As food insecurity in Madagascar worsens, Humanity & Inclusion uses stimulation therapy and food aid to prevent long-term disabilities in malnourished children.

As the south of Madagascar—an island country off the east coast of continental Africa—faces its worst drought in 40 years, its people continue to face the brutal consequences of starvation and malnutrition. Years of insufficient rainfall and the added impact of climate change have ravaged the land and devastated the agricultural production that much of the population depends on. Today, more than 1.35 million people in the Atsimo Andrefana region face acute food insecurity, and are experiencing dangerous levels of hunger. Death rates are soaring and local health and social services are unable to meet such high demand. These challenges are worsened by the Covid-19 pandemic.

“Accessing food has become a real challenge for many families,” says Emilie Sauvanet, Humanity & Inclusion’s Country Director for Madagascar. "In this already very difficult context, the situation is made even worse for people with disabilities. They experience discrimination and socio-economic inequalities, high levels of insecurity, poor access to drinking water and sanitation facilities, difficulties in moving around and, above all, a lack of consideration for their specific needs. As in any crisis situation, people with disabilities, children and women are most affected.”

Long-term risks of malnutrition

The increasingly high levels of malnutrition and undernutrition in children under the age of 5 put them at heightened risk of delaying their growth or developing long-term disabilities.

Severe acute malnutrition (SAM) affects approximately 20 million children worldwide and is the estimated cause for 400,000 child deaths each year. In Madagascar, nearly half of all children under the age of 5 experience SAM, which is only worsening amid the current crisis. SAM can lead to difficulties in developing motor skills such as crawling, sitting and grasping, or to Hypotonia, a disorder that affects motor nerve control by the brain. If not properly managed, these developmental delays can transform into lifelong disabilities. 

Humanity & Inclusion teams in the region have already identified more than 800 children in need of nutrition support and physical therapy to facilitate normal growth and development. Physical therapists use functional exercises, early childhood stimulation therapy and physical therapy to enable children with SAM to maintain normal weight gain, growth patterns and cognitive development. Through individual therapy sessions with trained professionals, children gain skills through interactive play. Techniques are also taught to their caregivers so they can continue therapy at home. 

HI's TIALONGO project

After an assessment, Humanity & Inclusion launched the “TIALONGO” project in the Madagascar program. Teams provide urgent food support to people with disabilities and their households and are working to reduce the development of disabilities linked to malnutrition and undernutrition in children. Among others, the key outcomes include: 

• Providing quality and sufficient food to people disproportionately affected by the crisis
• Improving the nutritional situation of children below the age of 5 and reducing the development of disabilities linked to malnutrition
• Educating local health professionals on early identification and management of disabilities
• Training physical therapists and occupational therapists in stimulation therapy

The project is expected to reach nearly 115,000 people in need of support. 

Image: A mother and her children from Humanity & Inclusion’s early childhood project in Tana, Madagascar. Copyright: S. Bonnet/HI Archives, 2007

More than 1 million people face starvation in Madagascar. Humanity & Inclusion is launching an aid program to support people with disabilities, families and children at risk of malnourishment.

Madagascar is experiencing its worst drought in four decades, putting more than 1.35 million people at risk of starvation and malnutrition. In southern Madagascar, particularly the Atsimo-Andrefana region, families are facing major food insecurity that threatens their lives and well-being. This is especially true for children, women and people with disabilities, who are most affected in times of crisis. 

According to the World Food Program, more than 1 million people are in a food security “crisis,” nearly 300,000 are in “urgent” need of aid, and 14,000 people have reached the final “catastrophe” phase of the Integrated Food Security Phase Classification (IPC). The number of people in this final phase is expected to double if sufficient aid is not provided urgently. 

“The famine is everywhere, and it affects the majority of the population,” says Vincent Dalonneau, Humanity & Inclusion’s Operations Manager for Madagascar. “The death rates are high and household incomes are decreasing because people are too hungry to work. Health and social services are overloaded, children are at risk, and people with disabilities are further isolated and stigmatized.”

The potential consequences are particularly alarming for young children, as malnutrition and undernutrition can disrupt proper development and put them at a higher risk for developing both short- and long-term disabilities. Children are also likely to miss school or have difficulties learning due to symptoms of extreme hunger. Humanity & Inclusion teams have already identified approximately 800 children in need of support for malnourishment.

