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.
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