Trees of hope background document

1 | T r e e s o f H o p e
Trees of Hope: The potential of Moringa oleifera to nourish Haiti
[Background document]
Vanessa Pike (Young), RD, MPH(c)
Master of Public Health – Community Nutrition
Summer Research Practicum
University of Toronto
May 22, 2015
“No other plant…appears able to match [the moringa’s] combination of overall
utility, micro- and macronutrient composition, rapid growth habit, high yield leaf
production, and survival in harsh climates.”
~ Thurber and Fahey, 2009

Table of Contents
Introduction.......................................................................................................................... 3
Malnutrition.......................................................................................................................... 3
The Haitian Context............................................................................................................... 3
Introducing Moringa.............................................................................................................. 7
Moringa Nutrition ................................................................................................................. 8
Moringa as Food.................................................................................................................... 9
Moringa Interventions in Other Countries............................................................................ 11
The First 1000 Days.............................................................................................................. 13
Moringa in Haiti .................................................................................................................. 14
Food-based Approaches to Addressing Malnutrition............................................................ 16
The Value Home Gardens .................................................................................................... 17
Multisectoral Approach....................................................................................................... 18
Social Marketing of Moringa................................................................................................ 18
Conclusion........................................................................................................................... 19
References .......................................................................................................................... 20

Introduction
Hunger and micronutrient deficiencies are crippling problems in Haiti, a fragile country facing
mammoth challenges to development. There is a local resource, however, in the form of a
humble tree that can be taken advantage of for boosting food security, health, and economic
development. This paper will first outline the effects of malnutrition, then Haiti’s historical,
political, geographical, and development context. Next, the moringa tree and its benefits will be
introduced, and interventions involving its use will be highlighted. Then, an overview of what
has been done in Haiti so far with moringa will be given, and the merits of food-based and
home garden approaches to reducing malnutrition will be discussed. Finally, the potential of
social marketing in moringa promotion will be outlined.
Malnutrition
Malnutrition contributes to one third of all child deaths globally, and lack of access to nutritious
food is often the cause (WHO, 2015b). Haiti, a country of about 10.3 million (WHO, 2015a)
sharing the island of Hispaniola with the Dominican Republic, is all too acquainted with hunger
as about one third of its population is food insecure (WFP, 2015b). The 2013 Global Hunger
Index (GHI), a tool by the International Food Policy Research Institute (IFPRI) to track and
compare hunger by region and country, indicates that Haiti’s score of 23.3 is at the level of
“alarming” (IFPRI, Concern Worldwide, and Welthungerhilfe, 2013). As is so often the case, the
burden of malnutrition lands heaviest upon women and young children, leaving them
undernourished and deficient in key vitamins and minerals (Government of the Republic of
Haiti, 2010; USAID, 2014) and thereby hinders both the development of human potential as
well as national economic development (Zongo, Zoungrana, Savadogo, and Traoré, 2013).
Chronic malnutrition affects one in every five children in Haiti, and 6.5% suffer from acute
malnutrition. These rates vary geographically with rural being most affected. For children under
5 years of age, the prevalence of stunting is 22%, and the prevalence of underweight is 11%
(USAID, 2015). Micronutrient deficiencies are also widespread; more than half of Haiti’s women
and children suffer from anemia (WFP, 2015b), 32% of preschool children are deficient in
vitamin A, and almost 60% of school-aged children are iodine deficient. Zinc intakes are also
inadequate for a large portion of the population (Micronutrient Initiative, n.d.). These nutrition
outcomes are influenced by constraints in the health care system (USAID, 2014), but have much
deeper root causes.
The Haitian Context
As accurately explained by Kimura (2013), hunger and malnutrition are complex issues rooted
in history, influenced both global and local natural, political, and economic factors. Haiti has
struggled for decades with high levels of poverty and food insecurity, along with recurrent

natural disasters, political instability, and high population growth (USAID, 2015). In 2014, Haiti
ranked 168 out of 187 countries on the Human Development Index – a composite index
measuring health, lifespan, knowledge, and standard of living (UNDP, 2014). As one of the
poorest countries in the world, more than half of the Haitian population lives on less than $1 US
per day (CHAI, 2013) and over 80% live on less than $2 per day (USAID, 2014). This affects not
only individuals, but also communities, the operation of administration, and therefore the
entire country. Unemployment rates are at 50% in the nation’s capital, and illiteracy rates are
about the same (USAID, 2014; WHO, 2015b). Although Haiti has made some progress towards
education, access remains low and the average citizen receives a mere 4.9 years of schooling
(CHAI, 2013) – a particularly relevant statistic since it is known that maternal education is
inversely related to stunting (USAID, 2014), and education is a strong predictor of food security
(Canadian Feed the Children, 2015).
