1

U.S. Position on the World Bank’s Madagascar – Improving Nutrition Outcomes 

Using the Multiphase Programmatic Approach

December 13, 2017

One of Madagascar’s most pressing development challenges is to address widespread chronic 

malnutrition, a major impediment to each child reaching his or her full potential. The proposed 

program’s multi-sectoral interventions, which support an integrated package of services during 

pregnancy, during and after childbirth, and in the early years of a child’s life, have the potential 

to greatly reduce the prevalence of stunting in Madagascar and improve human development 

indicators. 

The program is ambitious, aiming to reduce the current rate of stunting from 47 percent to 33 

percent in 10 years, and its success will largely depend on a sustained commitment by the 

authorities to push through needed reforms over many years and follow-on investments. This is 

a complex scheme, one that will require effective management and supervision, complemented 

by robust data collection, to ensure that quality services are well-targeted and delivered across 

the country. It will undoubtedly require stronger institutions, particularly at the local level. 

Therefore, we greatly welcome the program’s emphasis on sharing knowledge and building 

capacity. 

As the first World Bank program using the new Multiphase Programmatic Approach (MPA), the

proposal warrants special attention. In particular, the United States reviewed carefully whether 

the information provided in this program appraisal document (PAD) is in line with what had 

been anticipated coming out of MPA discussions over the summer. The United States made 

clear during those discussions that the United States has significant reservations about ceding 

important Board oversight in the absence of greater accountability and transparency; the MPA’s 

delegation to Management requires the Board to keenly focus on future phases at the time of 

Board consideration. While the United States worked with Management during the design of the 

MPA to address these concerns, how MPAs are implemented is of great interest. 

The United States believes this PAD could have been more explicit in several areas to assure the 

Board and broader public that the Bank is implementing the new MPA well, and that the MPA 

will not undermine Board oversight, Bank transparency, or the application of the Bank’s

safeguards. Some relatively minor additions would have significantly improved the PAD and 

would have enabled all to understand the proposed project better. Ideally, the United States 

would like to see these additions added in the PAD before it is made public to help improve the 

reception that this first MPA will receive. Specifically: 

 On transparency: Affected communities, the general public, and shareholders should be 

provided a timeframe for when future phases will be prepared, considered, and approved by 

Management. The Bank’s intent to provide this information publicly and in a timely manner 

should be explicit in all MPA PADs. Given that there will not be a Board date for the second 

and third phases, affected communities and the public need to be given the necessary 

information about when key decisions on future phases will be taken. This may require some 

improvements to the Bank’s IT system. The United States expects that all relevant 
2

documentation of future phases of an MPA, including this one, will be disclosed as it would 

if the phases were standalone projects. 

 On lessons learned: One of the key benefits of an MPA is that the lessons learned in the 

earlier phases can help improve the design of future phases. MPA PADs should outline how 

the Bank will identify key issues to be tested in each phase and establish monitoring and 

assessment protocols that enable data to be collected to lead to useful learning. The United 

States found the level of discussion around learning insufficient in the Madagascar PAD and 

call on the Bank to ensure this is addressed in future MPA PADs.

 On environmental and social safeguards: While this project does not envision large social 

and environmental impacts (given its focus on nutrition), future MPAs may entail greater 

risks. MPA PADs should alert the Board (and the public) about the potential risks and 

impacts of future phases, as required by the policy, so that the Board can make informed 

decisions, based on good analytics and risk assessments relevant to the entire MPA. If this is 

not possible, the MPA approach may not be the proper approach for the proposed 

intervention. As agreed during the MPA discussions, an MPA PAD should explicitly discuss 

the envisaged environmental and social risks and impacts of each phase in turn and should 

explicitly discuss the type of due diligence that may be needed on future phases (in addition 

to the basic assurance that the appropriate due diligence will be carried out). Depending on 

the nature of the proposal, it may be appropriate to do a strategic or sectoral environmental 

and social impact assessment as a means of better understanding risks beyond Phase 1 

activities. It is also critically important that the Board be apprised if there are important 

uncertainties in future phases, such as sector, instrument, location or private sector 

engagement, and the implications of such uncertainties for environmental and social 

safeguards. Management needs to instruct staff to consider thoroughly any risks that are 

likely in future phases and detail how they will be addressed at the time the first phase is 

brought to the Board for approval. 

In addition, the United States understands that Management is in the process of developing 

procedures, guidance, and directives that will instruct staff on how to develop and implement an 

MPA. The United States would like to underline the importance of having clear, consistent 

guidance so that staff can prepare and implement a quality MPA. The United States will be 

looking for these instructional documents to be prepared soon. 

The United States looks forward to hearing from Management on how they intend to address 

these concerns in this and future MPAs. To be clear, U.S. support will depend on inter alia

whether future MPA program documents provide greater clarity on disclosure and consultation, 

environmental and social risk management, and how lessons learned will be applied to future 

phases.