Improving health and nutrition resilience through solar cold chain in Madagascar

Madagascar, home to over 24 million people, faces severe human development challenges compounded by political instability and high exposure to climate-related disasters. Supported by the World Bank, this project aimed to improve maternal and child health, nutrition, and resilience through an evidence-based package of interventions. A climate and health diagnostic conducted during project preparation identified entry points for climate action. Key components included the deployment of solar refrigerators to strengthen the vaccine cold chain, the use of solar-powered data collection tablets, and the integration of climate change and nutrition education into community health programmes. 

The project’s success stemmed from its proactive integration of climate resilience into a core health program. Including a no-cost Crisis Preparedness and Response (CERC) component under the World Bank’s Operational Policy enabled flexible reallocation of funds during emergencies, ensuring service continuity. The climate and nutrition assessment informed risk reduction strategies and guided climate-smart infrastructure investment. Strong government commitment and alignment with national climate and nutrition policies enhanced ownership and implementation. By linking preparedness planning with health system strengthening, Madagascar’s experience demonstrated that climate-resilient design can reduce fragility and sustain essential services during crises.

To replicate Madagascar’s approach, projects should embed climate diagnostics and adaptation measures during design rather than retrofitting them later. Prioritise “quick-win” solutions - such as solar cold chains and climate education - to build local ownership and early success. Include financial flexibility mechanisms like CERC to maintain health services during emergencies. Align interventions with existing national adaptation and nutrition strategies to maximize policy coherence. Finally, invest in local capacity for climate and health data collection to inform future decision-making. Embedding these features ensures that health and nutrition programs deliver both development and climate resilience co-benefits over the long term.