IPC ANALYSIS OF FOOD INSECURITY AND ACUTE MALNUTRITION SOUTH AND SOUTH EAST March 2019 ‐ March 2020 Published in July 2019

CURRENT ACUTE FOOD INSECURITY PROJECTED ACUTE FOOD INSECURITY (June 2019 ‐ July 2019) (August 2019 ‐ December 2019) Phase 5 Phase 5 000 000 000 000 Catastrophe Catastrophe 730 522 Phase 4 916 201 Phase 4 134 595 171 421 21 % of the population Emergency 26% of the population Emergency Phase 3 Phase 3 595 927 744 780 Crisis Crisis People facing severe acute People who will be facing Phase 2 Phase 2 food insecurity 1 280 949 severe acute food insecurity 1 280 052 Stressed Stressed (IPC Phase 3 +) (IPC Phase 3 +) Phase 1 Phase 1 IN NEED OF A 1 550 716 IN NEED OF A 1 365 934 URGENT ACTION Minimal URGENT ACTION Minimal

ACUTE MALNUTRITION August 2019 – February 2020

SAM* 188 550 35 393 Number of cases *SAM = severe acute malnutrition; Number of 6‐59 months children MAM* MAM = moderate acute malnutrition; acutely malnourished 153 158 Number of cases GAM = global acute malnutrition IN NEED OF TREATMENT 188 550 GAM* Number of cases

How severe, how many, and when? Up to July 2019, SEVEN of THIRTEEN analyzed Districts are classified in IPC phase 3 (Crisis‐ IPC Acute Food Insecurity). 730,522 people, including 134,595 in IPC Phase 4 (Emergency) are estimated to be facing severe acute food insecurity. They represent 21% of the population of the areas analyzed (13 districts). 188,550 children are likely to suffer from acute malnutrition, with 35,393 severe cases located in the 12 districts analyzed based on the combined prevalence of the three forms of acute malnutrition from SMART surveys.

Where and who? The Districts of Ambovombe, , Tsihombe, Amboasary, Ampanihy, and Betioky are facing both acute food insecurity‐phase 3 (crisis) and acute malnutrition‐phase 3 (serious). Bekily is classified in IPC Phase 4 (Critical ‐ IPC Acute Malnutrition), the District of Toliara II is in IPC phase 3 (Serious ‐ IPC Acute Malnutrition), and the 5 communes of Taolagnaro are classified in IPC Phase 3 (Crisis ‐ IPC Acute Food Insecurity). Compared to the results of the last IPC Acute Food Insecurity analysis in October 2018, the food security situation in Beloha and Ampanihy districts has significantly improved. The improvement can be attributed in part to humanitarian intervention packages carried out in these two districts: Beloha moved from IPC Phase 4 to IPC Phase 3 with the proportion of households in Phase 3 and 4 falling from 67% in 2018 to 25% in June 2019. The District of Ampanihy was projected to be in IPC Phase 4 but its current phasing is maintained in Phase 3.

Why? This situation of localized severe acute food insecurity is caused by several aggravating factors:  more than 30% of households in these areas have inadequate food consumption  at least 65% of households have reduced portion sizes at meals,  a fairly significant proportion of households (between 15 and 38%) adopted crisis strategies, reflected in the accelerated depletion of productive assets, particularly the sale of productive livestock (around 10% of households have reduced their cattle herds).

Major contributing factors to the deterioration of the nutritional situation in these areas include inadequate food intake, low dietary diversity of children, high prevalence of diseases (diarrhea, Acute Respiratory Infection, malaria and measles) with more than 30% related to poor access to health services. The high level of food insecurity (IPC Phase3) in most districts and low access to safe drinking water contribute to increased levels of acute malnutrition.

