Madagascar - Second Phase of Improving Nutrition Outcomes Using the Multiphase Programmatic Approach : Additional Financing

Overview & Synopsis

The development objective is to increase utilization of a package of reproductive, maternal and child health and nutrition interventions and to improve key nutrition behaviors known to reduce stunting in targeted regions. The additional financing will finance uninterrupted delivery and quality improvement of integrated reproductive, maternal, newborn, child, adolescent health and nutrition services through 7,232 community sites and 1,576 primary health centers in 13 regions; essential inputs and commodities for the minimum package at community and facility levels; enhanced supervision, coaching, and adolescent-responsive services; measures to reduce access barriers including continuation and digitization of a voucher program, piloting and evaluation of performance-linked vouchers and capitation approaches, targeted social and behavior change communication, and outreach strategies for remote populations; health workforce capacity through in-service e-learning, mentorship coordinated by Regional Training Offices (BRF), strengthened pre-service education, and improved human resource management systems; health information system strengthening including District Health Information Software 2 upgrades, digital data capture at community level, user-friendly dashboards, gender sensitive data, and a climate-health analytics module to support anticipatory actions; performance-based financing to improve service quality; climate-resilient upgrading of health facilities with essential equipment, reliable water and electricity, and small grants to facilities channeled through communes with strengthened public financial management and civil society oversight; multisectoral convergence by linking with the national social registry to reach vulnerable households, reinforcing nutrition-sensitive agriculture linkages, and strengthening coordination and joint monitoring led by the National Nutrition Office and nutrition councils with digital platforms and performance contracts; project management and institutional capacity building including preparation for future operations using the Program for Results instrument; and a Contingent Emergency Response Component to enable rapid reallocation in crises. These investments will sustain and expand coverage for women, adolescents, and children, protect households from financial barriers, improve service quality and continuity, accelerate reductions in stunting and nutrition-related morbidity and mortality, enhance data-driven decision-making, and strengthen climate resilience of service delivery. They will also reinforce institutional capacity and accountability at central and subnational levels, deepen multisectoral collaboration with social protection and agriculture, and consolidate a sustainable platform for high-impact nutrition outcomes in underserved areas.