The mountainous geography coupled with the tropical weather of Haiti also leaves the country
prone to natural disaster (CHAI, 2013). Frequent tropical storms and hurricanes batter the
landscape – so much so that it has been said that “every summer, Haitians fear nature’s wrath”
(IFPRI, Concern Worldwide, and Welthungerhilfe, 2013). Localized droughts and floods also
occur and lead to massive erosion and disrupted ecosystems, exacerbated by the limited
capacity of authorities to respond to crises (IFPRI, Concern Worldwide, and Welthungerhilfe,
2013; WFP, 2015b). Perhaps the most memorable recent natural disaster occurred on January
12, 2010, when a massive earthquake struck Haiti, resulting in the death of over 200 000 people
and the displacement of over 1.5 million. Much of the country’s vital infrastructure was
destroyed and 40 million m3 of debris was created (Feldmann, 2013; Government of the
Republic of Haiti, 2010; Vertefeuille, Dowell, Domercant, and Tappero, 2013). Just 10 months
later, Haiti experienced its first (and most severe) cholera outbreak in a century, affecting 470
000 people (CDC, 2011). Two short years later in 2012, Tropical Storm Isaac and Hurricane
Sandy assaulted Haiti causing major flooding and crop damage, as well as blocking access to
some communities altogether. While not a new phenomenon, the frequency of weather shocks
are increasing, and in 2012 Haiti was ranked as the country at the most extreme risk worldwide
in vulnerability to climate change (Maplecroft Global Risk Analytics, 2012).
These natural disasters frequently destroy many of the crops used for subsistence farming
(World Bank, 2013) driving up food prices and worsening the devastation (IFPRI, Concern
Worldwide, and Welthungerhilfe, 2013). According to USAID (2014), the average number of
meals per person per day decreased from 2.48 to 1.58 after the earthquake, and the
percentage of food insecure households rose from 40% to 52% (Government of the Republic of
Haiti, 2010). Of the households affected by the 2010 earthquake, over half were already in debt
– a debt almost wholly related to food purchases (Government of the Republic of Haiti, 2010).
The fact that the majority (63%) of Haiti’s land mass is considered too steep for crop or
livestock production (Columbia University Earth Institute, 2012) also cuts into agro-economic
opportunities.
Electricity is scarce in Haiti, with only about a quarter of the population having access, many for
only several hours a day (USAID, 2015). As a result, charcoal (made from wood) is relied upon as

a main energy source for cooking. Because selling it is the only option for income for many
Haitians, 30 million trees are being cut down each year – one of the highest rates of
deforestation in the world – and Haiti now has only 2% of its original tree cover remaining
(Smallholder Farmers Alliance, 2013 and 2015). This extreme deforestation has eroded the
landscape to produce treeless mountains and soil erosion which facilitates flooding and
landslides (especially during hurricane season) – further degrading the land and reducing
agricultural potential. Drinking water is also polluted and fish stocks are damaged with
sediment deposition, propelling the vicious cycle (Interlandi, 2010; USAID, 2015).
The stress on Haiti is not solely due to the environment, however. In addition to natural forces,
the agriculture sector is hindered by a history of underinvestment in infrastructure and poor
resource management (USAID, 2014). As only 10% of crops are irrigated, the vast majority of
farms rely on rainwater (WFP, 2015a), and fertilisers are used on only 5% of farms (Government
of the Republic of Haiti, 2010). Although agriculture accounts for up to 40% of the country’s
GDP and 60% of its population make their livelihoods through agriculture (Smallholder Farmers
Alliance, 2015; USAID, 2014), still about half of Haiti’s food is imported, including 80% of its
staple, rice (USAID, 2015a). Nonetheless, efforts are in place to reform the agri-food system.
For example, in 2012, shortly after Hurricane Sandy, the Haitian government announced plans
to increase production capacity with a goal of meeting 60-70% of the country’s food needs by
2017 (IFPRI, Concern Worldwide, and Welthungerhilfe, 2013). Large agribusinesses continue to
dominate, however, and there has been little investment into the revitalization of Haiti’s
agriculture system through small farmers (IFPRI, Concern Worldwide, and Welthungerhilfe,
2013).