IPC ANALYSIS OF FOOD INSECURITY AND ACUTE MALNUTRITION MADAGASCAR SOUTH AND SOUTH EAST March 2019 ‐ March 2020 Published in July 2019

OVERVIEW OF THE ACUTE FOOD INSECURITY SITUATION AND DETERMINING FACTORS 2

Overview of the current situation (June-July 2019)

The period of analysis covers the beginning of the harvest for all analyzed areas. The majority of districts in the South are in IPC Phase 3 (Crisis) except Bekily and Toliara II Districts that are classified in IPC Phase 2 (Stress). . In the South East, , Vangaindrano and Districts are also classified in IPC Phase 2 (and Atsimo is in IPC Phase 1 (Minimal).

More than 730,000 people, i.e. 21% of the population of the analyzed areas are in IPC Phases 3 and 4 (Crisis and Emergency) and therefore require urgent action. A significant decrease in the proportion of the population categorized in these phases was observed compared to the IPC analysis results in 2018 for the same period. For Beloha District, the proportion of population in IPC Phase 3 and 4 has decreased considerably from 65% to 25% for the same period (June 2018/2019); slight improvements have also been recorded in the other Districts: Ampanihy from 49% to 40%; Ambovombe from 30% to 22%; Bekily from 28% to 18%; and Tsihombe from 27% to 23%. For Amboasary district and the 5 communes of Taolagnaro, the situation has stabilized slightly. In general, despite the attack of insect pests and a somewhat unfavourable meteorological context, harvests in 2019 were better than the critically low levels in 2017 and 2018. However, difficulties persist, even if they are transient and localized.

Food security in the south remains critical because although the harvests from the main season crop have improved, this has been very marginal. Household incomes remain very low, limiting purchasing power. Insect damage, irregular rainfall in terms of quantity received and geographical distribution, have destroyed cereal crops such as rice and maize. There was a significant crop loss of almost 100% in Ambovombe.

As for the South East, the weather conditions were more favorable. Spared by cyclones and major floods and benefiting from sufficient rainfall, the harvests of the main season crop were better than in 2018. Compared to 2017, the harvest improved better. Moreover, no one is in IPC Phase 4 and the proportion of the population in IPC Phase 3 (crisis) does not exceed 15%.

Overview of the projected situation (August to December 2019)

The projected period corresponds to the period of off‐season preparation that takes place during the lean season. It coincides with the period of significant expenses: funeral ceremony, back‐to‐school time, preparation of farmland. These conditions lead to the risk of deterioration in some districts. For a large part of the population, stocks from the harvest of the main season will be depleted early. For the South, the harvest of tubers, cassava and sweet potato would help to mitigate this shortage. However,it is primarily middle‐income and wealthy households that can see major impacts from this opportunity and poor households with limited access to land will benefit on a smaller scale. The weather conditions, though quite conducive, do not give hope for more favorable harvests with the threat of pest attacks. The lean season from September to November 2019 will exacerbate household difficulties. Household living conditions will deteriorate. For the South East, Manakara would move from Phase 1 to Phase 2 IPC (Stressed). For the other districts, the proportion of households in phase 3 will remain relatively stable (Vangaindrano and Vohipeno) even increase slightly by around 5% for Farafangana. For the South the proportion of the population in IPC Phase 4 (Emergency) in Beloha, Taolagnaro and Tsihombe) will increase slightly. IPC ANALYSIS OF FOOD INSECURITY AND ACUTE MALNUTRITION MADAGASCAR SOUTH AND SOUTH EAST March 2019 ‐ March 2020 Published in July 2019

OVERVIEW OF THE ACUTE MALNUTRITION AND CONTRIBUTING FACTORS 3

Overview of the current situation (March-July 2019)

For all the analyzed districts, the current period corresponds to the end of the lean season up to the period of main season crop harvest, which coincides with the peak of acute malnutrition cases between March and April, according to nutritional monitoring data and SMART surveys. For the current period, the Districts of Betioky, Ampanihy, Toliara II, Tsihombe, Beloha, Ambovombe and Amboasary are classified in IPC phase 3 (Serious), followed by the Districts of Mananjary, Taolagnaro, Vangaindrano in IPC phase 2 (Alert) and Farafangana in IPC phase 1 (Acceptable). The high prevalence of diseases in Bekily, including diarrhea (34%), fever and malaria (60%) and acute respiratory infections (68%) combined with the persistence of inadequate feeding practices (33% exclusive breastfeeding) and low vaccination coverage (vitamin A‐64%, measles‐ 50%) have increased levels of acute malnutrition in the district and led to its classification in IPC phase 4 (Critical), requiring a crucial and targeted response.

