How severe, how many, and when: Up to July 2019, SEVEN of the THIRTEEN analyzed districts are classified in IPC Phase 3 (Crisis). 730,522 people, including 134,595 in IPC Phase 4 (Emergency), are estimated to be facing severe acute food insecurity – 21% of the 13 districts analyzed. 188,550 children are likely to suffer from acute malnutrition, with 35,393 severe cases located in the 12 districts analyzed based on the combined prevalence of the 3 forms of acute malnutrition from SMART surveys. 

Where and who: The Districts of Ambovombe, Beloha, Tsihombe, Amboasary, Ampanihy, and Betioky are facing both acute food insecurity - Phase 3 (Crisis) and acute malnutrition - Phase 3 (Serious). Bekily is classified in IPC Phase 4 (Critical - IPC Acute Malnutrition), the District of Toliara II is in IPC Phase 3 (Serious - IPC Acute Malnutrition), and the 5 communes of Taolagnaro are classified in IPC Phase 3 (Crisis - IPC Acute Food Insecurity). Compared to the results of the last IPC Acute Food Insecurity analysis in October 2018, the food security situation in Beloha and Ampanihy districts has significantly improved.  The improvement can be attributed in part to humanitarian intervention packages carried out in these two districts: Beloha moved from Phase 4 to Phase 3 with the proportion of households in Phase 3 and 4 falling from 67% in 2018 to 25% in June 2019. The District of Ampanihy was projected to be in Phase 4, but its current phasing is maintained in Phase 3.

Why: Major contributing factors to the food insecurity are the poor harvest due to insect damage and irregular rainfall, and the low household income and purchasing power. Major contributing factors to the deterioration of the nutritional situation include inadequate food intake, low dietary diversity of children, high prevalence of diseases (diarrhea, Acute Respiratory Infections, malaria and measles), with more than 30% related to poor access to health services, and low access to safe drinking water.

In districts in Phase 3 of Acute Food Insecurity, emergency interventions are needed to reduce food consumption gaps and protect livelihoods:

• Reduce the intensity of the lean season that is likely to begin in August for the most vulnerable (households with limited access to land, households with fewer or no assets, households headed by young people or women and households with many dependents), in particular through humanitarian interventions in social protection and early recovery. These interventions should include an accountability mechanism and modalities to limit the depletion of livelihood assets and/or facilitate access to food.
• Capitalize on the achievements in the implementation of emergency responses (minimum package system) and early recovery that have helped to limit the deterioration of the situation of households in emergency situations. 

A careful targeting of these categories of people in emergency situations should be undertaken at the district level to ensure that they receive appropriate support. 

For districts classified in Phase 3 (Serious) of the IPC Acute Malnutrition, strengthening the health system and, in particular, the prevention and integrated management of childhood diseases (malaria, diarrhea and respiratory infections) as well as continued support for the expanded programme on immunization and the Mother and Child Health Weeks (MCHW) should be a priority in the response. 

In order to strengthen the resilience of communities' livelihoods prone to recurrent cyclones/floods (South-East) and drought (South):

• Implement the resilience strategy for the agricultural sector on a larger scale;
• Support the effective operationalization of the cyclone and drought contingency plan under government leadership at the regional level; capacity building of the government counterpart should be carried out to ensure better coordination and effectiveness of the various multisectoral interventions implemented under this plan;
• Strengthen early warning systems running for timely and informed decision-making and facilitate the implementation of early interventions in districts in IPC Phases 2 and 3 to prevent or mitigate the effects of hazards;
• Intensify the control of insect pests (Fall Armyworm, locusts, etc.) and plant health diseases to limit damage to crops in the fields at development stage; and
• Support income-generating activities that enable households to diversify their sources of income and strengthen their productive capacity.

And in the prevention of malnutrition:

• Promote the diversification of crops with high nutritional value through nutrition education, cooking demonstrations, food conservation and processing techniques to achieve a diversified and nutritious diet;
• Focus interventions on infant and young child feeding best practices, mainly improvement on diet best practices and their application by mothers, the quality of food consumed by children, and the prevention and treatment of childhood diseases;
• Conduct a response analysis involving all nutrition, health, food security and WASH actors to identify appropriate interventions to fight against acute malnutrition. This response analysis could initially be focused on Bekily in a critical situation and in districts in serious phases, which have relatively high levels of acute malnutrition; and
• Intensify resource mobilization efforts to increase the coverage of existing malnutrition prevention and treatment interventions while exploring their expansion at the community level.