This history of weak governance leads Haiti to be classified as a fragile state due to serious gaps
in security, constitutional laws, and economic development (IFPRI, Concern Worldwide, and
Welthungerhilfe, 2013), and also leaves Haiti relying heavily on foreign aid and the work of
NGO’s. For example, in the 29 months after the earthquake in 2010, roughly $9 billion of aid
from foreign governments and private donations came into Haiti (Locke, 2012). The return on
investment, however, has been hindered by a disorganized channelling of resources and layers
of procedures among the receiving bodies – the vast majority of whom are NGO’s. According to
the United Nations, only 1% of post-earthquake relief and 12% of recovery aid was channeled
through the government (Office of the Secretary General’s Special Adviser, 2013).
Haiti has become infamously known as a “republic of NGO’s” due to the thousands of
international entities that work within its borders (Feldmann, 2013). This has become even
more pronounced since the earthquake – despite resolutions to allow Haitian government to
take the lead – when estimates of the number of NGO’s in Haiti ballooned to 10 000 (USIP,
2010). Coordination of the activities of these organizations amongst a backdrop of political
instability and weak infrastructure has been poor. Although NGO’s are largely responsible for
the rebuilding of Haiti, they generally lack the expertise to work according to a long-term plan
with a comprehensive understanding of the country’s needs (Feldmann, 2013). Many NGO’s
also attract well-trained locals to work for them instead of equivalent positions within
government by offering much better compensation and benefits (Garrett, 2007). This has led to

an essential take-over of NGO’s providing public services and a perpetuation of the cycle of low
capacity and accountability in Haitian leadership (Garrett, 2007).
It could be argued that the good intentions of donor countries actually do Haiti a misdeed,
locking the country into a dependency on aid as opposed to contributing to a more capable
public sector (IFPRI, Concern Worldwide, and Welthungerhilfe, 2013). But this phenomenon of
dependency is not new. The structural adjustment programs in the 80’s have been criticized for
fostering a dependence on imports as opposed to encouraging local production solutions from
the Haitian people (IFPRI, Concern Worldwide, and Welthungerhilfe, 2013). Food distribution
programs, for example, made it difficult for local farmers to compete with low imported food
prices. This heritage of import reliance has left its mark on the Haitian food system, making
Haitian consumers sensitive to fluctuations in the world market (IFPRI, Concern Worldwide, and
Welthungerhilfe, 2013).
According to Labonte and Torgerson (2005), “public policies determine the ultimate allocation
of opportunities and resources” in a country, and Haiti is no exception. Haiti’s lack of land
ownership rights has long been a long-standing issue, influenced by the country’s colonial
predecessors and post-colonial policies discouraging rural tenure (Columbia University Earth
Institute, 2012). This legacy was especially damaging after the 2010 earthquake as it impeded
reconstruction and kept people living in temporary shelters. Urban sprawl and uncoordinated
regional planning led to unauthorized construction on agricultural land and crops being grown
on unsuitable land (Feldmann, 2013; World Bank, 2010). For example, small scale farmers are
increasingly using steeply sloped land which contains fragile soil, unfortunately contributing to
erosion in the process. As a result, most farmers in Haiti use several dispersed plots of land,
while large-scale farmers and industrial companies have easily acquired fertile land (IFPRI,
Concern Worldwide, and Welthungerhilfe, 2013).
Rapid urbanization combined with a lack of public services greatly diminishes community
capacity (Labonte and Torgerson, 2005). Adding to the equation brain drain from government
jobs along with longstanding political instability, little policy capacity remains for developing
and maintaining the public sector. As alluded to above, even some of the most fundamental
government services such as security, sanitation, education, energy, and taxation are lacking in
Haiti (Feldmann, 2013). Consequently, most of Haiti’s reserves of more hidden natural
resources such as gold, copper, and silver have not yet been explored (Oxfam America, 2012).
Evidently there is a pressing need for global governance and tighter regulation of NGO’s in Haiti
to empower local leadership. It is only through strategic management of Haiti by Haitian people
that the collective population’s long-term best interests can be attended to; a country cannot
be effectively led by forces beyond its own borders.