Major contributing factors to the deterioration of the nutritional situation in the analyzed districts during this period include:  exposure to relatively high acute food insecurity (IPC phase 3 for all southern districts and IPC phase 2 for the southeastern districts) of households with negative impacts on children's dietary diversity;  inadequate food intake;  the prevalence of diseases such as diarrhea, acute respiratory infection (ARI), malaria, access to drinking water;  and the measles epidemic.

Overview of the projected situation (August to October, and November to February 2020) The first projected period (August‐October 2019) corresponds to a post‐harvest period implying an improvement in food availability and a dry period leading to a decrease in the number of cases of malnutrition‐related diseases. Thus, a more marked improvement in nutrition is expected in 4 Districts (Bekily, Toliara II, Mananjary and Vangaindrano) which will lead to a reclassification to a lower phase, notably Tulear‐II (3 to 2), Bekily (4 to 3), Mananjary (2 to 1) and Vangaindrano (2 to 1), and less pronounced in the other 8 districts where a phase change is not to be anticipated. The second period (November 2019 to February 2020) coincides with the beginning of the lean season, which is characterized by the depletion of household food reserves, declining access to food, and the rainy or even cyclonic season in the Southeast, with risks of an upsurge of diarrhea and malaria cases. An increase in malnutrition cases is expected from November to reach the peak in the first quarter of the following year. Thus, it is expected that all 3 Southeast districts analyzed will deteriorate and Toliara II will move to IPC Phase 3 (Serious) and Ambovombe to IPC Phase 4 (Critical).

In the South, an improvement in the food security situation is expected during November and December owing to the the off‐season crop harvest that will also reduce the level of malnutrition in 6 Districts (Bekily, Beloha, Tsihombe, Amboasary, Ampanihy, and Betioky) which will remain in the same Phase (Serious) with a prospect of degradation in the Phase classification without humanitarian assistance. Overall, priority responses should be directed towards strengthening health and food awareness activities, improving access to water and sanitation infrastructure. In addition, the risks of epidemics and hydro‐climatic risks (cyclone, flood and drought) have to be monitored. Finally, in the long term, activities targeted to enhance human capital might have a significant impact on the nutritional situation.

IPC ANALYSIS OF FOOD INSECURITY AND ACUTE MALNUTRITION MADAGASCAR SOUTH AND SOUTH EAST March 2019 ‐ March 2020 Published in July 2019

