Fondazione Irma Romagnoli intends to fund the project with €10,000 a year for three years.

WHO WE ARE

The voluntary organization “Amici di Ampasilava Madagascar” is an independent association operating in the healthcare sector; it adheres to the Charter of Values ​​for International Volunteering and the volunteer’s code of ethical conduct.
It was established on July 23, 2006 (officially registered on November 2, 2006) and is listed in the Single National Third Sector Register (RUNTS) under entry number 90586.
The Association is headquartered in Bologna, at Via del Pratello 13.
In Madagascar, it is registered as a Non-Governmental Organization (NGO).
It is dedicated to providing completely free healthcare services in southwestern Madagascar—specifically in the village of Andavadoaka (Morombe District, Toliara region), located along the Mozambique Channel.
Between 2006 and the end of 2008, the association built and furnished the “Vezo” Hospital in Andavadoaka, subsequently donating it to the Malagasy healthcare system.
The “Vezo” Hospital in Andavadoaka was inaugurated on October 15, 2008; the association funds and manages the facility through a Headquarters Agreement (*Accord de Siège*) with the Malagasy State and an agreement with the Ministry of Health.
Since 2008, the hospital has undergone various expansions and renovations funded by grants and donations, resulting in its current configuration:

• 2 adult inpatient rooms with en-suite toilet and shower facilities: 4 beds for men and 4 beds for women.
• 1 room with 2 beds allocated to intensive observation.
• A maternity unit featuring: an obstetrics and gynecology clinic, a labor and delivery room, a 4-bed inpatient room for mothers and babies with an en-suite bathroom and shower, a pediatric clinic, and a 4-bed pediatric inpatient room.
  A total of 18 beds.
• An operating room with a pre-operative management area and an adjoining sterilization room.
• A well-stocked pharmacy containing medicines and medical supplies to meet clinical needs, with a computer for computerized inventory management. The pharmacy also includes an area equipped for preparing compounded medicines.
• A conventional radiology room with a mobile X-ray unit for examinations in inpatient rooms, and a computer for transmitting X-rays to the various clinics.
• A laboratory for testing biological samples, equipped with 2 complete blood count analyzers, 2 clinical chemistry analyzers (Dry Chemistry), and 2 optical microscopes for examining blood smears, stool, urine, and other biological samples using specific stains or fresh preparations; rapid immunological tests are also available (malaria, HCV, HBV, HIV, etc.).
• A staff changing room.
• Eight clinics, all equipped with computers running dedicated clinical case-management software: 2 for internal medicine consultations (one equipped with a monitor, ultrasound machine, electrocardiograph, defibrillator, and monitored stocks of medicines and supplies for the initial management of medical emergencies); 1 pediatric clinic; 1 wound-care clinic (adjacent to and connected with the clinic equipped for medical emergencies), with monitored stocks of dressing and suturing supplies, 2 examination couches, and a surgical light; 1 dental clinic with a dental treatment unit; 1 physiotherapy clinic with all the necessary equipment; 1 clinic for morning triage and other activities after triage, particularly ongoing care for patients with well-controlled hypertension and type 2 diabetes well controlled with oral medication, equipped with an examination couch, electrocardiograph, and ophthalmic equipment; and 1 obstetrics and gynecology clinic with a mobile ultrasound machine (also usable in inpatient rooms) and appropriate probes for obstetric and gynecological scans.
• A hospital management office with a computer.
• A server room.
• An external storage facility for stocks of medicines and medical supplies.
• A repair workshop.

Hopitaly Vezo operates 24 hours a day, 365 days a year, with a doctor and a nurse on duty to respond to emergencies involving patients arriving from outside and to meet the needs of inpatients. A cultural mediator is available at the hospital to assist with patient communication throughout the day and night, or, from 6 p.m. to 7 a.m. the following morning, a Malagasy nurse. The Malagasy staff have a fair to good command of Italian and French.
In addition to the Malagasy healthcare staff—1 doctor, 2 midwives, 6 nurses, and 5 interpreters—a total of 150 volunteers contributed their professional expertise at the hospital during 2024: 46% were healthcare professionals other than doctors, 47% were doctors, and 7% were non-medical volunteers.
From the start of its hospital activities through the end of 2024, it provided free treatment and care to more than 320,000 people.
In 2023, VEZO Hospital in Andavadoka launched its project to combat malnutrition.

PROJECT TITLE

Combating child malnutrition in the village of Andavadoka, in the commune of Befandefa and neighboring communes.