Physical therapy and nutrition

Humanity & Inclusion is launching an intervention project to provide emergency food aid to people with disabilities and their families (around 5,000 people), and reduce the risk of disability in children between the ages of 0 and 5 years due to malnutrition or undernutrition. Humanity & Inclusion physical therapists will provide stimulation therapy and early physical therapy to vulnerable children, enabling them to maintain normal weight gain, growth patterns and cognitive development through functional exercises and playing. 

The project will train local physical therapists and occupational therapists in early childhood physical therapy, as well as conduct activities with community providers to raise awareness on disability development and the link between nutrition and disability. Humanity & Inclusion will support medical services linked to disability, and partner organizations plan to ensure long-term nutrition-specific support for identified children.

Families will receive food security assistance from Humanity & Inclusion in the form of food vouchers, cash transfer and food packages including standard items such as rice, peas, oil and salt.

In Malagasy, the project is called “TIALONGO: Tosika Iarahana Aby LONGO,” which translates to “Supporting all families together.” It is expected to reach at least 115,000 people.

Image: A mother and her young child were supported after their home flooded due to tropical storms in Madagascar in 2017. Copyright: Diana Vanderheyde/HI

Madagascans with disabilities are highly vulnerability to the pandemic. Humanity & Inclusion has adapted many of its projects in Madagascar to assist them.

The Covid-19 pandemic has not spared the people of Madagascar. The country has gone into lockdown several times since March 2020, when the government declared a national health emergency.

“It's important to help people with disabilities and all of the beneficiaries of Humanity & Inclusion's projects get through this unprecedented health, social and economic crisis," explains Emilie Sauvanet, Humanity & Inclusion's program director in Madagascar. "Our teams have revised each of their projects and the way activities interact with each other in order to get as close as possible to the people we assist."

One of those people is Offrancia, who has had epilepsy since she was 10. Humanity & Inclusion began working with Offrancia, now 38, in 2019, providing personalized social support for Offrancia to receive medical care, financial assistance to secure the future of her medical treatment, and psychosocial assistance.

As a small business owner, Offrancia faced an economic crisis when Covid-19 hit. Humanity & Inclusion provided Offrancia and her family hygiene and protection kits and shared information on the virus and how to prevent its spread. Like 335 other families, Offrancia's family also received two cash transfers of 100,000 Ariary, the local currency – equivalent to approximately $25 – to help make ends meet.

"Part of the money was very useful to buy food, and medicine for my treatment, and I diversified my merchandise stock with the rest," explains Offrancia, who has since reopened her business.

Humanity & Inclusion has also trained 33 people from disability advocacy organizations to help inform people with disabilities on ways to protect themselves during the pandemic. So far, they have made at-home visits to more than 1,000 vulnerable families in the Atsinanana and Analanjirofo regions.

Onisoa, a sign language interpreter and trainer at an inclusive school in Atsinanana, is among those conducting at-home visits.

"Awareness-raising is a particularly effective way to reach the most vulnerable families, including the families of people with disabilities," says Onisoa. "This method allows us to talk with their relatives or guardians, to understand their living conditions, and to provide them with advice on personal protective measures. Some visits take longer, especially for people with sensory disabilities. But we're convinced we're on the right track."

Norbertin, a father of two, works on Onisoa's team. “Although I am visually impaired, I am healthy and I want to help my fellow citizens by ensuring they take Covid-19 seriously,” he says.

Header image: A woman stands over a table of produce at her small business in Madagascar. She is wearing a mask.

Inline image: A woman speaks with a group of four people who sit on the grass. She is sharing information about Covid-19. They are all wearing masks.

Volunteer orthopedic specialists in a workshop in Lyon, France, also home to Humanity & Inclusion's global headquarters, are changing the lives of people around the world by reconditioning valuable prosthetic parts donated by people with amputations.

Humanity & Inclusion has worked in Madagascar for more than thirty years. Our teams have successfully developed an inclusive and solidarity education program which ensures the most vulnerable students, including children with disabilities, are enrolled in school. In 2019, 1,349 girls and boys with disabilities, vulnerable children, and students at risk of exclusion or dropout returned to school in the regions of Boeny, in the west of the island, and Diana, in the north.

Our teams are now working to better protect students and teachers from the spread of COVID-19 in Madagascar. As part of a consortium[1], the organization has launched a project to supply 21 schools with disinfection and protection equipment and products and is now actively supporting the Malagasy education system to help communities cope with the spread of COVID-19. Since May, the Malagasy authorities have organized workshops on the COVID-19 protocol with school staff to ensure personal protection measures are implemented.

We launched our activities in the north of the island in schools in the Betsbiboka and Boeny region. Together with local authority officials[2], Humanity & Inclusion has trained officers to disinfect beneficiary schools.