CURRENT IPC ACUTE FOOD INSECURITY SITUATION FOR JUNE TO JULY 2019 4

Region Unit of analysis Phase 1 Phase 2 Phase 3 Phase 4 Phase Phase 3 + Total Population number % number % number % number % number % Ambovombe‐ 362 309 126 808 35 155 792 43 68 838 19 10 869 3 3 79 707 22 Bekily 236 715 82 850 35 111 256 47 35 507 15 7 101 3 2 42 608 18 Androy Beloha 154 652 38 663 25 77 326 50 30 930 20 7 733 5 3 38 663 25 Tsihombe 149 700 52 395 35 62 874 42 26 946 18 7 485 5 3 34 431 23 Subtotal 903 376 300 716 33 407 248 45 162 221 18 33 188 4 195 409 22 5 communes of Taolagnaro 39 225 13 729 35 17 651 45 5 884 15 1 961 5 3 7 845 20 Anosy Amboasary‐sud 256 977 77 093 30 102 791 40 51 395 20 25 697 10 3 77 092 30 Subtotal 296 202 90 822 31 120 442 41 57 279 19 27 658 9 84 937 28 Ampanihy 398 374 59 756 15 179 268 45 119 512 30 39 837 10 3 159 349 40 Betioky‐sud 308 774 61 755 20 138 948 45 92 632 30 15 438 5 3 108 070 35 Atsimo Andrefana Tuléar II 369 485 221 691 60 92 371 25 36 948 10 18 474 5 2 55 422 15 Subtotal 1 076 633 343 202 32 410 587 38 249 092 23 73 749 7 322 841 30 Farafangana 406 174 243 704 60 121 852 30 40 617 10 ‐ ‐ 2 40 617 10 Atsimo Atsinanana Vangaindrano 355 329 177 665 50 124 365 35 53 299 15 ‐ ‐ 2 53 299 15 Subtotal 761 503 421 369 55 246 217 32 93 916 12 ‐ ‐ 93 916 12 Manakara‐sud 380 538 308 236 81 53 275 14 19 026 5 ‐ ‐ 1 19 026 5 Vatovavy Vohipeno 143 935 86 371 60 43 180 30 14 393 10 ‐ ‐ 2 14 393 10 Sous total 524 473 394 607 75 96 455 18 33 419 6 ‐ ‐ 33 419 6 Total 3 562 187 1 550 716 43 1 280 949 36 595 927 17 134 595 4 730 522 21

IPC ANALYSIS OF FOOD INSECURITY AND ACUTE MALNUTRITION MADAGASCAR SOUTH AND SOUTH EAST March 2019 ‐ March 2020 Published in July 2019

PROJECTED IPC ACUTE FOOD INSECURITY SITUATION FOR AUGUST TO DECEMBER 2019

Region Unit of analysis Total population Phase 1 Phase 2 Phase 3 Phase 4 Phase 3 + number % number % number % nombre % Phase number % Ambovombe‐androy 362 309 126 809 35 126 808 35 90 577 25 18 115 5 3 108 692 30 Bekily 236 715 78 116 33 99 420 42 47 343 20 11 836 5 3 59 179 25 Androy Beloha 154 652 30 930 20 61 861 40 46 396 30 15 465 10 3 61 861 40 Tsihombe 149 700 37 425 25 62 874 42 37 425 25 11 976 8 3 49 401 33 Subtotal 903 376 273 280 30 350 963 39 221 741 25 57 392 5 279 133 30 5 communes of Taolagnaro 39 225 11 768 30 17 651 45 5 884 15 3 923 10 3 9 807 25 Anosy Amboasary‐Atsimo 256 977 89 943 35 89 942 35 51 395 20 25 697 10 3 77 092 30 Subtotal 296 202 101 711 34 107 593 36 57 279 19 29 620 10 86 899 29 Ampanihy 398 374 59 756 15 159 350 40 139 431 35 39 837 10 3 179 268 45 Betioky‐sud 308 774 61 755 20 123 510 40 108 071 35 15 438 5 3 123 509 40 Atsimo Andrefana Tuléar II 369 485 147 794 40 155 184 42 48 033 13 18 474 5 2 66 507 18 Subtotal 1 076 633 269 305 25 438 044 41 295 535 27 73 749 7 369 284 34 Farafangana 406 174 223 396 55 121 852 30 60 926 15 ‐ ‐ 2 60 926 15 Atsimo Atsinanana Vangaindrano 355 329 159 898 45 127 918 36 56 853 16 10 660 3 2 67 513 19 Subtotal 761 503 383 294 50 249 770 33 117 779 15 10 660 1 128 439 16 Manakara 380 538 266 377 70 76 108 20 38 053 10 ‐ ‐ 2 38 053 10 Vatovavy Fitovinany Vohipeno 143 935 71 967 50 57 574 40 14 393 10 ‐ ‐ 2 14 393 10 Sub total 524 473 338 344 65 133 682 25 52 446 10 ‐ ‐ 52 446 10 Total 3 562 187 1 365 934 38 1 280 052 36 744 780 21 171 421 5 916 201 26

