:
Profile of the ACN
Farmers (rice), small-scale animal raising

2 km from the site
In collaboration with the site:
Referral of children and pregnant women
1 km
With the head of fokontany and mayor
Health (referral for MCHW, DMM education, snack)
200 households with a protected water point
288 households with individual latrines
Construction of the site
Recent rehabilitation of the sites roof
51
2002: ACN in charge of the site
married, with children and grandchildren
Achieved end of junior high school, understands French
81
TECHNICAL DATA ON THE SOAVINA SITE

A PMPS II SITE
NUTRITIONAL
SITUATION
years
years
Jan
Feb.
March
April
May
June
July
Aug.
Sept.
Oct.
Nov.
112
117
108
186
114
121
109
109
106
112
109
106
109
94
186
105
112
109
100
102
106
100
10
15
10
16
12
13
10
10
Children with GPMMA
56
58
55
108
54
54
58
53
59
57
62
52.83
53.21
58.51
58.06
51,43
48.21
53.21
53,00
57.84
53.77
62,00
CR children 0-2 years
GPMMA rate
94.64
93.16
87,04
100.00
92,11
92.56
100.00
91.74
96.23
94.64
91.74
UWR children 0-2 years

years
years
Children MUAC <125
mm
11.32
15.60
12.77
7.53
17,14
13.39
12.84
11,00
10.78
8.49
10.00
CR children <5 years

Rate <5 years
Preg. women identified
Preg. women monitored
Rate of preg. women
seen in NE
Mothers identified <2
years
Mother NE <2 years
Mothers rate NE <2
years
Mother identified <5
years
Mother NE <5 years
Mothers rate NE <5
years
Newborns
New born birth weight
2,500
Women delivering at
CSB
Referral of children to
CSB
CORAL Home Visits
#
DIV/0!
#
DIV/0!
#
DIV/0!
#
DIV/0!
#
DIV/0!
#
DIV/0!
# DIV/0!
#
DIV/0!
#
DIV/0!
13
88.89
# DIV/0!
182
191
97
91
91
53.30
# DIV/0!
# DIV/0!
47.64
# DIV/0!
# DIV/0!
0.00
# DIV/0!
# DIV/0!
100.00
# DIV/0!
# DIV/0!
18
14
12
11
12
14
13
10
100
100
100
92.31
77.78
92.86
75
90.91
100.00
85.7143
115
108
186
114
119
109
100
106
112
109
104
100
92.86%
91.74%
108
94
186
105
107
109
100
102
#
93.91% 87.04% 100.00% 92.11% 89.92% 100.00% 100.00% 96.23%
DIV/0!
#
DIV/0!
#
DIV/0!
#
DIV/0!
182
191
97
91
# DIV/0!
#
DIV/0!
53
# DIV/0!
# DIV/0!
48
# DIV/0!
# DIV/0!
11
26
10
10
10
census period
82
4 - Changes in coverage rates (CR) and underweight rates (UWR) <2

children <2
years
Jan
Feb.
April
May
CR
94.64
93.16
87,04
100.00
92,11
92.56
100.00
91.74
96.23
94.64
91.74
UWR
11.32
15.60
12.77
7.53
17,14
13.39
12.84
11,00
10.78
8.49
10.00
March
June
July
August
Sept.
October November
83
Explanations provided by the ORN in Amoroni Mania

I.
Changes in the actual UWR: increase in 2014 and overall increase from 2012 to 2014
ORN of Amoron'i Mania

Underweight prevalence
Year
Jan.
Feb.
March
April
May
June
July
Aug.
Sept.
Oct.
Nov.
Dec.
2012 16.24
16.38
15.92
15.33
14.78
15.22
14.34
13.95
14,02
13.8
14.36
14.35
2013 17.27
17,21
16.61
15.18
15.22
15,13
14.83
14.37
16
15,87
12.57
2014 16.97
17.71
16.25
19,09
18.77
17.32
17.81
17.62
17.36
17.91
18.35
Interpretation and analysis:

1) Number of children monitored
2) Census
3) Socio-economic and political crisis.
4) Start-up phase
Number of children registered and monitored:
2012
2013
January
27,777
24,365
March
27,584
21,521
2014
24,900
23,647
June
September
26,111
25,381
21,100
20,209
25,420
December
24,718
5,483
Entering in
27,609 process
84
1) Number of children in 2013