In total, 56 people have been trained to disinfect school premises in 21 schools in the communes of Ambatoboeny, Berivotra, and Maevatanana.

Donation of equipment to the project's target schools

Every classroom in each school will be supplied with hand-washing kits containing a bucket with a tap, soap, and informational posters on personal protection measures.

These schools will also be supplied with school-cleaner kits containing disinfectants and protective equipment. The kit can be used to disinfect all classrooms for up to 50 days.

Informing the community

COVID-19 awareness announcements are also being broadcast on the local station Varatraza to help inform the community of these measures.[3]

Focus on the most vulnerable 

As COVID-19 takes aim at our planet's most vulnerable neighbors, Humanity & Inclusion donors ensure that people with disabilities, people with injuries from conflict, children, women, and especially older people have the information--and even the soap--they need to stay healthy. Learn more about Humanity & Inclusion's vast COVID-19 response.

Begin a monthly gift today to help sustain this work and reach as many people as possible.

[1] Humanity & Inclusion is leading the MIARO project, funded by European Union Humanitarian Aid and Civil Protection, in consortium with CARE International.

[2] The trainers are representatives of the Regional Water, Sanitation, and Hygiene divisions.

[3] The Regional OCC (Operational Command Center coordinating the fight against the COVID-19), with support from Humanity & Inclusion.

Humanity & Inclusion’s teams in Togo are taking action to prevent the spread of COVID-19. Our priority is to help the most vulnerable people understand the importance of taking basic precautionary measures. We’re also helping others cope with their fear of the virus.

How does the virus spread? How can a person protect themselves? What’s best way to help people with disabilities, who are often the most vulnerable? Humanity & Inclusion tackles these questions and more.

Spreading awareness messages far and wide

Humanity & Inclusion’s team drives around the streets of Togo’s capital, Lomé, broadcasting prevention messages through loudspeakers mounted on the roof of their vehicles. “It works really well because people want clear information on how to protect themselves and their loved ones,” explains Irène Manterola, Humanity & Inclusion's country director in Togo. “There are a lot of mixed signals out there, so it’s not easy for everyone to navigate.”

Basic precautionary measures adapted to the most vulnerable

For many, the recommended precautionary measures are impossible to apply. For example, what about a wheelchair user who needs help bathing or eating? “Social distancing, okay! But people with disabilities or older people—individuals who normally need a caregiver or health or medical assistant, cannot be left to fend for themselves. We need caregivers to be able to protect themselves, while also attending to the most vulnerable,” Irène adds. 

Making hygiene accessible to all

The price of hygiene products in Togo has soared in recent weeks—including a seven-fold increase in the cost of sanitizer gel. This makes it even more difficult for people to take precautionary measures. To combat these challenges, Humanity & Inclusion’s teams are making bleach and soap for hygiene kits, so that the most vulnerable have access to these essential items. “We hand them out to our beneficiaries and in the poorest areas, where there is more overcrowding.”  

Radio programs to reassure the population

The pandemic has generated a lot of fear in Togo. To help people manage this fear, our teams have recorded a series of radio segments. “One of the biggest problems we face is how to gauge the information. People need to know how serious the situation is without making them feel completely helpless,” says Irène. Building on the success of these programs, we are now working with the country’s union of psychiatrists and psychologists to create a free counseling helpline that anyone can call seeking support.

Humanity & Inclusion in Togo  

Humanity & Inclusion has been working in Togo for nearly 23 years and implements multiple projects. This work is particularly in aid of people with disabilities and highly vulnerable groups. We work to improve the healthcare services provided to mothers and children, we promote inclusive education, and much more. Learn more about our work in Togo.

Make a monthly gift to help us sustain this work and reach as many people as possible.

For people living in the world's poorest countries, accessing information looks very different than it does in the United States. Living far from town, many remote villagers know little or nothing of the pandemic.

As COVID-19 devastates communities around the globe, Humanity & Inclusion is going the extra mile to ensure that as many people as possible, especially people with disabilities, know how to protect themselves.

Learning how to protect yourself and others from COVID-19 is the only way to prevent countless tragedies and to mitigate the spread. Humanity & Inclusion's teams have launched 72 COVID-19 projects in dozens of countries to protect and care for the people that often get overlooked. 

Going door-to-door

Life is harsh in Fokontany Ambodimanary, part of Madagascar's Maevatanana district. Here, people struggle to provide food, clothing and care for their families. COVID-19 can seem like a distant threat. But the emergency is becoming very real.

