Project #2485

Childhood Malnutrition in post-earthquake Haiti

by Partners In Health (PIH)

Zanmi Agrikol, which translates to “Partners In Agriculture” in Creole, uses agricultural initiatives to both encourage local production of crops used in the treatment and prevention of pediatric malnutrition and to increase food security for families of malnourished children. Zanmi Agrikol has three main components: the local production of therapeutic foods (called Nourimanba and Nourimil) used to treat and prevent malnutrition; the operation of two farms and contracts with local farmers who grow crops (mainly peanuts) used to make these foods; and the Family Assistance Program, an agricultural assistance program for the poorest families, many of whom are identified because their children have been treated for malnutrition. Launched as a pilot program in one site, Boucan Carré, Zanmi Agrikol now encompasses all of Zanmi Lasante’s sites in the Central Plateau.

Through Zanmi Agrikol, Zanmi Lasante produces Nourimanba and Nourimil to meet the pressing need for effective and cost-efficient treatment for malnutrition, which affects a third of children living in Haiti. Producing these therapeutic foods locally means that we are creating jobs and contributing to the local economy. 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. It is used for severely malnourished children and has the advantage of being a home-based treatment: children are treated with Nourimanba in hospital for two weeks (in which parents and caregivers are trained in how to give the treatment) and then continue their treatment at home for another four weeks. Nourimil is made of beans and rice or corn and is used on an outpatient basis for moderately malnourished children to prevent further deterioration. In FY 2011, PIH and Zanmi Lasante anticipate treating approximately 6,000 malnourished children with Nourimanba and Nourimil.

Currently, Zanmi Lasante operates a small production center in Cange where local workers mix ingredients, produce, and package Nourimil and Nourimanba. To further reduce cost and stimulate the local economy, Zanmi Lasante operates two farms in the nearby village of Corporant and Lachteau, where 79 farmers are employed to grow corn and beans used for Nourimil. We also buy peanuts for Nourimanba from local farmers around Corporant. Zanmi Lasante provides initial seeds to these farmers (who return an equivalent amount of seeds at the end of the growing season) and pays a fair market price for their entire peanut crop. This arrangement provides the farmers with predictable revenue and in sufficient quantity to invest in new tools, land, and other inputs. Currently over 200 farmers are involved in growing peanuts for Zanmi Lasante. Plans are currently underway to complete the construction of a main depot in Corporant where the production of Nourimanba and Nourimil can be housed. In FY 2011, PIH and Zanmi Lasante will support 279 farmers to produce roughly 43,000 kilograms of Nourimanba and 184,600 lbs of Nourimil (based on last year’s production totals).

The third component of Zanmi Agrikol  is the Family Assistance Program which helps extremely destitute families improve their basic household food supply in order to battle long-term food insecurity. Typically, Zanmi Lasante has enrolled families of children who are being treated for malnutrition at a Zanmi Lasante site. Each family is assigned an ajan agrikol – a local resident employed by Zanmi Lasante as an outreach worker – who works with each family to boost their household production of food. Practically, this means the ajan agrikol provides tools, seeds, training, and at least bi-weekly visits to families enrolled in the program. Each ajan agrikol is responsible for 10 families, visiting them weekly or every other week; there are 240 families who have been enrolled in the project over the past two years. Immediately following the earthquake, Zanmi Lasante hired 20 additional ajan agrikol (bringing the total to 42), and expanded the Family Assistance Program to meet the pressing needs of families, most of whom have taken on survivors from the earthquake who fled Port-au-Prince. We have also started the farm at Lachteau, mentioned above, which will have dedicated areas for demonstration and farming plots for families to practice new techniques and grow crops. Zanmi Lasante has identified 50 kombit (groups) of 20 families, meaning thatin FY 2011 the Family Assistance Program will now serve 1,240 families who are extremely food insecure.

Monitoring, Evaluation, and Key Partners

The project will be monitored and evaluated with the following indicators:

  • Number of malnourished or at-risk children provided Nourimanba and Nourimil: target of 6,000 children
  • Amount of Nourimanba/Nourimil produced: goal of 43,200 kilograms of Nourimanba and 184,600 lbs. of Nourimil
  • Number of farmers employed to work on production farms: target of 79 (including both contract and permanent farmers)
  • Number of local farming families who are provided with seeds, use of tractor, and guaranteed market price, in order to grow peanuts for Nourimanba: target of 200 families
  • Number of families provided seeds, training, and support: target of 1,240 families
  • Number of agricultural trainings held: target of all families participating in at least 2 trainings

Evaluation will be overseen by Marie Flore Chipps, coordinator of Zanmi Agrikol. The first indicator listed will be reported by the clinicians in the pediatric wards of Zanmi Lasante clinics. The remaining indicators will be monitored and reported by Zanmi Lasante’s three lead agronomists. Two Boston-based Haiti program managers and one Haiti-based nutrition coordinator will provide ongoing monitoring of program progress and assistance with budgeting and reporting to donors.

To further assess the impact of the project, in FY 2011 PIH and Zanmi Lasante are continuing our partnership with a local organization, Fonkoze, a local NGO that provides microcredit opportunities and has begun screening families in their program for malnutrition. Fonkoze trains their community agents to screen families for malnutrition and then refers them to Zanmi Lasante clinical sites, and also trains them in following up with these families after referral. Because increased screening will likely lead to greater identification of pediatric malnutrition and more need for treatment, Fonkoze is also working to find donations of additional RUTF for these families.


