Office of National Nutrition and Ministry of Health – Reducing Childhood Malnutrition in Madagascar

The Office of National Nutrition (ONN) and the Ministry of Health in Madagascar, with funding from the World Bank, are working to reduce childhood stunting, which is known to impact lifelong well-being. To do this, they’d like to  increase the use of a set of  reproductive, maternal and child health and nutrition interventions that have been proven to  improve key nutrition behaviors known to reduce stunting in targeted regions of Madagascar. One of these proven interventions is CommCare. The UPNNC (National Community Nutrition Program Unit, a branch of ONN) has been independently using CommCare since 2019 with their project PARN (Nutritional Outcome Improvement Project), and has partnered with Dimagi to optimize the existing application and to harmonize it with another digital health initiative that is also running in Madagascar, the Mikolo/ACCESS program. The PARN application built on CommCare tracks childhood malnutrition for children under 5 years of age, with the goal of providing nutritional education to parents and nutritional supplements to malnourished children.

The Dimagi team began gathering requirements in 2021 and scoping out ways to optimize the PARN application. After app development, the team traveled to Madagascar to carry out user acceptance testing (UAT) in four different regions in Madagascar. Meeting with community health workers, PARN app users, and the UPNNC team, the Dimagi team was able to see firsthand how important this application is to reducing childhood malnutrition in Madagascar. 

Two moments stand out from this visit:

Digitizing malnutrition data: One particularly impactful occasion was seeing the evolution of a malnourished child’s growth in the handwritten logs that health workers keep in community health centers. The child initially came to the center malnourished, but over time with continuous follow-up and the administration of a nutritional supplement, Plumpy Sup, the child gained enough weight to become healthy. With CommCare, this information is digitized, and can be used by government officials and stakeholders to track malnutrition in the country. 

Automating monthly reporting: Another impactful moment was showing the application users (referred to as animateurs) a new reporting module that the Dimagi team created within the PARN application. In the past, animateurs had to manually calculate different indicators, such as the number of malnourished children at a particular health center, and record them in a monthly report to deliver to supervisors. Now, with the improved PARN application, indicators are automatically calculated by the application, which reduces human error and the amount of time that animateurs need to spend on their monthly reports. When users saw this new feature, they erupted in applause and cheering! 

The new and improved PARN application will ultimately make people’s jobs easier and improve nutrition outcomes. Users will spend less time entering data into the application, because it runs faster and is more intuitive, and they will benefit from access to reporting modules and interactive graphs, among other new features, to view and enter key data. Human error will be reduced by automating data points that were previously manually entered and calculated. Government actors and other stakeholders will benefit from having access to reliable data that can reveal trends over time. Overall, this application will support the larger goal of reducing childhood malnutrition in Madagascar. 

As Gerard Lalaniaina Rasamimanana, the director of monitoring and evaluation at UPNNC, states, “Over a 10-year period, assuming additional investments in nutrition are carried out, [PARN] is expected to reduce the prevalence of stunting by 30% in target regions. This is a very significant reduction given that the situation baseline indicates very low availability of services and significant barriers to access for beneficiaries.”

Partners and other collaborators who are interested in learning more about this work can reach out to Dimagi at: info@dimagi.com.