Marcellin, 36, was trained by Humanity & Inclusion to help teach people here to prevent the spread of the coronavirus. A member of the local relief team, he makes daily visits to the homes of people with disabilities, people who are older or highly isolated, and the most vulnerable families in his community.

He teaches them how to protect themselves and the people around them.

“We need to wash our hands regularly”

Albert, a father of five, has taken the lessons on board. The whole family gathered in front of their home and listened carefully recently, as Marcellin explained the basic precautionary measures to protect themselves from the virus. He took his time, showed them the proper way to wash their hands, and answered their questions.

“I learned that we need to wash our hands regularly with soap and stay at least one meter (or three feet, the WHO guidance) from other people to protect ourselves from the virus,” explains Albert.

Preventing the virus' spread

In regions of Madagascar not yet under lock down, it is essential that everyone is able to access information, particularly the most vulnerable people living in highly remote areas.

Marcellin is keenly aware of the importance of his mission. “The community takes a close interest in the messages I share with them about this terrible virus,” he says. “I’m glad to be able to do my civic duty.”

Humanity & Inclusion in Madagascar  

Humanity & Inclusion has been working in Madagascar for nearly 35 years and implements multiple projects. This work is particularly in aid of people with disabilities and highly vulnerable groups living in areas regularly devastated by cyclones and floods. Learn more about our work in Madagascar.

Make a monthly gift to help us sustain this work and reach as many people as possible.

Our team is taking special measures in Madagascar in response to the health emergency, following several confirmed cases of COVID-19. As part of two projects organized with CARE International and funded by the European Union, local relief teams are being trained to convey core prevention messages on the disease and to limit its spread. The teams are staffed by volunteers—men and women of all ages—including people with disabilities.

Relief teams adjust to the emergency

The local relief teams involved in these two projects normally work on prevention and natural disaster and weather risk management, to help people develop responses to cyclones, floods, etc. One project targets more than 300,000 people, including 300 highly vulnerable families, 60 schools and 43 disaster risk management committees. Another targets 412,000 people, including older people and people with disabilities, along with 23 local organizations. Local relief teams are adjusting projects in order to raise awareness of the disease and teach others how to protect themselves and their families from COVID-19.

Providing vital information

We’re sharing essential information on the virus--its transmission, the symptoms, suspected cases and people at risk, but also social distancing, hand washing, routine prevention measures, practical advice and other ways of raising awareness of health and protection measures to combat COVID-19. Humanity & Inclusion is training the members of the local relief teams, teaching them how to protect themselves and raise awareness amongst the people they assist. The learning aids used, such as posters and leaflets, comply with international standards. Posters will be displayed in each sector of the village communities where we work and in schools supported by the project. Specific and adapted advices will be provided to those with specific communication needs, such as Deaf people, people with hearing disabilities, and those with visual disabilities.

Training has already begun

Training sessions have already begun in the regions of Boeny, Betsiboka and Diana, and particularly in the Fokontany of Ambalavola, in the urban district of Diego. Participants were asked to stay a minimum of one meter (3 feet) apart and to refrain from any physical contact. Although the twelve members of this local relief team are more familiar to sharing information about weather-related natural disaster risks, such as cyclones and floods, they understand the pressing need for this initiative, faced with the epidemic. Each member follows the news closely and takes their role seriously.

A member of the local relief team and deputy head of the Ambalavola Fokontany, Paul has already begun raising awareness amongst the community. “At a gathering this morning, we asked beneficiaries to stay one meter (3 feet) apart. This training is very important because some information is not known here,” he explains. “The training allows us to separate the facts from the rumors and fake news circulating now, and to get across evidence-based, focused and comprehensive messages on how to prevent the disease. We also taught them new things, like hand-washing techniques. Now it is our turn to play our part.”

Photo: A beneficiary holds a flyer in Madagascar that was created by Humanity & Inclusion to share awareness messages about fighting the spread of COVID-19.

In many low-income and middle-income countries, only 5%-15% of people who require assistive devices, including artificial limbs, have access to them. In areas that are remote or dangerous, specialized health professionals can be scarce and materials expensive. Poorly made or unadjusted, artificial limbs can make life uncomfortable for patients by causing skin sores, pressure wounds, and muscle fatigue.

400,000 people were affected by cyclone Enawo, which hit Madagascar in early March. According to the latest reports, 250 people were injured, 78 were killed, and 18 are missing. Many homes and public buildings have been damaged or destroyed by the cyclone and floods and a total of 1,244 classrooms have been destroyed and hundreds damaged.