IPC ANALYSIS OF FOOD INSECURITY AND ACUTE MALNUTRITION MADAGASCAR SOUTH AND SOUTH EAST March 2019 ‐ March 2020 Published in July 2019

CURRENT IPC ACUTE MALNUTRITION SITUATION FOR MARCH TO JULY 2019 6

Number of Number of children (6‐59 months) in need of treatment Unit of analysis GAM (%) children <5 years GAM treatment MAM treatment SAM treatment old Ambovombe‐Androy 14 57 969 21 101 17 438 3 663 Bekily 14 37 874 13 491 11 206 2 285 Beloha 12 24 744 7 913 6 948 965 Tsihombe 11 23 952 6 975 6 215 760 Amboasary Atsimo 15 41 116 16 356 12 828 3 528 Taolagnaro 11 54 637 15 058 13 353 1 705 Ampanihy 16 63 740 27 013 20 881 6 132 Betioky 12 49 404 15 542 13 102 2 441 Toliara II 18 59 118 28 282 21 365 6 917 Mananjary 6 44 598 7 189 6 146 1 044 Vangaindrano 9 56 853 13 747 11 678 2 069 Farafangana 9 64 988 15 883 11 997 3 886 Total N.A. 578 993 188 550 153 158 35 393

IPC ANALYSIS OF FOOD INSECURITY AND ACUTE MALNUTRITION MADAGASCAR SOUTH AND SOUTH EAST March 2019 ‐ March 2020 Published in July 2019

PROJECTED IPC ACUTE MALNUTRITION SITUATION FOR AUGUST‐OCTOBER 2019 & NOVEMBER TO FEBRUARY 2020

RECOMMENDATIONS FOR ACTION 8

Response priorities

In districts in IPC Phase 3 of Acute Food Insecurity, emergency interventions are needed to reduce food consumption gaps and protect livelihoods:  Reduce the intensity of the lean season that is likely to begin in August for the most vulnerable (households with limited access to land, households with lower or no assets, households headed by young people or women and households with many dependents), in particular through humanitarian interventions in social protection and early recovery. These interventions should include an accountability mechanism, and modalities to limit the depletion of livelihood assets and/or facilitate access to food;

 Capitalize on the achievements in the implementation of emergency responses (minimum package system) and early recovery that have helped to limit the deterioration of the situation of households in emergency situation.

A careful targeting of these categories of people in emergency situations should be undertaken at the district level to ensure that they receive appropriate support.

For districts classified in IPC phase 3 (Serious) of the IPC Acute Malnutrition, strengthening the health system and, in particular, the prevention and integrated management of childhood diseases (malaria, diarrhea and respiratory infections) as well as continued support for the expanded programme on immunization and the Mother and Child Health Weeks (MCHW) should be a priority in the response.

IPC ANALYSIS OF FOOD INSECURITY AND ACUTE MALNUTRITION MADAGASCAR SOUTH AND SOUTH EAST March 2019 ‐ March 2020 Published in July 2019

And in order to strengthen the resilience of communities' livelihoods prone to recurrent cyclones/floods (South‐East) and drought (South): o Implement the resilience strategy for the agricultural sector on a larger scale

o Support the effective operationalization of the cyclone and drought contingency plan under government leadership at the regional level; capacity building of the government counterpart should be carried out to ensure better coordination and effectiveness of the various multisectoral interventions implemented under this plan;

o Strengthen early warning systems running for timely and informed decision‐making and facilitate the implementation of early interventions in Districts in IPC Phases 2 and 3 to prevent or mitigate the effects of hazards;

o Intensify the control of insect pests (fall armyworms, locusts, etc.) and plant health diseases to limit damage to crops in the fields at development stage;

o Support income‐generating activities that enable households to diversify their sources of income and strengthen their productive capacity.