PROJECT BENEFICIARIES

Children aged 0–5 in the village of Andavadoka, in the commune of Befandefa and neighboring communes.

PROJECT DESCRIPTION

The mission of ODV Amici di Ampasilava also includes protecting children’s health at Hopitaly Vezo in Andavadoaka. To understand the scope of this healthcare project, we need to examine the structure of the Malagasy healthcare system and the area served by Hopitaly Vezo.

The Malagasy healthcare system is organized into four levels:

• The central level: responsible for overall coordination of the healthcare sector, policy and strategic direction, and the establishment of rules and standards;
• The intermediate or regional level: represents the ministry at regional level and reports directly to the general secretariat. Its mission is to plan, guide, monitor, and evaluate the implementation of programs of national interest within the health districts of the region;
• The peripheral or district level: represented by the district public health service, whose mission is to coordinate and support primary and first-referral health services in delivering healthcare. This level is the cornerstone of the healthcare system and must have decision-making and financial autonomy;
• The community level: participates in health promotion and the management of primary healthcare facilities.

Healthcare delivery is organized into three levels:

• The first, at health-district level, consists of healthcare workers and primary healthcare facilities, known as Centre de Santé Basic (CSB), which serve as patients’ first point of contact with the healthcare system;
• The second consists of district referral hospitals (CHRD) without surgical services, which provide the complementary package of activities (PCA), and CHRD facilities with operating rooms, which function as first-level hospitals;
• The third consists of regional referral hospitals (CHRR) and university hospitals (CHU), which are second-level hospitals.

The 2019–2022 interim plan introduced new areas of focus, including oral and dental health, eye health, HIV/AIDS, malaria, tuberculosis, and rehabilitation services.
At district level, there is no development plan to define objectives and enable the implementation of activities to improve healthcare development in the sector. As a result, access to specialist care is very difficult, particularly in rural areas.
At peripheral level, the limited leadership capacity of the EMAD (district management team) leads to a lack of coordination and integration of the care system across communes, as well as inadequate care-management arrangements.
In terms of governance, the department’s poor functioning results from limited managerial capacity at all levels and insufficient sector funding. This has led to:

• A highly centralized sector budget, with 80% allocated to the central level; weak decentralized technical services that are unable to fulfill their role in supporting, coordinating, mentoring, and assisting healthcare facilities;
• Poor budget management and a weak financial monitoring system;
• Limited use of external audits and anti-corruption mechanisms, such as enforcement measures when wrongdoing is caught in the act, thereby enabling the mismanagement of funds.

Andavadoaka is a small coastal fishing village in southwestern Madagascar, with an estimated population of around 4,000–4,500. Most residents belong to the Vezo ethnic group, whose name means “nomadic fishers.” It is located approximately 150 km north of the regional capital, Toliara, and 50 km south of Morombe, another large settlement in southern Madagascar. The village is part of the rural commune of Befandefa and is overseen by the Fokontany (council of elders). It also belongs to the Atsimo Andrefana region and falls within the southwestern region’s health plan.

The population and catchment area led to the construction of a public primary healthcare center (CBS), which provides prevention, family planning, initial care, and basic diagnosis.

From the time it was built, the hospital aimed to serve as a referral point not only for Andavadoaka but also for neighboring villages. Its catchment area now covers 200 km².

Although it is part of the Malagasy healthcare system, it provides free care, unlike the other healthcare facilities, which charge fees, and offers a range of health services.

In January 2023, during an event organized in collaboration with the local CSB, all children aged 0–5 living in Andavadoaka had their weight and height measured. Of the 320 children assessed, 65 (20%) showed signs of malnutrition. To address this situation, the project to combat malnutrition was launched in February 2023 and developed in successive phases throughout the year. All children identified as malnourished during the initial assessment were evaluated at the hospital and underwent the tests required by the Malnutrition Protocol. Children with severe malnutrition were hospitalized, while the others joined the nutritional support program as outpatients.

The project also launched an information, education, and prevention program, with meetings in schools and neighboring villages.
Unfortunately, systematic monitoring has not yet been possible in the surrounding villages, where malnutrition is likely to be a much greater problem than in Andavadoaka. Nevertheless, many children from other villages were identified as malnourished during visits to Hopitaly Vezo and received treatment. As a result, the number of children who accessed the nutritional support program was much higher than the number of malnourished children living in Andavadoaka.