2013 compared to 2014:
Not all the targets are covered in 2013, especially from April as seen in the graph and the data in the 2013
report.
The weighing sessions are done in group (i.e. all children aged 0-5 years are weighed in a single session)
and ACNs no longer travel to hamlets far from the communes main site, though the most vulnerable
children may be found in such areas.
The table below summarizes the report received by ORN.
As regards the sites missing in 2013, ACNs could not send their reports from data recorded in their
registers (there were no register in 2013).
From January to October, the partnership with NGOs was suspended and as a result there were no
animators to collect reports and monitor activities. ACNs sent directly their reports to ORN (by taxibrousse or by asking people to carry them); some were unable to send their reports. As a consequence,
the reporting rate decreased as shown in the table above where figures are missing.
It should be noted that funding from the PAUSENS Project and FA -PMPS II were involved in November
and December. There are 2014 data included in November and December for the old sites in this summary
report (where indicators were simplified because no standard report forms were available).
REPORTING RATE FOR 2013:
2013
Number of sites
Reports to ORN
Reporting rates
Jan
249
238
95.58
Feb. March
249
249
238
240
95.58 96.39
April
249
239
95,98
May
249
239
95,98
June
249
237
95,18
July August
249
249
238
230
95.58
92.37
Sept. October
249
249
229
228
91.97
91.57
85
Monitoring of children 0-2 years:

Number of children 0-2 years monitored
March June
Sept.
December WEIGHING SESSION
2012
27,584 26,111 25,381 24718
Grouped: children 0-5 come to a single session
2013
21,521 21,100 20,209 5423
Grouped (incomplete reports)
2014
23,647 25,420 27,609 N.A.
By age category: 0-2 years monthly, 2-5 quarterly

Goal set ex 0-2: 97 children per month, which
accounts for the number increasing
December report being processed by NGO
2) Annual census:
2012 and 2014: annual census conducted.
2013: the census did not take place, which accounts for the lower numbers in 2013 compared to 2012
and 2014.
3) Socio-economic and political crisis:
The prevalence of malnutrition increased from one year to the next (2012-2013; 2013-2014) as did food
access and price of basic commodities.
The money that households earn from their various activities (sale of food or vegetable products,
transportation, production of bricks, planks, charcoal, rum, daily waged field work) does not cover their
expenses.
In addition, households have to save to meet expenses related to local customs, (New Year gifts,
exhumation, new building inauguration, etc.) which often involves bringing together the entire extended
family and neighbors to attend a few days of festivities.
86
2012
2013
Jan. Feb. - March

lean period
lean period
April May
Rice harvest
Rice harvest
2014
lean period
Though harvest time, the money the

family earns does not cover
expenses given the price of basic
commodities that keep on
increasing. The positive impact of
harvest is not observable in the short
run.
Nov. Dec.
Lean period
Data not collected
cf. AP dashboard
Lean period
Changes in other indicators
indicators
Number of sites
Number of ACNs operational
Number of ACNs
resigning/defaulting
Coverage rate of children <2
Number of sites sending reports
2012
176
168
Boeny
2013
176
161
2014
176
158
8
75.03%
172
15
74.44%
151
18
73.58%
136
Amoron'i Mania
2012
2013
2014
249
330
330
249
330
330
94.40%
249
89.75%
330
85%
330
II. Coverage rates:

Possible explanations in variations in mothers attendance of weighing sessions at community-based
nutrition sites include the following:
1.
Variations across years due to insecurity issues: mothers who live in remote hamlets tend to be
less regular in bringing children to weighing sessions.
2.
Mothers may be busy looking for money: transportation of bricks, production of planks, rum,
granite, sand, field work. In some cases, families move out of the fokontany, commune or even
region to carry out economic activities.
3.
Traditional festivities: in July and August, mothers are less serious about bringing their children
for weighing sessions at the sites as they are busy with traditional festivities.
Conclusion:
The national target being 19%, the results in terms of chronic malnutrition and stunting are deemed
satisfactory whether in areas without PNNC or areas with PNNC other than supported by the ORNs. At the
87
beginning of the SEECALINE project in 1999, the malnutrition rates were as high as 40 to 50% in those
sites. As such, the results over three years reviewed in our study, which constitute a start-up phase, are
satisfactory. This is further evidenced by the malnutrition rates among children under found in the 20082008 DHS: the rate was 50.10 at the national level; 63.10% in Haute-Matsiatra, 48.90% in Vatovavy
Fitovinany ; 46.00 in Atsimo-Atsinanana; and 70.60% in Amoroni Mania.
For the PAUSENS project, 2014 was a starting phase that was faced with a number of difficulties: death of
the National Director, resignation of the M&E Manager at the PNNC which result in delays in all activities
as procedures had to be repeated from the beginning (contracts with NGOs and association, provision of
material and equipment for sites) despite the efforts made by the team to address the situation.
Some improvements have been noted:
- Household food security activities were planned for and strengthened.
- Community and mothers were sensitized further to the last since in 2015 (summary data will be
available by end of month).
- The NGOs site were reorganized according to their geographical areas.
- NGOs POs/chairs were introduced to technical aspects to improve monitoring.
To summarize, the results over the three years were satisfactory though a number of challenges remain
to achieve success: strengthening strategies regarding key indicators and development, objectives to
achieve in relationship with the motivation of participants through performance-based contracts. In
addition, project impact remains to be measured to understand trends in the coming years.
88
TIMELINE OF COMMUNITY-BASED NUTRITION IN MADAGASCAR