And in the prevention of malnutrition:

. Promote the diversification of crops with high nutritional value through nutrition education, cooking demonstrations, food conservation and processing techniques to achieve a diversified and nutritious diet

. Focus interventions on infant and young child feeding best practices, mainly improvement on diet best practices and their application by mothers, the quality of food consumed by children, and the prevention and treatment of childhood diseases

. Conduct a response analysis involving all nutrition, health, food security and WASH actors to identify appropriate interventions to fight against acute malnutrition. This response analysis could initially be focused on Bekily in critical situation and in districts in serious phases, which have relatively high levels of acute malnutrition

. Intensify resource mobilization efforts to increase the coverage of existing malnutrition prevention and treatment interventions while exploring their expansion at the community level.

IPC ANALYSIS OF FOOD INSECURITY AND ACUTE MALNUTRITION MADAGASCAR SOUTH AND SOUTH EAST March 2019 ‐ March 2020 Published in July 2019

Monitoring and activities update For informed and timely decision making: o Strengthen the running of early warning systems and regular monitoring systems for food prices, staple products, reference market dynamics, agro‐meteorological data, the spread of crop pests

o Support coordination and data sharing mechanisms on different interventions in the areas of food security, nutrition and related areas (water, hygiene, sanitation...)

Following the analysis conducted in the Grand Sud, it is suggested: o To organize an IPC training and analysis workshop on Chronic Food Insecurity in order to explore the underlying causes that justify the persistence of the situation in these areas and to provide more appropriate responses. This workshop should be preceded by awareness‐raising sessions at different levels involving all relevant stakeholders o Conduct a comprehensive and contextualized analysis of responses to effectively address acute food and nutrition insecurity in areas where crises are recognized as persistent.

IPC ANALYSIS OF FOOD INSECURITY AND ACUTE MALNUTRITION MADAGASCAR SOUTH AND SOUTH EAST March 2019 ‐ March 2020 Published in July 2019

COMPARISON OF AREAS IN ACUTE FOOD INSECURITY AND MALNUTRITION (IPC PHASE 3+) 9

AIGUË

Food security is a major contributing factor to acute malnutrition in all the districts analyzed. In Amboasary, Betioky, Vangaindrano, Mananjary and Toliary II Districts in particular, food insecurity is a major determinant of acute malnutrition levels in the period of analysis from March to July 2019, when the annual peak of malnutrition occurs between March and April for the South and between January and February for the South Eastern. In Ambovombe, Ampanihy, Beloha and Tsihombe Districts, levels of acute malnutrition result from a combination of food insecurity and other major contributing factors such as relatively high disease prevalence (>30%) and inadequate childcare. In both cases, the food security phases are aligned (or delayed for Farafangana) with those of acute malnutrition, although acute malnutrition levels fluctuate within the phases.

On the other hand, in Bekily District, the major contributing factors to malnutrition other than food security explain most of a critical phase (IPC Acute Malnutrition Phase 4) of acute malnutrition while the district is classified as stressed (IPC Acute Food Insecurity Phase 2). Indeed, these factors are among others: i. the very high prevalence of diseases, such as malaria (>60% prevalence), which is increasing this year compared to historical data over the same period, ii. and specifically serious cases that have quadrupled compared to the average of the last 3 years, cases of diarrhea (35% prevalence) boosted by inadequate use of water sources for drinking and daily needs in terms of quality and quantity (only 7.5 Liter per person and per household, whereas the minimum recommended is 15 Liter), and respiratory infections that affect more than 2 in 3 children in this district. Also, the level of inadequate care for children (exclusive breastfeeding: 33%) as well as low levels of coverage of disease prevention activities (measles ‐50%, vitamin A ‐65%, deworming ‐50%).