Introducing Moringa
One of the most promising ways for increasing food and nutrition security in Haiti – and
potentially increasing economic opportunity as well – involves the unique Moringa oleifera
(moringa) tree, (known as the ‘benzoliv tree’ in Haiti (ECHO, 2007)). It would be difficult to
overstate the potential of this nutritious, easily-cultivated, multi-purpose tree. Belonging to the
Moringaceae family which is in the Brassicales order (including cabbage, radish, and capers)
(Olson and Fahey, 2011), the moringa tree produces nutritious leaves, flowers, bean pods, and
oil (Martín et al., 2013). Native to northern Pakistan and India, the moringa tree has been
introduced (and has flourished) all over Asia, Africa, South America, southern Florida, and the
Caribbean, and is available in almost every part of the world still affected by malnutrition
(Mahmood, Mugal, and Haq, 2010; Martín et al., 2013, Smallholder Farmers Alliance, 2015);
there are records of indigenous knowledge and use of moringa across 80 countries in over 200
languages for thousands of years (Mahmood, Mugal, and Haq, 2010). The moringa is such a
versatile plant that many refer to it as a “miracle tree” or “tree of life” (Smallholder Farmers
Alliance, 2015). Examination of the tree’s many applications and benefits makes it clear why.
Almost every part of the moringa tree can be useful, making it a potential income source both
directly and indirectly. Beyond cultivating moringa for food, its benefits extend into other areas
of agriculture. Farmers use the seeds and shoots as a fertilizer to enrich the quality of the soil,
thereby increasing plant growth (ECHO, 2007). Moringa’s leaves and seeds are also useful as
nutritious fodder for fish and poultry (Smallholder Farmers Alliance, 2015; Thurber and Fahie,
2009; Yisehak, 2011); allowing them to grow more robust and benefit the farmers through overall
increased yield. The trees themselves are often used as living fences to protect against animals
and wind, or to prevent erosion of other crops (ECHO, 2015; Yisehak, 2011). The wood is quite
soft and lends itself well to paper- and rope-making, and can also be used to create a blue dye
(ECHO, 2007; Yisehak, 2011). Furthermore, its flowers are a good year-round source of nectar for
honey bees (Republic of Haiti, 2013; Smallholder Farmers Alliance, 2015; Yisehak, 2011).
Moringa seeds are a wonder in and of themselves. Not only are they rich in oil for biofuel,
cooking, and for use as lubricant (ECHO, 2015; Yisehak, 2011), but an impressive quality, once
crushed, is their ability to clarify and purify turbid water with its flocculating and anti-microbial
properties (ECHO, 2015; Martín et al., 2013; Smallholder Farmers Alliance, 2015; Yisehak,
2011). Moringa flowers and oil are also gaining ground as a new trend in the cosmetics industry
in fragrance and skin care products (The Body Shop International, 2015; Smallholder Farmers
Alliance, 2015), and the antioxidants in moringa have led to exploration of the use of moringa
as a natural alternative to food preservatives (Olson and Fahey, 2011).
Having impressive claims of medicinal applications, moringa leaves, bark, roots, and seeds have
been used by traditional healers for hundreds of years for the treatment conditions such as skin
diseases, joint pain, infections, headaches, diarrhea, and even chronic diseases such as
hypertension, diabetes, anxiety, cancer treatment (Mahmood, Mugal, and Haq, 2010; Thurber
and Fahie, 2009; Trees for Life International, 2011). Although not common in Western
medicine, doctors in some countries also use moringa in disease prevention due to its anti-

inflammatory, antimicrobial, antioxidant, anti-tumor, hypoglycemic, and anti-hypertensive
properties (Martín et al., 2013; Olson and Fahey, 2011; Trees for Life International, 2011). The
seed pods are also an important source of fibre (Yisehak, 2011). These properties of Moringa
can have the added benefit of helping to protect against chronic disease increasing among low-
income countries, thereby helping to reduce the double burden of disease.
This giving plant is also an agricultural wonder. With its natural pest resistance and ability to
thrive in hot, dry climates, (Yisehak, 2011) it is available even with many other crops are not. It
costs little to plant and can be grown from either seedlings or cuttings (Thurber and Fahey,
2009), and older flowering branches can be pruned to continuously produce new leafy shoots
for food (Yisehak, 2011). The moringa tree is a source of food year-round as the leaves can be
eaten fresh during growing season and dried for use during other parts of the year (Yousefian,
2012). Due to the ease and speed with which it is cultivated, it can be used on a large scale – up
to 15 feet from a seed in one year – and can grow interspersed with other crops (Smallholder
Farmers Alliance, 2015). Overall, moringa trees have low nutrient and water requirements and
is able to grow in very dry, sandy soil (Smallholder Farmers Alliance, 2015).