Facts - Children
Facts - Children's Health and Malnutrition

The health of children has always been one of Zanmi Lasante’s central concerns, as children are often the most vulnerable to falling ill in the impoverished communities we serve. Of every 1,000 children born in Haiti, 72 of those young boys and girls will die before the age of 5. In the US that number is 8. Following the earthquake, PIH/ZL knew that sick and malnourished children would comprise a large portion of the patients in need of our services. So the team focused on strengthening pediatric and nutrition services at both our existing facilities in the Central Plateau and Artibonite regions, and in the new clinics serving displaced survivors in Port-au-Prince.

An estimated 40 percent of the 146,940 patient encounters logged thus far at the PIH/ZL clinics at the four settlement camps in the capital city were with patients under the age of 20, and roughly half of these were with children under the age of 5. Many of the illnesses these young people present with are related to malnutrition. In response, the team significantly bolstered its pediatric malnutrition program. Over the past 6 weeks, they’ve enrolled 1,191 children, and have distributed Nourimil* and Nourimanba**, locally produced highly nutritious therapeutic foods. So far, 12,255 pounds of Nourimil and 2,016 pounds of Nourimanba have been distributed.

To support mothers caring for young children, the PIH/ZL clinics located in the spontaneous settlements, in partnership with UNICEF, set up special tents. Here, mothers can receive education on nursing and nutrition, weigh and monitor their baby’s progress, and, if needed, receive infant formula. So far, these tents have logged roughly 2,600 visits.

Many families in the Central Plateau and Artibonite regions have taken in relatives and friends fleeing from the chaos of Port-au-Prince. With support from the American Jewish Joint Distribution Committee (JDC), ZL’s existing clinics in these regions have expanded their pediatric nutrition program to help local households affected by the earthquake, with the goal of eventually expanding its capacity to treat an additional 2,200 children, growing by over 30 percent.

ZL’s hospital in Boucan Carre, roughly 2 hours by car north of Port-au-Prince, has already logged a spike in the number of children enrolling in their program. “Since the earthquake, we’ve had more children [in the malnutrition program] than we’ve ever had before,” says nurse Thony Magdala, who was recently hired to help manage the growing need. “Every day we are having more and more children coming to the clinic and entering the program.” She estimates about 2-3 children a day on average, but as many as 5-6 on some days. Since she’s started in March, the program has grown from 329 children to over 600. She’s also begun running mobile clinics in some of the remote areas on the fringes of the hospital’s catchment area, all in an effort to help Haiti’s poorest families.

*Nutrient enriched, locally produced mixture of rice, corn, and beans **Nutrient enriched, locally produced peanut butter-based Ready to Use Therapeutic Food (RUTF)


PBS NewsHour featured the work of Zanmi Agrikol (“Partners In Agriculture”), PIH’s agricultural partner organization in Haiti. Following the January earthquake, Zanmi Agrikol’s efforts have focused on ramping up food production and helping local farming families harvest enough food to feed their growing communities in sustainable ways.

Zanmi Agrikol works with local farmers to grow peanuts and create Nourimanba, the RUTF used to treat malnourished children.

Watch the PBS NewsHour piece at the link below (the segment with Zanmi Agrikol begins around 4:30):


In the aftermath of the earthquake, a primary concern of PIH is the vulnerability of children among the survivors and displaced. With nearly 40% of Haitians are under the age of 14, children are at risk in several ways. First, many children have lost or been separated from parents, thus swelling the ranks of orphans and vulnerable children in the country who must be protected. Second, with large numbers of displaced people living in temporary shelters or tents, or crowded into inadequate housing, there is danger of public health epidemics such as cholera, diarrheal diseases, and typhoid, particularly among children. Children are also at heightened risk for malnutrition: prior to the earthquake, nearly 25% of children were chronically malnourished in Haiti, and with rising prices, the onset of the rainy season, the May-July seasonal hunger gap, and protracted displacement, most expect pediatric malnutrition rates to rise in Haiti.

PIH's food programs serve to both treat and prevent pediatric malnutrition We treat acutely malnourished children by using a locally manufactured therapeutic food called Nourimanba. Nourimanba is a peanut butter-based "Ready to Use Therapeutic Food" that provides 100% of the daily nutritional requirements for protein, fat, carbohydrates, vitamins and minerals for malnourished children. For children who are moderately malnourished or transitioning off of Nourimanba, we provide a locally produced mixture of milled grain and legumes called Nourimil. In 2009, PIH provided these foods to 5,600 severely and moderately malnourished children. However, we expect that the disruption in day-to-day life and the rising cost of food will increase rates of pediatric malnutrition, and we expect to serve 8,000 children this year, both among displaced children who are now in our catchment area, and within the IDP camps we are working in Port-au-Prince.

Alongside our efforts to provide access to education, PIH also recognizes that children cannot learn if they do not eat. Through our school lunch program at 27 local schools in our catchment area, roughly 9,000 students are provided with a high-protein, low-cost, nutritious meal. And considering the fact that the price of food has already risen since the earthquake - this nutritious meal is essential in ensuring the capacity of Haiti's youngest to absorb their educations. In each of the communities where we provide school lunches, PIH employs local women to prepare the meals from hundreds of giant sacks of rice and beans. The benefits of this program are enormous, and yet the cost is minimal - just 27 cents per child per school day. Now that parents no longer have to choose between education and food for their children, school attendance has increased significantly, and so have the attention spans and classroom performance of the children once they get to school. As the influx of families from PAP increases demands on local schools, we expect this program to also grow, and are expecting to reach 11,000 children this year with the school lunch program.



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Organization Information

Partners In Health (PIH)

Location: Boston, MA - USA
Website: http:/​/​
Project Leader:
Laura Soucy
Annual Giving Coordinator
Boston, MA United States

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