The nutritional monitoring data made possible the classification of the entire Taolagnaro District in alert phase (IPC Acute Malnutrition which implies a strengthening of the ongoing response and resilience activities. In addition, this analysis shows higher levels of acute malnutrition in 5 border communes (Ranopiso, Andranobory, Analapatsy, Ankariera and Ankilivalo) in Amboasary District, largely due to the severity of food insecurity in these communes (classified in IPC phase 3: Crisis‐ IPC Acute Food Insecurity).

IPC ANALYSIS OF FOOD INSECURITY AND ACUTE MALNUTRITION SOUTH AND SOUTH EAST MADAGASCAR March 2019 ‐ March 2020 Published in July 2019

CONTRIBUTING FACTORS TO ACUTE MALNUTRITION 10 CONTRIBUTING FACTORS: Major Minor No No Legends contributing contributing contributing data factor factor factor Betioky Bekily Bekily Toliara II Beloha Ampanihy Mananjary Mananjary Amboasary Amboasary Tsihombe Farafangana Farafangana Ambovombe Taolagnaro Taolagnaro Vangaindrano Vangaindrano

Inadequate food intake Minimum dietary diversity (MDD)

Minimum Meal Frequency (MMF)

Minimum Acceptable Diet (MAD)

Minimum dietary diversity ‐ Women (MDD‐W) Others Diseases Diarrhea

Dysentery

Malaria

Prevalence of HIV/AIDS

Acute respiratory infection (ARI)

Outbreak of disease

Others

Inadequate access to food Result of the IPC analysis of acute food insecurity

Inadequate care for children Exclusive breastfeeding up to 6 months

Continuation of breastfeeding at 1 year

Continuation of breastfeeding at 2 years of age

Introduction of solid, semi‐solid or soft foods

Others Inadequate health services and unhealthy Measles vaccination environment Polio vaccination

Vitamin A supplementation

Births assisted by a qualified caregiver

DECEMBER 2018 – JANUARY 2019 Issued on 00 Month Year

IPC ANALYSIS OF FOOD INSECURITY AND ACUTE MALNUTRITION SOUTH AND SOUTH EAST MADAGASCAR March 2019 ‐ March 2020 Published in July 2019

PROCESS ET METHODOLOGY 11

Acute food insecurity and malnutrition workshop analysis were held in Toliara (Atsimo Andrefana What IPCs are, the IPC Acute Region) from 13 to 21 June 2019. Each workshop included four days of training on IPC tools and Food Insecurity and the IPC protocols version 3.0 and five days of analysis. Acute Malnutrition: The IPC is a set of tools and procedures to classify the District covered in the analysis Region IPC Acute Food Insecurity IPC Acute malnutrition severity and characteristics of Ambovombe Androy x x food and nutrition crises and Tsihombe x x chronic food insecurity based Beloha x x Bekily x x on international standards. Amboasary Atsimo Anosy x x The IPC consists of four Taognaro 5 communes : Ranopiso, Andranobory, Analapatsy, The district mutually reinforcing Ankariera, Ankilivalo functions, each with a set of Ampanihy Ouest Atsimo x x specific protocols (tools and Andrefana Betioky Atsimo x x procedures). The core IPC Tuléar II x x parameters include consensus Vohipeno Vatovavy x Manakara Atsimo Fitovinany x building, convergence of Mananjary x evidence, accountability, Nosy Varika Not classified without transparency and evidences comparability. The IPC Farafangana Atsimo x x analysis aims to informing Vangaindrano Atsinanana x x emergency response as well