The moringa tree can produce quite a generous yield when properly planted and fertilized.
Ideal seed spacing for leaf production is 30 inches within rows and 1 meter between rows,
although beds with 4 x 4 inch spacing might be the most feasible for the home gardener
(Radovich, 2009). Seeds should be planted about 2 centimeters deep in soil kept moist (ECHO,
2007), and seedlings pruned at 1 meter tall to encourage more branches to grow from the sides
(Radovich, 2009); regular pruning produces maximal output – up to nine harvests per year from
the same plants (Thurber and Fahey, 2009; Trees for Life USA, 2010). It has been estimated that
10kg of seed produces 1.3 litres of oil (Radovich, 2009), and that each tree can produce 1-5kg of
fresh leaves per year, but ultimately yields vary widely with cultivation techniques (Radovich,
2009; Smallholder Farmers Alliance, 2015). Leaves can be harvested in as little as four months
after planting, and most produce bean pods within a year (Smallholder Farmers Alliance, 2015).
Moringa Nutrition
The nutritional properties of moringa are perhaps the most astounding. The leaves of the
moringa tree are a nutritional goldmine, providing protein, calcium, iron, vitamin A, Vitamin C,
and B vitamins in amounts rarely seen in one single food. Although reports of nutrient content
vary by source (and are also influenced by harvest season and geographical region), generally
100g of fresh leaves contains more calcium than milk, more iron than beef, soybeans, or
enriched grains, about double the protein of quinoa or half the protein in eggs, as much vitamin
A as carrots, more than three times as much vitamin C than oranges, almost as much potassium
as bananas (Yisehak, 2011 compared with Canadian Nutrient File, 2010).
Assessed in another way, per 100 g of fresh weight, Radovich (2009) reports that moringa
leaves contain over 7500 IU of vitamin A, 51.7mg of vitamin C, 185mg calcium, and 337mg
potassium (although caution should be used when interpreting these amounts since quantities

vary by source). For a young child, even a relatively small amount of powder or fresh leaves
would provide a large amount of his daily nutrient needs, including these along with B vitamins
and essential amino acids (Smallholder Farmers Alliance, 2015). Moringa oil, as well, added to
the diets of young children has proven beneficial as a concentrated source of energy and
vitamins (Smallholder Farmers Alliance, 2015). Importantly, anti-nutritional factors such as
tannins, protease inhibitors, and lectins are also low (Olson and Fahey, 2011).
One of the most nutritionally-relevant features of moringa leaves in settings of malnutrition are
their high protein content – up to 30% of its weight (Olson and Fahey, 2011). Moringa leaves
contain all the essential amino acids in a well-balanced profile (Martín et al., 2013; Olson and
Fahey, 2011; Trees for Life USA, 2010), including significant amounts of sulfur-containing
methionine and cysteine which are usually present in very small amounts in plant sources
(ECHO, 2007). Moringa therefore holds significant potential in the diets of those who do not
have access to much meat. In powdered form, the leaves contain more concentrated amounts
of nutrients, comparable with powdered milk for its calcium and protein content and
additionally has vitamin A (Olson and Fahey, 2011).
With these amounts of macro- and micronutrients, it is not difficult to see how consuming
moringa regularly could completely revolutionize the health of a malnourished individual.
Furthermore, if these nutritional benefits were understood by populations, there would be a far
greater demand for it as a commodity, and the population health benefits could be
considerable. Not surprisingly, many organizations (including the FAO) have noticed the
potential of moringa and have incorporated it into their strategies and programs to combat
malnutrition and food insecurity, particularly among children and pregnant and lactating
mothers (Martín et al., 2013; Smallholder Farmers Alliance, 2015). Moringa powder is
commonly used as a nutrition supplement in Africa and other parts of the world where 1-2
teaspoons are added to cooked food daily to enhance its nourishing ability (Radovich, 2009).
Indeed, addition of moringa to diets of extremely malnourished people in West Africa has been
documented as “saving their lives” (Olson and Fahey, 2011).
