- Product Type:Micronutrient powders (MNP)
- Product Name: Zazatomady®
- Implementation Partners:UNICEF; PSI Madagascar
- Scale:Pilot project
- Primary Target Group:children aged 6-23 months
- Distribution Channel:Market-based channel: NGO
- Cost to Target Recipient:payment (subsidized)
The Madagascar National Nutrition Office, with the support of its partners launches the micronutrient powder Zazatomady® to combat high levels of anemia and vitamin deficiencies among children in two coastal and two highland areas Madagascar.
Madagascar is one of the 20 countries in the world with the highest burden of undernutrition and recent data shows that with half its children under 5 stunted, Madagascar ranks 6th in the world with regards to stunting. The latest Demographic Health Survey also found that anemia affects half of Malagasy children under 5, with as much as 68% of children between 6-11 months reported anemic. Only an estimated 13% of Malagasy children 6-23 months benefit from adequate complementary feeding, particularly a diverse diet4 that provides the minimum daily required vitamins and minerals.
With UNICEF financial and technical support, the National Nutrition Office, the Ministry of Health and PSI/Madagascar are implementing an 18-month pilot project called Fortidom that includes promotion of food diversification and distribution of a branded micronutrient powder (MNP) in two rural areas (Vavatenina and Fénérive-Est) and in two urban areas (Antananarivo and Fianarantsoa) of Madagascar. The pilot aims to improve complementary feeding practices by increasing access to and use of a ready-to-use MNP for home food fortification through a combination of community based distribution using trained community health workers (CHWs) and social franchising channels through the PSI/Madagascar supported Top Reseau private clinic network. A very strong and innovative communication strategy is also employed to improve infant feeding practices in general. The business model is being tested for sustainability.
Following successful launches in February 2013, PSI/Madagascar has started distributing Zazatomady among caregivers of children 6-23 months, using the existing model for distribution of essential health commodities through the use of community based trained supply points. In the pilot rural areas Zazatomady is now available to trained community health workers at PSI/Madagascar supported supply points and at public sector basic health centers. For children 6-23 months in urban project areas, trained franchisees will start promoting and sale of the product in early March, following the urban launches.
To assist the CHWs in their work, PSI/Madagascar developed a series of 3 minute long radio spots and a mobile video unit spot, which are being used to reinforce home fortification and MNP promotional activities. In addition to explaining what Zazatomady is and what benefits it has, the spots discuss exclusive and continued breastfeeding, and the importance of food diversity for young children. Members of the Nutrition Task Force’s IEC committee worked alongside in the definition and validation of messages and IEC tools for trained CHWs.
The launches in Fenerive Est and Vavateny were the result of intensive advocacy work with local authorities. Project partners from the different entities at central level traveled repeatedly to the Analanjirofo region and the districts to discuss the project with health and administrative authorities, and to ensure their commitment and interest. As a result, both launches were attended by high level regional and district authorities who reiterated their enthusiasm for the project in a series of eloquent speeches.
?When the official delegation arrived at the site of the launch in Fenerive Est, hundreds of people welcomed them in a joyous event that involved music, songs from different communes, dances by the CHWs and official speeches. Those speaking included the ‘Chef de Region’, the regional Director of Health, the National Coordinator of the National Nutrition Office, and the UNICEF/Madagascar and PSI/Madagascar Country Representatives. Speeches were followed by a visit to various stands that showed newly disseminated IEC materials for CHWs to counsel mothers with infants and young children on nutrition, posters that describe the key research findings from the qualitative and the quantitative studies that were conducted in late 2012. The stands also included a table with several trays of local food and a tray of Zazatomady, which CHWs used to demonstrate on-the-spot to mothers with children 6-23 months how the product is meant to be used.