From a document on the developments and shifts in nutrition in Madagascar
CONTEXT
- The annual economic growth rate has been about 4% since 2001 and has been slowed down by
cyclical social and political crisis (in 1972, 1991, 1994, 2002, and 2009).
- The population is poor with a GDP per capita of USD 294 in 2003 and USD 308 in 2006.
POSITION OF NUTRITION IN MADAGASCAR IN THE THREE REPUBLICS (1960-2010)
- The Governments concern was to Feed the population but they differed by their vision
Food self-sufficiency
Safety net project

Malnutrition control
Anti-poverty strategy
National Nutrition Policy
Setting up the National Nutrition Office
- The key words over these periods were:
Nutritional security
Community mobilization
Institutional development
Scaling up nutrition
Integrating Nutrition
- Shifts occurred when nutrition moved from the status of "low priority" to that or "high priority"
or the other way round.
MALNUTRITION IN MADAGASCAR
- Malnutrition is a public health problem in Madagascar and underlies 35% of child mortality.
- Chronic malnutrition affects 1 children under five out of 2.
- Protein and energy malnutrition affects the entire country.
- Among under five children:
o 47.5% suffer from stunting
o 5.4% from wasting
o 34.3% from underweight
- Vitamin A deficiency affects:
o 42% of preschool children
o Women of reproductive age
- Iron deficiency affects:
o 2 child of preschool age out of 3
o 8% of school-age children (6 to 14 years)
89
o 46% of pregnant women

-
The prevalence of clinical forms of iodine deficiency has decreased from 45% in 1990 to 9% in
1998 and to 5% in 2001.
POLITICAL CONTEXT IN WHICH NUTRITION POLICIES DEVELOPED
1. 1st Republic (1960-1975)

The full belly policy: ensure availability of and access to food in sufficient amounts
2. 2nd Republic (1975-1991):
There were two different periods:
Until 1980: the socialist era where the goal was to ensure food self-sufficiency and the
geostrategic vision was to produce excess basic food commodities as an economic
weapon.
From 1980 to 1990: the country went through structural adjustment (1981) to address
the economic and monetary crisis it was going through. There a large mass of poor and
malnourished people and a safety net program along with school feeding programs were
launched (food for work) with the support of Bretton Woods institutions.
3. 3rd Republic from 1993

This period was preceded by a transitory period (1991 to 1993).
Madagascar took part in a number of global summits on nutrition and/or feeding.
The government gradually committed to fight malnutrition in the PRSPs starting in 2003
(5th commitment).
The National Nutrition Policy was adopted in 2004 and the National Nutrition Office was
created in 2005 followed by the National Nutrition Council in 2007 in charge of strategic
orientations, putting nutrition under the leadership of the Prime Ministers Office.
Nutrition was included in the Madagascar Action Plan (2007-2012).
NUTRITIONS TRACK RECORD IN MADAGASCAR
From 1960 to 1993: the focus was on access to food.