Moringa as Food
Of course a food must be palatable if it is to be regularly eaten. In this case, the moringa tree
scores moderately well. From a culinary perspective, all parts of the tree are edible except the
wood, and taste perceptions range from “tasteless” to “slightly bitter,” depending on the
geographic origin of the leaves (Thurber and Fahey, 2009). Acceptability has been
demonstrated even among children (Thurber and Fahey, 2009). The variety of ways in which
this valuable “miracle tree” can be consume make it a versatile ingredient. There are numerous
sources of moringa recipes online which incorporate moringa leaves, flowers, and bean pods
into sauces, stews, smoothies, stir-fries, traditional food, teas, and even treats like chocolate
truffles.

The leaves of the moringa tree are the most extensively used of all parts of the tree (ECHO,
1996). Essentially a substitute for spinach or any other leafy green, moringa leaves even more
nutritious (ECHO, 2007). Both young and old leaves are eaten, but older ones are preferred due
to having a milder taste. Tea is sometimes made from dried leaves, and fresh leaves can be
added to sauces and stews (Yisehak, 2011), soups, or even consumed raw in salads (Martín et
al., 2013). The taste of fresh leaves varies from “radishy” and hot to quite mild (Doerr et al.,
2009). Boiling the leaves has been shown to enhance their antioxidant activity (ECHO, 2007).
Young and old leaves alike can be harvested for drying, and should be processed the same day
by washing, draining, then drying the leaves in the shade (as direct sunlight can destroy some of
the vitamin A) or dehydrated in a dehydrator. The dried leaves are then pulverized using a
mortar and pestle (or by machine) and sifted to produce a fine powder, sometimes called
moringa flour. The powder should be stored away from heat, light, and humidity in order to
preserve nutrients; it lasts up to 6 months in air-tight containers (Mishra, Singh, and Singh,
2012; Radovich, 2009). A big advantage of drying and powdering moringa leaves is that it makes
this nutritious food available throughout each season, even during drought (Yisehak, 2011).
Moringa powder can be used in place of fresh leaves in cooking (Yisehak, 2011), or combined
with locally-available and commonly-consumed foods such as peanut butter (Simms, 2010).
Moringa powder is mixed with porridge and other semi-liquid food and used in complementary
feeding in many areas, accepted in appearance and taste despite the green color imparted onto
the food (Zongo, Zoungrana, Savadogo, and Traoré, 2013). In the Philippines, moringa powder
is mixed with flour and used in bread making (in particular, “nutri-buns” for use in school
feeding programs) (The World Vegetable Centre, n.d.). Most commonly, though, moringa
powder is sprinkled on food just before eating in order to maximally preserve nutrients
(Radovich, 2009).
Moringa oil (better known as `ben oil`) has been shown to be a better oil for deep frying than
canola and soybean and palm oils due to its stability at high heat, as well as having high
monounsaturated fat content (Abdulkarim et al., 2007). Ben oil is also rich in tocopherols and
similar to olive oil chemically and physically. In Haiti, ben oil is used in salad dressings, for stir-
frying, and in marinades, having a slightly nutty flavor (Martin et al., 2013; Smallholder Farmers
Alliance, 2015). It can also be used to stabilize other oils by helping reduce oxidation, improving
their culinary use (Martin et al., 2013).
Moringa flowers are used both for nutritional and medicinal benefits. Considered a delicacy in
some countries, flowers which reportedly taste like mushrooms are often mixed into other
dishes or fried and eaten as a snack (Martín et al., 2013; Smallholder Farmers Alliance, 2015)
They are also steeped in water to make a tea used as a cold remedy (ECHO, 1996; Smallholder
Farmers Alliance, 2015).

The seed pods of moringa begin as small tender green pods which taste like asparagus and are
often eaten like green beans (Martín et al., 2013; Yisehak, 2011) or as a substitute for okra
(ECHO, 1996). As pods mature, they elongate to about 15 inches and become more fibrous and
can be boiled and seasoned as any bean, but are more often cracked open for extraction of the
green seeds which are cooked like green peas, or the more mature seeds which can be fried,
roasted like peanuts, used in sauces and stews, or ground into a powder and used as a spice
(ECHO, 1996; ECHO, 2015; Martín et al., 2013; Smallholder Farmers Alliance, 2015).