?UNICEF and PSI/Madagascar had worked closely together to organise the launch events. Radio, TV and print media journalists from Antananarivo and the region attended the launch and a press release was provided for coverage in national and regional newspapers. The launches received widespread coverage (samples of articles that appeared in the newspapers are attached), Mr Lauwerier, the UNICEF Representative to Madagascar attended the first launch in Fenerive Est. During his speech he reiterated the importance of the project: “Iron rich foods remain inaccessible for many malagasy households.That’s why it is important for all of us to launch this home food fortification product to give children vitamins and minerals to grow well and improve their nutritional status”and ensured the audience that this was just the beginning ; in his vision, all children in Madagascar deserve to have access to Zazatomady. The same message was reiterated by the PSI/Madagascar representative, Chuck Szymanski, who also underlined the importance social marketing strategies to bring essential health commodities to communities in Madagascar. Messages from the National Nutrition Office and the Ministry of Health focused on the anticipated health impact the product would have on micronutrient deficiencies in the districts and on their commitment to making the pilot a success.
At the occasion of the second launch in Vavatenina district, Mr Paul Ngwakum, UNICEF/M Head of the Health and Nutrition Section also noted the strong engagement of the political leaders from the region to move forward with the nutrition agenda. He further commented on the successful social mobilisation aspects of the launch, and remarked how well the trained CHWs seemed to have mastered the newly taught messages.
CHWs who participated in the launches seemed proud to serve their communities and very pleased with the new IEC tools, the product, and the supervision they will be receiving from the Regional Nutrition Office and the district health facility staff. Yet, the success of the project is in the hands of the communities and though results from the acceptability study showed very positive interest and motivation, it is ultimately the mothers of Fenerive Est and Vavateny who need to embrace Zazatomady. As one CHW said, ‘it will be the moms deciding how to use the product, it can be for breakfast, for lunch or for dinner, it depends on their preferences, we can only provide guidance’.
Urban launches with Top Reseau providers followed on March 8th in Fianarantsoa and on March 13th in Antananarivo. Launches were held at participating clinics where edu-tainment activities through mobile video unit (MVU) sessions were organized to ensure mothers understand where the product is available. During these sessions, IEC materials were distributed, radio spots were broadcasted and humorous animations were conducted by Mr. Honorat, Zaza Tomady’s ambassador, and his comedy troup Fou Hehy. Mr. Honorat has been collaborating with PSI/Madagascar for 10 years and his widespread fame in rural and urban areas largely contributed to create demand for socially marketed health products throughout the country. During the launches, Top Réseau doctors reported being particularly impressed by Mr. Honorat’s mastering of complementary feeding-related messages. As a matter of fact, mothers were so enthusiastic about the product that many of them visited Top Réseau doctors to purchase Zazatomady for their child right after the MVU sessions.
As the Fianarantsoa launch coincided with the International Women’s Day, promotion of the Fortidom project was also organized as part the celebration’s events, which included speeches from regional and district administrative authorities, a Zazatomady stand showing the product together with the IEC tools developed to promote complementary feeding and a parade with songs, dances and music.
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The urban launches were then closed by an official launching ceremony attended by regional and district health authorities, Top Réseau doctors and the president of the Regional Body of Doctors. Two community health NGOs commented a few days after the Fianarantsoa launch: «the presentation you made at the launching ceremony with the local authorities convinced us about the effectiveness of this product. We would also like to distribute this product as soon as possible ».
During the speeches, health authorities expressed their engagement to ensure successful implementation of the pilot and their strong willingness to rapidly take the project to scale. Health partners also commented on their confidence in the pilot’s success. The head of a Fianarantsoa- based NGO said : « your communication strategy is so strong that we expect excellent results for this project ». A participating Top Réseau doctor in Fianarantsoa also reported that, « the fact that Zazatomady is available through Top Réseau clinics reassures mothers about the product’s effectiveness because the network is recognized for the high quality of its services» and that « introducting this new project will contribute to increase consultations for children under five through Top Réseau clinics ».
Project partners will be closely monitoring project activities in rural and urban sites, and sharing lessons learnt in the early stages, to reinforce advocacy for rapid scale up in other districts and regions. Regular review meetings are planned with CHWs and Top Reseau providers to this end. Towards the end of the pilot the quantitative and qualitative research studies will be repeated to measure any changes in knowledge, attitude and practice in the rural communities that were part of the pilot.
For more information on this nutrition project, please contact :
Ietje Reerink, Senior TA for Research and Programs PSI/Madagascar
ietjer@psi.mg
+261 32 07 25226
Contact Presse:
Daniel Timme
Chief of Media & External Relations dtimme@unicef.org
+261 32 03 411 31
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