Zanmi Agrikol

The fight against malnutrition is at the heart of the Zanmi Agrikol (Haitian Creole for “Partners In Agriculture“) project. Haiti’s Central Plateau, where PIH works, has the highest rates of malnutrition in the country. Not only does malnutrition make it harder for a child to fight off diseases like diarrhea, pneumonia and measles, it makes it five to eight times more likely that a child will die from that disease than a well-nourished child. Further, malnutrition stunts physical and intellectual development in young children, causing irreversible harm that may follow them through life.

To combat the malnutrition epidemic, PIH is working to identify, treat and monitor malnourished children. We address the root causes of malnutrition by enhancing the productive capacity of household farms and combating the pervasive environmental degradation that has negatively impacted the growth potential of the soil in Haiti.

Project Background || Treating Children || Local Production of RUTF || Helping Families || Long Term 
|| Project History

Project Background

Zanmi Agrikol was founded in 2002 as a partnership between ZL and Christ Church in Greenville, South Carolina. In the early days of operation, Haiti Horticulture, as it was then known, focused on growing vegetables in a hillside garden in Cange, with the goal of combating acute food insecurity as well as transferring knowledge about farming practices.

In 2004, the project expanded its mandate to include production of fruits and grains in addition to vegetables in order to meet as much of the food needs of our clinics and hospitals. At that time, the project leased 40 acres of then-barren land in an area outside of Cange called Corporant. The farm was not only able to provide food to our patients, but also provided jobs for local agronomists and laborers, who planted fourteen thousand banana trees in the first year on the farm.

In the hopes of furthering the ability of local farmers to implement the best farming practices, in 2006 ZA opened a small experimental farm adjacent to the hospital in Boucan Carré. ZL clinicians were seeing the highest rates of malnutrition in the Central Plateau at this site, so the ZA team partnered with a peasant organization, SOPABO, which was well connected with local farmers. The SOPABO farm is focused on trying different varieties of seeds, and soil management practices to see what maximizes harvests. This way, farmers can not only see which practices increase yield without absorbing the risk on their own plots, but they also learn how to implement these best practices. In addition, the ZA team at SOPABA has built an extensive tree nursery, with a focus on fruit trees like avocados and mangoes as well as varieties that encourage soil conservation. The team then gives these saplings to local farmers.

Treating Children: Pediatric Malnutrition Program

The identification, treatment and follow up care of moderate and severe malnutrition by PIH is managed at the community level, with supplemental clinical care available as necessary. The experience of colleagues, particularly Médecins Sans Frontières and Valid International, in the use of community-based ready-to-use therapeutic food for the treatment of acute malnutrition offered an approach that had been proven clinically effective and has since been adopted as the standard WHO protocol.

In 2006, PIH began treating severely malnourished children with Nourimanba, a ready-to-use therapeutic food (RUTF) made from peanut butter, milk powder, vegetable oil, sugar and a specially formulated vitamin mix. This model of treatment for malnutrition was adopted due to the fact that it is an outpatient treatment. Nourimanba is “ready to use,“ meaning that no cooking is required, which allows parents to feed it to their children at home easily, thereby eliminating or reducing the amount of time children need to spend in the hospital. Because of its peanut butter base, Nourimanba has low water content, making it resistant to bacterial growth, which allows it to be stored safely for months. For children who are suffering from moderate malnutrition, doctors at PIH clinics prescribe Nourimil, which is a milled legume/grain mixture – either rice and beans or corn and beans – meant to be prepared in the home. Nourimil is a supplemental therapeutic food, which provides an essential source of protein to malnourished children.

On this regimen, malnourished children can recover in 6-8 weeks, with most of the treatment occurring at home. Although used in other countries in Africa and Asia, PIH was one of the first organizations in Haiti to begin treating severely malnourished patients with RUTF.

Local Production of RUTF

PIH's ZA chose to source the ready-to-use-therapeutic food locally. Most of the ingredients for both Nourimanba and Nourimil were already being produced in the area that ZA works, and PIH believes that financing local production helps increase agricultural production and economic growth in the region. The farm operated by Zanmi Agrikol therefore altered its mandate, and replaced fruit and vegetable plots with corn, rice and beans. Currently, the farm produces most of the beans, rice and corn needed for Nourimil. In order to further support local agricultural initiatives already in place, we source all of the peanuts for Nourimanba from local producers.