From 1993 to 2004: a first shift occurred with the focus shifting to micronutrients
deficiency control and community-based nutrition.
In 2004: a second shift occurred with the adoption and follow-up of the National Nutrition
Policy and the adoption of the National Nutrition Action Plan (2005) with its 14 strategic
focuses to control malnutrition.
1. From 1960 to 1993
90
There were two republics with their own food security policies.
From 1975 to 1993: malnutrition was regarded and addressed as the consequence of food
insecurity.
o The Ministry of Agriculture was in charge providing direct support to the
populations cropping and animal-farming activities.
o Vulnerable populations benefited from direct food provision and the policy to rise
out of underdevelopment was that of the full belly.
o The goal was to achieve food self-sufficiency b 2000 to become a powerful
country with the concept of food security at the macroeconomic level.
In 1984: A nutrition unit was set up within the Ministry of Health, while other ministries
conducted nutrition activities.
In 1989: a mechanism was set up for nutritional and food security monitoring and was
coordinated by the Directorate of M&E support at the Ministry of Research Applied to
Development.
These institutional developments reflected a better understanding of nutrition, which
was acknowledged as a public health issue concerning mothers and children rather than
the poor. As a result, the narrative shifted to household food security and communitybased actions to fight malnutrition.
In 1992: A number of surveys, including the DHS and MICS, gave a better understanding
of the scope of malnutrition issues in the country and served as a basis for developing a
nationwide malnutrition control program as well as for various community-based and
multisectoral nutrition programs (CBN, c-IMCI, and LMC in 1994).
2. Shift in 1993
The shift coincided with the Third Republic, a democratic regime where good governance
and human rights were upheld.
The shift led to LCM and community-based nutrition.
In 1993, the SECALINE project was established under the leadership of the Prime
Ministers Office and included food distribution, nutritional education, and occasional
micronutrients supplementation activities targeting vulnerable groups. It became a
nationwide program with the introduction of food fortification (iodized salt, vitamin A).
Malnutrition was regarded as multisectoral and crosscutting issue.
In the following years, nutrition actions multiplied and diversified (both treatment and
prevention) and was included in the public investment and internal resources budget,
reflecting the governments commitment.
In 1997, the stunting rate was 48% (DHS II, 1997).
The number of interventions and actors in the field of nutrition increased, giving an
impetus to nutrition.
91
A coalition to defend nutrition was set up with the role of advocating on the importance
of good nutrition for human and national development. PROFILES, a tool that estimates
the consequences of malnutrition over a period of 10 years (2000 to 2010) based on
national and international data, was developed and used for advocacy, linking
malnutrition and poverty reduction under the leadership of GAIN (intersectoral action
group for nutrition).
Nutrition became institutionalized with GIN (Nutrition Initiation Group) and the National
Nutrition Policy was launched in 2002 and then adopted by the Government in 2004.
3. Second shift in 2004

The National Nutrition Policy and the National Nutrition Action Plan (PNAN) started being
implemented during this period, building on past achievements.
Nutrition was put under the leadership of the Prime Ministers Office.
The PNAN was approved and put under the management of a dedicated organization
(ONN) whose manager is appointed by governmental decree.
The various structures (GAIN, GIN), policies and plans (PNN and PNAN) were supported
by development partners (UNICEF, USAID, the World Bank), with the entire government
being mobilized for nutrition.
An international consultant was recruited to help develop a consensus-based nutrition
policy.
Nutrition benefited from large media coverage and advocacy with high level authorities
at the national, regional, and local levels.
Nutrition started being included in donors agenda.
Community-based nutrition became integrated with the topics of EBF, micronutrients
supplementation, school feeding, food supplementation, and nutritional rehabilitation
centers (CREN).
Responses were provided to nutritional and food security crises.
The nutrition sector benefited from CARP, with an amount of MGA 3 billion for 2001-2004
and MGA 66,794,564,400 for 2005-2008.
The official narrative was that nutrition is a right for the entire population and that from
an economic point of view, it forms part of the poverty reduction and country
development strategies.
As such, it was integrated in the Madagascar Action Plan under Commitment 5, Challenge
7 which pertain to controlling malnutrition and reducing underweight among children,
while improving the populations health as a whole.
4. 2009: Positive trends were recorded with a decrease in the UWR among children under 5 (an
indicator of the PNNC): 19.22 in 2009 and 19.98 in 2008.
5,500 sites are operational providing a minimal package of activities in the 22 regions.
92
Changes were made and actors in the field became disoriented.

The social and political crisis changed the situation, with the narrative shifting to food
security and less attention being paid to malnutrition prevention.
5. From 2009 to date

CARP came to an end in 2009 and the nutrition sector operated on extrabudgetary resources from
2010 to 2012.
The World Bank- funded PAUSENS Project came in from 2013 to 2016, integrating education,
nutrition, and health in five of the countrys 22 regions at the beginning, namely Vatovavy Fitovinany,
Amoroni Mania, Haute Matsiatra, Androy, Atsimo Atsinanana.
93
94
95
96
97
98
99
100
101
102
103
104
105
106
107
108
109
110
111
112
113
114
115
116
117

RAKOTOMALALA, Bodo, Case Study Under The Social Sector Public Expenditure Review - 2014, Antananarivo: UNICEF Madagascar, 2014, 117 P.