The project aims to continue supporting children aged 0–5 in Andavadoaka by planning “weigh-in days.” The intention is to hold two days a year rather than one, at six-month intervals, inviting all children aged 0–5 to the hospital for screening of weight, height, BMI, and growth percentiles. These events will be preceded by awareness campaigns in schools.

On the day anthropometric measurements are taken, children who fall below the percentile cutoff used to rule out malnutrition are referred to the pediatrician for a carefully structured nutritional program with clearly defined stages. The project aims to expand these weigh-in days to neighboring villages, starting with Ambalorao and Ampasilava, respectively 2 and 4 km from the hospital.

Structured planning of initial weight and height measurements enables early, specific, and detailed interventions. Three different levels of nutritional support are identified for children aged 0–5 diagnosed with malnutrition:

● Hospital admission when necessary, with oral administration (or tube feeding if required) of OrsKids, an oral rehydration solution containing basic electrolytes and mineral salts, during the first 12 hours. This is followed by Formula 75 (therapeutic “starter” milk) for at least 10 days, then a specific home protocol (F-100) for a further 20 days, with weekly follow-up for at least one month.

● Formula 75–100 administered at home, with weekly hospital checkups. A relative—the mother or another family member—must visit the hospital every day to collect the formula prepared by healthcare staff, based on an estimated 20 ml/kg every 3 hours, or approximately 160 ml/kg per day.

● Plampinat, for non-severe malnutrition that can be managed at home under the supervision of the local CSB, with hospital checkups at least monthly. The program involves preparing and distributing increasing doses of a high-calorie, high-protein mixture made with whole milk, oil, and sugar, supplemented with a multivitamin preparation, mineral salts, and trace elements.

These supplements were donated by Biofarma in Colloredo di Prato (Udine). The remaining ingredients are purchased locally.
The nutritional support preparations (F 75-Vezo and F100-Vezo) are formulated according to WHO recommendations (F-75; F 100), adapting the original recipe to obtain equivalent preparations using locally available ingredients. They are prepared in the small compounding laboratory of the Hopitaly Vezo pharmacy.

The local CSB has become increasingly involved in the project. It has agreed to take over care after acute-phase treatment (F 75–F 100), distributing high-calorie, semi-solid nutritional products (Plumpy nut) to children who have achieved nutritional stability. The CSB obtains these products from international organizations (WHO, UNICEF).
This arrangement has made it possible to provide children with ongoing nutritional support through primary healthcare services after acute-phase treatment, which lasts an average of around 30 days.
In January 2024, exactly one year after the project began, weight and height measurements were repeated among children aged 0–5, using the same methods and equipment.
The rate of severe malnutrition was 5% (15 children out of 300), a fourfold reduction compared with the start of the program. This finding shows how essential it is to continue and strengthen the program to combat child malnutrition. ODV Amici di Ampasilava bears full responsibility for sustaining the project; during 2023, approximately 4,000 doses of 1,000 ml, each providing 750–1,000 kcal, were prepared and distributed to families.

PROJECT GOALS AND OBJECTIVES

The project to combat malnutrition continues and expands an existing program. It is expected to need a further three years to achieve all its objectives, particularly extending its catchment area to the two neighboring villages.

PROJECT TIMELINE, IMPLEMENTATION, AND LOCATION

The project is currently planned for the three-year period 2025–2027, with an extension into neighboring communes also envisaged for 2028–2029.

EXPECTED RESULTS AND BENEFITS

A 15%–25% reduction in the number of cases requiring treatment under the care program.

PROJECT COSTS

• The costs incurred are listed below:
• 1,200 liters of milk at a cost of 9,000,000 ariary (€1 = 4,500 ariary).
• 80 liters of oil at a cost of 760,000 ariary.
• 300 kg of sugar at a cost of 2,250,000 ariary.
• Infant formula at a cost of 10,700,000 ariary.

Total expenditure on the Nutrition Project over 12 months was 22,710,000 ariary, equivalent to approximately €5,000.
The total annual cost of the “Combating Child Malnutrition” project is therefore estimated at €15,000. Taking into account the expansion of the catchment area to two neighboring villages (Ampasilava and Ambalorao), the estimated total for 2025–2027 is €45,000, with the possibility of extending the project over time to reach an even wider area.

A REPORT IS REQUIRED AT THE END OF THE PROJECT

The AdA association will be responsible for reporting annually on the project’s progress.

Fondazione Irma Romagnoli intends to fund the project with €10,000 a year for three years.