The roots of moringa trees are less commonly used for culinary purposes, but are known to
taste like horseradish (hence another name for moringa is `horseradish tree`). Roots can be
used to create sauces or as a spice, and also serves medicinal purposes (ECHO, 2015; Martín et
al., 2013; Smallholder Farmers Alliance, 2015), however some warn of toxic effects when roots
are consumed in large quantities due to the presence of a nerve-paralyzing agent spirachin
(ECHO, 1996; ECHO, 2015).
Moringa Interventions in Other Countries*
*not an exhaustive review
The moringa tree has unfortunately been “one of the most underutilized tropical crops”
(Oduro, Ellis, and Ousu, 2008). According to a list of global food commodities in 2013 by the
Food and Agricultural Organization’s Statistics Division, moringa was not even one of the top
50. This is a disproportionate amount of production compared with the need for nourishment
around the world. Its benefits are being tapped into in some countries (particularly in Sub-
Saharan Africa), however, and the results are encouraging. Success has been seen in using
moringa as a tool for building sustainable communities in the tropics (Olson and Fahey, 2011),
addressing malnutrition, and of improving livelihoods.
A longitudinal study in Burkina Faso documented the ability of moringa in the diets of severely
malnourished children. Results showed that compared to those who received standard care,
children receiving moringa powder as an additional supplement experienced more weight gain,
quicker recovery, and dramatically lower rates of diarrhea (Zongo, Zoungrana, Savadogo, and
Traoré, 2013). Although there were no differences in hemoglobin status between the two
groups, it was suggested that analysis of another related parameter such as serum ferritin could
have been more telling (or, that it could have been due to the low bioavailability of iron in
Moringa leaf powder) (Zongo, Zoungrana, Savadogo, and Traoré, 2013).
Local health workers in Senegal are now using moringa for malnutrition instead of imported
goods because “it’s accessible and indigenous” (Trees for Life USA, 2010). One Senegalese
woman, a supervisor of a primary health unit, said “We have always had problems with the
classical approach to treating malnourished children…based on industrial products: whole milk
powder, vegetable oil and sugar. All these things are expensive. When you tell a parent to go
out and buy them—this can be truly costly for them” (ECHO, 2007). One of the main
advantages of the moringa tree as a partial solution to food security is the fact that it is a local

resource. It would not be viewed as a ‘Western’ solution, but a part of the land to which the
people belong and a solution in which they can take pride.
In Nigeria, the Faculty of Agriculture and Forestry at the University of Ibadan, in cooperation
with the Community Integrated Rural Development Project (CIRDP), with a grant through the
MacArtuhur Foundation, implemented a moringa training program for rural women. The result
has been community members developing processing and marketing skills as moringa is grown
and sold, generating income and community well-being. The women and community members
have also been reporting health improvements from regularly consuming moringa (DRUSSA,
2013). The initial crop of moringa trees was planted to be ready for harvest once the women
finished their training, but since then, women have added to the moringa plantation and report
making additional income (DRUSSA, 2013). This is intervention is sustainable as the women
were not only educated, but empowered with the tools they needed to start off, and linked
with a market for uptake of their product, while simultaneously providing them a way to make
a living.
While not involving moringa specifically, a study by Farber et al. (2002) has important parallels
which are relevant to this discussion. Yellow and dark green leafy vegetables grown in home
gardens were promoted in order to increase the serum retinol concentrations of children of
low-income households in rural South Africa. Over 125 home gardens were established (about
one third of households), and at the end of the 20-month intervention involving educational
components, significant increases were seen in consumption of these vegetables, serum retinol
concentrations of children, along with maternal knowledge of vitamin A. Intake of other
essential micronutrients were significantly increased in the intervention group compared to the
controls as well. The authors point out that linking this type of intervention with both nutrition
education and primary health care activities (in this case, growth monitoring) are key to
success, particularly among rural populations not having direct access to health facilities and
commercially-available fortified food (Farber et al., 2002). Home gardening integrated with
multisectoral community programming (encompassing health care, agriculture, nutrition, and
education) was perhaps a ‘perfect storm’ in this case.
