Integrating Nutrition into Early Action: Lessons from the 2025 Pilot Project

Context: why integrate nutrition into early action (EA)?

In 2025, Action Against Hunger (ACF) conducted a pilot project in Mali and Madagascar to address a critical gap: nutrition is largely absent from Activipatory Action (AA) systems despite obvious and rapid nutritional impacts following climate shocks. Droughts, floods, and cyclones lead to accelerated deterioration in nutritional status, particularly in vulnerable areas. Health systems and Case Management of Acute malnutrition (CMAM) programs are often insufficiently prepared, intervening only in response to post-crisis situations and only partially meeting increased needs.   

Methodological approach: a multi-level, community based approach based on field research 

In order to best document the impacts on communities and the needs and capacities on which the approach could be based, ACF applied a three-level action research methodology at the community, sub-national, and national levels.

Through interviews with households, communities, and local and national experts, ACF teams were able to develop an initial draft of recommendations and actions specific to nutrition within early action (EA) protocols.

In total, nearly 400 community members and experts in Mali and Madagascar were interviewed using a survey methodology specifically designed for this initiative.

The recommendations were subsequently discussed, strengthened, and validated by a panel of stakeholders, authorities, and community representatives during capacity-building and knowledge‑exchange sessions.

Survey results and findings 

The surveys conducted in Mali and Madagascar led ACF to identify the following seven findings:

1. Shocks rapidly exacerbate nutritional vulnerability, particularly in already fragile contexts such as Madagascar and Mali. 
2. Existing preparedness and anticipation measures for health systems and structures are limited, unsystematic, and insufficient to effectively prevent nutritional insecurity and health problems among affected populations.
3. Early warning systems need to be improved, as they do not sufficiently include or reach the most at-risk segments of the population or health and nutrition actors, thereby preventing autonomous anticipation and preparedness.
4. Health and nutrition actors have not benefited from the same level of support and skills development in anticipatory approaches as other actors (WASH, FSL, DRM) and government agencies, creating an imbalance in approaches and barriers to coordination.
5. National AA approaches and frameworks are still not widely disseminated at the regional level. Similarly, AA working and coordination groups are often sectoralized, preventing the multisectoral approach that is necessary to fully address the needs of communities.
6. Social protection mechanisms can be key to the implementation of multisectoral and sustainable anticipatory action (AA) approaches.
7. The immediate adoption of nutrition-sensitive AA approaches is crucial in order to support fragile communities that are increasingly exposed to recurrent shocks. 

Nutrition-sensitive recommendations and actions

Following the surveys and during the feedback and capacity-building workshops, several specific anticipatory actions were outlined. These actions are to be implemented at all stages of an AA approach: from preparation to pre-positioning and triggering. They also affect all pillars of AA (e.g., Early Warning System, Coordination, Preparation, Activation, etc.) to ensure the full and deep integration of nutrition into DRM approaches, particularly AA. 

Examples of identified nutrition-sensitive and nutrition-specific AA include: establishing nutritional alert messages and recommendations, screening for acute malnutrition by measuring upper arm circumference (MUAC) and looking for nutritional edema, pre-positioning inputs (nutritional and pharmaceutical), anticipatory cash transfers, and setting up mobile clinics in evacuation areas. 

Towards the systemic integration of nutrition into anticipatory action (AA) approaches in 2026

Following the implementation of the pilot project in Mali and Madagascar in 2025, ACF has made an operational methodology note (with its tools), available to all humanitarian and anticipatory action actors in French and English so that the approach can be replicated and disseminated in all contexts where it is needed. 

The approach will also be promoted in various working groups and during multilateral international exchanges.