In Haiti, the prevalence of malnutrition rates among children is tragic: according to the World Bank, nearly one-third of all children under five suffer from stunted growth and three-quarters of children 6-24 months are anemic, making Haiti’s malnutrition rates among the worst in the Latin American and Caribbean region. The prevalence of malnutrition among children is especially troubling in rural Haiti. At our clinics, almost all of which are in rural areas, malnutrition accounts for 30-40% of all pediatric visits, and up to 50% during certain times of the year. Malnourished children are at risk for disease and death; prolonged malnourishment can lead to cognitive and physical delays in development.
In response to this widespread need, PIH/ZL has developed an elegant solution that leverages local resources to treat the thousands of malnourished children who present at our clinics throughout the year. Zanmi Agrikol (“Partners In Agriculture”) is PIH/ZL’s broad-based nutrition program that encourages the local production of crops and uses them in the production of ready-to-use therapeutic food for the treatment for pediatric malnutrition. Zanmi Agrikol has three main components:
1) Local production of Nourimanba for the treatment of malnutrition
Children who come to our clinics suffering from severe malnutrition are given Nourimanba, a ready-to-use therapeutic food made of five simple ingredients: locally-sourced peanuts, milk powder, vegetable oil, sugar, and a specially formulated vitamin mix. This highly nutritional treatment leads to dramatic clinical improvements, bringing children back to full health in a few short weeks. Because treatment with Nourimanba can be administered by parents in the home, children are spared long stays in the hospital.
2) Locally sourcing Nourimanba ingredients
When PIH/ZL first recognized the success of Nourimanba in combating childhood malnutrition, we also saw a unique opportunity to increase the livelihoods of local farming families. To this end, we operate a 35-acre production farm in Corporant to grow the main ingredient of Nourimanba– peanuts. ZL employs farmers at the Corporant farm for various lengths of time depending on need. We also contract with local farmers to grow peanuts, which we purchase for use in producing Nourimanba.
Two elements make this arrangement particularly sustainable and beneficial to local farmers. First, the program includes a seed bank that provides the initial peanut inputs for local farmers, many of whom lack the initial capital to purchase seeds. After their first harvest, the farmers then return an equivalent amount of seeds at the end of the growing season, ensuring that the seed bank will be able to continue to provide seed to future farmers. Second, this arrangement provides the farmers with much-needed capital on a predictable schedule and in sufficient quantity to enable them to invest in new tools, land, and other inputs, which they are typically not able to do if they are selling their crops piecemeal on the local market.
3) Breaking the cycle of poverty and malnutrition by providing agricultural assistance and training to vulnerable families
The final component of Zanmi Agrikol works to break the cycle of poverty that leads to such high rates of childhood malnutrition on rural Haiti to begin with. To improve long-term food security for some of the most vulnerable families we encounter in the malnutrition program, PIH/ZL provides seeds, tools, goats, trees and agricultural training through an initiative called the Family Assistance Program. Families most in need are identified by ZL clinicians and social workers for enrollment in the program. We provide seeds and tools to the families for use on their lands; occasionally we have also helped rent land for families. The families grow food for subsistence or for market, and keep any profits that result. In addition, families receive a female goat, which then serves as the equivalent of a bank account, meaning that offspring or the goat can be raised and sold at market when a household is in need of cash.
Ongoing, individualized support and training to participating families is provided through ajan agrikol, community members who are trained by ZL agronomists to work directly with farming families on their own land. Recognizing that local farmers often have the wisdom and knowledge necessary to improve their yield, but have simply lacked the income and tools to do so, ajan agrikol enter into dialogue with each family in order to best understand their particular circumstances and determine what form of intervention will be most effective. Each ajan agrikol is responsible for visiting 10-15 families in their fields once every two weeks but often visit weekly during the rainy season.
In addition to ongoing support from ajan agrikol, families receive training through Zanmi Lasante agronomists, who train the families in better farming practices, soil conservation, tree conservation, how to farm on sloped terrain in order to maximize water distribution and minimize erosion, and how to build tools that measure the steepness of terrain and identify prime areas for farming. These trainings not only increase farmers’ skills but also help them develop farming methods that are environmentally friendly.
 World Bank, Promoting Nutrition Security in Haiti: An Assessment of Pre- and Post-Earthquake Conditions and Recommendations for the Way Forward, September 2010, http://siteresources.worldbank.org/NUTRITION/Resources/HaitiNutritionAssessmentEnglishFINAL.pdf, p. 2.
 Ibid., p. 3.
