Integrating nutrition into anticipatory action: lessons from 2025 pilot projects in Madagascar and Mali

Action Against Hunger (Action Contre la Faim/ACF) has published its new methodology for integrating nutrition-based activities into anticipatory action frameworks and systems. Available in English and French, the methodology, which includes practical tools, is based on lessons from pilot projects in Madagascar and Mali in 2025.

Addressing a critical gap in anticipatory action

Nutrition is largely absent from anticipatory action frameworks and systems, despite the fact that obvious and rapid nutritional impacts regularly follow climate shocks. Droughts, floods and cyclones can accelerate a deterioration in people’s nutritional status, particularly in areas that are already vulnerable. Many health systems and acute-malnutrition-management programmes only intervene in response to a crisis and are often insufficiently prepared to meet increased post-shock needs.

A multi-level, community-based approach to nutrition

The pilot projects aimed to address this critical gap. To document the impacts on communities’ nutrition status, and the needs and capacities on which the approach could be based, ACF applied an action research methodology at three levels: community, sub-national and national. Nearly 400 community members and local and national experts were interviewed across the two countries, using a survey specially created for this initiative.

Through these interviews, ACF teams were able to draft initial recommendations and actions specific to integrating nutrition into anticipatory action frameworks and systems. These were then discussed, reinforced and validated by a panel of stakeholders, authorities and community representatives during capacity-building and exchange sessions.

Main findings

The surveys conducted delivered seven main findings relevant to integrating nutrition into anticipatory action frameworks and systems:

1. Shocks rapidly exacerbate nutritional vulnerability, particularly in contexts that are already fragile, such as Madagascar and Mali.
2. Existing preparedness and anticipation measures for health systems and structures are limited, unsystematic and insufficient to prevent nutritional insecurity and health problems among populations affected by shocks.
3. Early warning systems need to be improved: they do not sufficiently include or reach the most at-risk segments of the population, or health and nutrition actors; this prevents autonomous anticipation and preparedness.
4. Health and nutrition actors have not benefitted from the same support and skills development in anticipatory approaches as other actors (e.g., those working in water, sanitation and health) and government agencies; this has created an imbalance in approaches and barriers to coordination.
5. National-level anticipatory action approaches and frameworks are not widely disseminated at regional levels. Similarly, working groups and coordination groups for anticipatory action are often sector-specific, preventing the multi-sectoral approach that is necessary to address communities’ needs fully, including their nutritional needs.
6. Social protection mechanisms can be key to the implementation of multisectoral and sustainable anticipatory action approaches.
7. The immediate adoption of nutrition-sensitive anticipatory action approaches is crucial in order to support fragile communities that are increasingly exposed to recurrent shocks.

Nutrition-sensitive recommendations and actions

Several nutrition-sensitive and nutrition-specific anticipatory actions were identified during the pilot projects. These include:

• establish nutrition-alert messages and recommendations
• screen people for acute malnutrition, for example by measuring their upper arm circumference and looking for signs of nutritional edema
• pre-position nutritional and pharmaceutical inputs
• nutrition-targeted anticipatory cash transfers
• set up mobile clinics in evacuation areas.

These should be implemented at all stages of an anticipatory action approach: from preparation to pre-positioning and triggering. They should also be applied to all pillars of anticipatory action (e.g., early warnings, coordination, preparation, activation) to ensure that nutrition is fully and deeply integrated within these systems.