Uploaded by

Document Information

Original Title

Copyright

Share this document

Share or Embed Document

Sharing Options

Did you find this document useful?

Is this content inappropriate?

Copyright:

RAKOTOMALALA, Bodo, Case Study Under The Social Sector Public Expenditure Review - 2014, Antananarivo: UNICEF Madagascar, 2014, 117 P.

Uploaded by

Copyright:

Case study under the social sector

public expenditure review - 2014

In-depth analysis on the improvement of the efficiency and

Deliverable : Final version of the case study

Nutrition Case Study for UNICEF-Final Report - Bodo Rakotomalala

Aims of the case study .................................................................................................................... 22

Procedures applicable to the implementation of funding for community-based nutrition

Nutrition Case Study for UNICEF-Final Report - Bodo Rakotomalala

Nutrition Case Study for UNICEF-Final Report - Bodo Rakotomalala

Figure 13: Support to ACNs for the implementation of activities .............................................................. 39

Nutrition Case Study for UNICEF-Final Report - Bodo Rakotomalala

National Nutrition and National Action Plan for Nutrition Policy.2004

Nutrition Case Study for UNICEF-Final Report - Bodo Rakotomalala

Nutrition Case Study for UNICEF-Final Report - Bodo Rakotomalala

Nutrition Case Study for UNICEF-Final Report - Bodo Rakotomalala

Nutrition Case Study for UNICEF-Final Report - Bodo Rakotomalala

Nutrition Case Study for UNICEF-Final Report - Bodo Rakotomalala

Nutrition Case Study for UNICEF-Final Report - Bodo Rakotomalala

taking into account the local context

A copy of the contract is annexed to this report.

Nutrition Case Study for UNICEF-Final Report - Bodo Rakotomalala

Part 1: Overall Funding of Nutrition

2. Reminder of the trends and conclusions highlighted in the 2007 PER

Nutrition Case Study for UNICEF-Final Report - Bodo Rakotomalala

3. Interim findings of the PER 2014 Team on nutrition

Nutrition Case Study for UNICEF-Final Report - Bodo Rakotomalala

Of which transfers (%)

Investment program (PIP)

Source: MFB, PFMIS

Total MoH expenditures (Mission=health) in Million Ar

Source: MoF, PFMIS

Nutrition Case Study for UNICEF-Final Report - Bodo Rakotomalala

4. The National Nutrition Action Plan (PNAN II) 2012- 2015

Nutrition Case Study for UNICEF-Final Report - Bodo Rakotomalala

Table 3: Estimated budget for the PNAN II, (in USD)

Number of functional PNAN schools

Drinking water access rate

Utilization rate of latrines

Nutrition Case Study for UNICEF-Final Report - Bodo Rakotomalala

5. Analysis of budgetary resources to finance nutrition

(IDA not included)

Nutrition Case Study for UNICEF-Final Report - Bodo Rakotomalala

Figure 1 reflects the changes in the amounts over time.

6. Review of ONNs expenditure

Nutrition Case Study for UNICEF-Final Report - Bodo Rakotomalala

Other expenditures implemented by ONN

Capacity building and monitoring &

1,738.6 2,746.6 3,117.3

Sites operation, including steering of

6,639.3 7,519.8 5,327.6

12,738.4 17,392.8 10,689.5

Nutrition Case Study for UNICEF-Final Report - Bodo Rakotomalala

Table 8: Expenditures implemented by ONN (in %) 2006-2013

Source: ONNs table on expenditures implemented

Nutrition Case Study for UNICEF-Final Report - Bodo Rakotomalala

Figure 2: Expenditures implemented by ONN - 2006-2013

Source: ONNs table on expenditures implemented

Nutrition Case Study for UNICEF-Final Report - Bodo Rakotomalala

Source: ONNs table on expenditures implemented

Source: ONNs table on expenditures implemented

Total of other expenditures implemented

Source: ONNs table on expenditures implemented

Nutrition Case Study for UNICEF-Final Report - Bodo Rakotomalala

Figure 3: ACNs compensation relative to ONNs expenditures implemented

Part 2: Findings of the comparative case study of community-based

Nutrition Case Study for UNICEF-Final Report - Bodo Rakotomalala