On Saturday, January 14, CBS Evening News featured a story about an agricultural initiative that will create new jobs and help treat malnourished children in Haiti’s Central Plateau. A partnership between Partners In Health and Abbott Laboratories is building a manufacturing plant which, when completed in late 2012, will increase PIH’s production of Nourimanba – a therapeutic peanut-based product used to fight malnutrition – more than ten-fold.
As CBS’s Maurice Dubois notes in his story, this new venture will employ local Haitians, expand PIH’s existing sustainable agricultural system, and, most importantly, offer life-saving nutrition to thousands of under-nourished children.
Please view the story here:
On November 2, the New York Times published an article about Nourimanba, a peanut and vitamin supplement produced and distributed to malnourished children in Haiti by Partners In Health.
In Haiti, local communities grow and harvest the peanuts used to make Nourimanba.
“The uniquely Haitian product…is an essential medicine for about 10,000 severely malnourished children a year,” writes Duff Wilson in his article “Making Nutrition a Sustainable Business in Haiti.”
“Even before the 2010 earthquake heaped more misery atop the poverty in Haiti, one in four children had stunted growth,” continues Wilson. “An estimated 2.2 percent of Haitian children under the age of 5 had severe acute malnutrition, according to the United Nations Children’s Fund.”
In early 2008 Abbott Laboratories began supporting PIH projects in Malawi and Haiti. “In early 2009 we began thinking about how we could work with Abbott in a more comprehensive fashion, we decided to focus on our nutrition work in Haiti,” says PIH’s Brandie Conforti. “In December 2009, Abbott leadership toured our work in Haiti and then in May 2010 we formalized our partnership and began laying out plans for a Nourimanba facility. By June we were working on the design.”
“Groundbreaking on the new factory was delayed this year by an outbreak of cholera,” writes Duff. “Now groundbreaking is planned for January and production before the end of 2012.
“While the rudimentary production plant makes about 70 tons of Nourimanba for 10,000 children a year, the new one will push capacity to more than 350 tons and 50,000 children,” according to PIH’s Andrew Marx. “Children receive it daily for six to eight weeks. The new operation will also expand on the 300 or so farmers who have a guaranteed market for their peanut crops.”
“The relationship with Abbott goes beyond the Abbott Fund and it engages their employees,” continues Conforti. “It really has buy-in from the entire company and it models a new trend in corporate giving. What’s unique about this factory is the notion that eventually Nourimanba production will be self-sustaining.”
Read the New York Times article in its entirety.
New video from PIH!
"I don't think there will be large scale change without a movement, and this could be part of that movement...What if it was a coalition of parents around the world saying my kid's not dying, and your kid shouldn't die either?" -- Dr. Joia Mukherjee
In an interview by Two Degrees, Dr. Joia Mukherjee, PIH's Chief Medical Officer, discusses the tragedy of preventable childhood deaths from malnutrition and the importance of such campaigns in raising public awareness and empathy for childhood starvation. Two Degrees, a health food company, is a partner organization of PIH's that provides RUTF treatment for PIH patients in Malawi, based on our the model of programs built in Haiti.
Watch these short videos (link below) about childhood malnutrition and the importance of locally-sourced and produced RUTF in reversing it.
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PIH uses two therapeutic foods to treat and prevent severe pediatric malnutrition. Nourimanba is a “Ready to Use Therapeutic Food” made from a peanut butter base combined with milk powder, vegetable oil, sugar and a specially formulated vitamin mix for malnourished children. Nourimanba can be offered as an outpatient treatment; receiving treatment at home means that children are prevented from being needlessly exposed to other ill children in the pediatric ward, which is a particular risk for children whose systems are compromised by malnutrition. Having to tend to a hospitalized child is also particularly difficult for many impoverished families we serve in Haiti, who often have several other children at home and live at great distance from clinic, so this outpatient aspect of the treatment is crucial. For children who are who are moderately malnourished or transitioning off Nourimanba, Zanmi Lasante provides a locally produced mixture of milled grain and legumes called Nourimil.
Both Nourimanba and Nourimil are prepared and packaged in Zanmi Lasante’s production and distribution center in Cange. Local in-house production of Nourimanba and Nourimil stimulates the local economy by employing the local workforce and encouraging local agriculture. Because the Cange production facility is too small, we are currently working with a partner to build and equip a new facility to produce Nourimanba and Nourimil. This facility will allow for better quality control and potential future expansion of our operations.
Even with the smaller space, Zanmi Lasante produced over 60,000 5lb bags of Nourimil, and over 56,000 kgs of Nourimanba in 2010. Attached you will find a monthly breakdown of production:
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