This local production not only provides a life-saving treatment for children with malnutrition, but also helps improve the socioeconomic situation of the community by providing jobs at the production center and at the farm, and also by providing a market for local farmers who grow and sell peanuts.

Learn more about PIH's new partnership with Abbott Pharmacies, one that will significantly increase Nourimanba production.

Helping Families: Family Assistance Program

Zanmi Agrikol not only seeks to treat children with malnutrition, but also asks why they fall ill with malnutrition in the first place. The desperate socioeconomic situation of poor families causes chronic hunger and malnutrition. In talking with parents of children who are being treated for malnutrition at the clinics, ZA learned that many families had very little land to cultivate, not enough seeds, and few tools. ZA wants to help these families so that their children would not fall ill with malnutrition again next year.

In 2006, ZA began enrolling the most desperately poor families it encountered through its malnutrition arm of the Family Assistance Program, to try to improve their economic and agricultural situations. ZA provides agriculture inputs such as tools, seeds, fruit trees and, where necessary, land to help farmers increase their output and offers families training on farming and on nutrition. Perhaps most importantly, ZA provides on-going support and accompaniment through ajan agrikol, agricultural extension agents. The ajan agrikol visit their families at least once every two weeks to provide encouragement and technical expertise on the science of farming. These ajan agrikol are trained by the professional agronomists who direct ZA activities at Corporant and Boucan Carré. As part of the program, ZA also distribute goats to these households. In order to reflect the astounding sense of empowerment found in Haitian communities, families pass a newborn goat along to another member of the program, which allows each recipient to also give to others.

Due to how widespread the co-afflictions of poverty and malnutrition are in the communities in which ZA works, the program is beginning to recruit and train a new corps of extension agents. These ajan teren, or agents on the ground, are members of the local community who check in on families even more frequently to see how they are doing in everything from farming to nutrition to health. During a recent home visit to a family in ZA's Family Assistance Program, one of our visitors asked, “How often does someone from ZA visit you?“ The response was, “Oh, they are always here.“ For ZA, being there makes all the difference.

Long Term: Renewing the Land

Deforestation is a tremendous environmental problem in Haiti, where forest now covers a mere 3.8 percent of Haiti’s total land area; this figure has continued to fall an average of 0.6 percent annually. The problem: wood and wood-based charcoal represents 71 percent of Haiti’s energy use. PIH's solution: create an alternative to wood charcoal so that families do not have to cut down trees for household cooking fuel and plant trees to replace those that are being harvested.

Working with a team from MIT, PIH has found a way to produce to a wood charcoal alternative: charcoal made from bagasse, the waste product that remains after sugar is extracted from cane. The organic matter is burned in a low oxygen environment and turns into charcoal powder, than it is mixed with a binding agent like manioc juice, which is readily available in Haiti, and finally is compressed into charcoal briquettes that burn very similarly to wood charcoal.

As of the end of 2009, PIH has had 50 presses manufactured in Haiti and taught local families how to use the device to make charcoal briquettes from organic farm waste, which they can then use in their own household, as well as sell in market. In addition to providing an alternative to wood charcoal, this project generates income for the families.

In order to encourage and support the reforestation of Haiti, PIH plants and gives away tens of thousands of saplings every year. We now have 6 tree nurseries, and not only does the program distribute fruit tree and soil conservation saplings to participants in the Family Assistance Program, but it also give trees to nearby villages and plant trees at sites that are important for water conservation. In addition to increasing farmers’ productivity in hopes of relieving their food instability, PIH's agriculture program restores environmental stability to the country’s hillsides.

Project History

2002 – Zanmi Lasante and its partners from Christ Church, in Greenville, South Carolina, launch an agriculture project called Haiti Horticulture. Hillside gardens in Cange are terraced and planted with vegetables.

2004 – Haiti Horticulture is renamed Zanmi Agrikol (ZA) and leases a 40-acre farm in Corporant, down the road from Cange. ZA plants 14,000 banana trees and grows beans, corn, spinach and other vegetables.

2006 – ZA opens an experimental farm in Boucan Carré. In November, ZA starts local production of Nourimanba and Nourimil for children hospitalized with severe malnutrition and enrolls 20 families in the Family Assistance Program. The farm at Corporant focuses on growing peanuts, corn and beans to be used in the production of Nourimil.

2007 – ZA produces 49,016 pounds of Nourimanba and 87,200 pounds of Nourimil and treats 3,464 children suffering from malnutrition.

2009 – ZA treats 5,000 malnourished children and supports 240 families in the Family Assistance Program.