as medium‐ and long‐term Analysts from different backgrounds, sectors, central and local levels, UN agencies, state and civil society food security policy and organizations participated in the analysis. The two analyses involved an average of 30 analysts. The analysis programming. periods also differ between the two analysis. For Acute Food Insecurity, the absence of a weather forecast until For the IPC, Acute Food February 2020 is a blocking factor to go beyond December 2019. For Acute Malnutrition, the seasonal fluctuation Insecurity is defined as any in the nutritional trend between August and March 2019 led participants to analyze two projected periods: August manifestation of food to October 2019 and November 2019 to February 2020. insecurity found in a specified area at a specific point in time of a severity that threatens Specifically on the IPC analysis of Acute Food Insecurity, a multisectoral database including the results of the lives and/or livelihoods, or comprehensive food security assessment survey (EAM‐SA, May 2019) was used during the analysis workshop, both, regardless the causes, data from the nutritional monitoring system of the 8 southern districts (Ambovombe, Beloha, Bekily, Tsihombe, context or duration. For the Amboasary, Taolagnaro, Ampanihy, Betioky) supported by UNICEF, data from the Ministry of Health, IPC, Acute Malnutrition is meteorological and climate data from the General Directorate of Malagasy Meteorology. The database includes defined as any manifestation the four food security outcomes (food consumption, livelihood change , nutritional status, mortality) as well as a of malnutrition in a specified wide range of contributing factors (food availability/accessibility, access to water, etc.). The analysis was based area at a given time and on 5 pieces of direct evidence (according to IPC protocols), and about 40 pieces of indirect evidence for whose severity threatens lives and/or livelihoods regardless classification. The main data used were collected between April and June 2019, and most of them had a high the causes, context or Reliability Score (R2 ) (except Bekily, Manakara, and Taolagnaro). An extrapolation was necessary to estimate duration. the situation for the projected period: August to December 2019. On the IPC analysis of Acute Malnutrition, data on the GAM indicator came from SMART surveys and nutritional monitoring conducted between March and May 2019. Other indicators needed for analysis and contributing factors were derived from food security assessment reports, disease trends produced by the National Health Information System (GESIS), acute malnutrition coverage survey reports, knowledge, knowledge‐skills and practices surveys (CAP), SMART and malnutrition causality surveys (LinkNCA). The participants analyzed their respective areas and the results were reviewed by a national technical committee of the IPC for Acute Malnutrition and then presented and submitted for validation with all the participants in the exercise.

DECEMBER 2018 – JANUARY 2019 Issued on 00 Month Year

IPC ANALYSIS OF FOOD INSECURITY AND ACUTE MALNUTRITION SOUTH AND SOUTH EAST MADAGASCAR March 2019 ‐ March 2020 Published in July 2019

Limitations of the analysis:

For the IPC Acute Food Insecurity Classification, the limitations of the analysis are based on the absence of official statistics that allows for a more in‐depth analysis. In addition, direct evidence on nutrition and mortality is lacking for the majority of districts. Data on prices and price trends are also missing for the districts of Atsimo Andrefana. Data on emergency aid in other sectors are no longer recorded; however, these aids might contribute to reducing family burdens in food access.

The major limitations of the IPC analysis of Acute Malnutrition remain the unavailability of recent necessary data for the analysis of contributing factors or at the scale of the analysis area. Although SMART survey data provided good information on district analysis; the number of SMART surveys for the current period was limited to only 3 districts. To fill this gap, regional assessment data to identify some contributing factors, and nutritional monitoring in the South have provided information on malnutrition levels and historical trends. There was insufficient evidence to classify the Nosy‐Varika district.

It is important to note, however, that the IPC is not a tool for analyzing the response. The proposed interventions should be further analyzed to determine their technical and economic feasibility.

For further information, please contact: This analysis was conducted under the sponsorship of the National Bureau of Risk and Disaster RAONIVELO, Andrianianja IPC Global Support Unit IPC Madagascar focal point, www.IPCinfo.org Management [email protected] Classification of food insecurity and malnutrition conducted using IPC protocols, which are developed and implemented by the IPC Global Partnership for Action Against Hunger, CARE, CILSS, EC-JRC, FAO, FEWSNET, Food Security Cluster Group, Malnutrition Cluster Group, IGAD, Oxfam, PROGRESAN-SICA, SADC, Save the Children, UNICEF and WFP. Partenaires de l'analyse IPC :