And finally, the Mukono District in central Uganda was the site of a recent nutrition education
intervention promoting moringa at the household level. Women were educated about
nutrition, the benefits of moringa, and how to incorporate it into their family cooking through
commonly consumed foods. After four weeks, improvements were noted in knowledge,
attitudes, and utilisation of moringa (Mukama, 2014). Also, several Grand Challenges Canada
grants are currently exploring the use of moringa to combat nutrient deficiency in various
countries (Grand Challenges Canada, n.d.). While perhaps not directly applicable to or
replicable in Haiti, parallels can be drawn and the lessons learned from such examples can
provide valuable insight and principles for developing moringa programs in Haiti.

The First 1000 Days
An emphasis on the critical first 1000 days of a child’s life as key for targeting nutrition has been
promoted by the WHO, UNICEF, World Food Program, and other funding agencies worldwide
(www.thousanddays.org). There are important applications of moringa’s use for this time
period. Moringa is widely promoted and used as a supplement for both nursing mothers and
weaning infants (Doerr et al., 2009; ECHO, 2007; The Hunger Project, 2013; Radovich, 2009).
For a pregnant or breastfeeding woman, one small portion of fresh leaves or powder could
provide her with a large proportion of her daily calcium needs, and significant amounts of iron,
protein, and B vitamins, which could help reduce infant mortality and morbidity.
These nutrients in moringa crucial for healthy pregnancy have been measured. According to
biochemical analysis conducted in Fiji, 100 grams of fresh moringa leaves contain approximately
86 µg of folic acid (Devi, Arcot, Sotheeswaran, and Ali, 2008), or about 20% of daily
requirements for pregnant women according to the WHO’s recommendation of 400 µg per day
(WHO, 2012). The same amount of moringa leaves contains 5-8 mg of iron, and moringa
powder contains an even more concentrated amount of 18-28 mg in 100g (Smallholder Farmers
Alliance, 2015). Measured against the WHO’s recommendation of 30-60mg of elemental iron
per day for pregnant women (WHO, 2012), moringa can provide significant proportions of the
daily iron requirements. As only 30% of Haitian women meet the recommended daily intake for
iron (contributing to anemia and consequential complications for both mother and baby
(USAID, 2014)), moringa could truly be transformative in this area. However, it should be taken
into consideration that some have recorded a low bioavailability of iron in moringa leaf powder
(Zongo, Zoungrana, Savadogo, and Traoré, 2013), and nutrient composition of moringa varies
by source.
Moringa can also help with breastfeeding and weaning. In a review of six randomized control
trials, Raguindin, Dans, and King (2014) show that eating moringa significantly increases serum
prolactin levels, thereby increasing breast milk production, with no accompanying adverse
events. Overall there was a significant increase in the weight of infants – a 12% difference after
four weeks compared with controls. Perhaps this is how the moringa came to be called
“mother’s best friend” (ECHO, 2007)! Similarly, moringa has beneficial applications in
complementary feeding once children begin weaning. Complementary foods used in developing
countries are often of low nutritive value (usually cereal-based) with low protein levels and
poor protein quality (Shiriki, Igyor, and Gernah, 2015). Fortification of these foods with moringa
powder, however, can dramatically improve their nutrient profile with very little increase in
cost. In a trial of complementary food formulations, maize, soybean, and peanut blends
fortified with 10% moringa flour gave the best performance compared with those with less or
no moringa (Shiriki, Igyor, and Gernah, 2015). These results are significant because children
who are better nourished as infants grow up with fewer physical and developmental
impairments. The cycle of poverty could be could be dealt a severe blow if a generation of
children grew up with optimal nutrition.

Moringa in Haiti
The average Haitian diet is based largely on starch stables (rice, corn, wheat, millet) and
vegetable oil along with beans, yams, fruit, and smaller amounts of chicken, pork, goat, seafood
(Food in Every Country, n.d.; World Food Program, 2015c). Considering the rates of food
insecurity as outlined above and this typical diet low in vegetables, the addition of moringa
could be quite beneficial. Actually Haitians are already familiar with eating local leafy greens (E.
Boldon, personal communication, May 13, 2015), so it may not be difficult to encourage the
incorporation of moringa. As Haiti’s climate is favorable for its growth and it already thrives
naturally across most of the country, moringa is already used by farmers as natural fencing and
animal fodder, and its medicinal properties have made it a trusted folk remedy (Smallholder
Farmers Alliance, 2015).
The government of Haiti has nutrition as a priority. A national strategic framework to eradicate
hunger and malnutrition by 2025 and a national-level Commission for the Fight Against Hunger
and Malnutrition (COLFAM) provides direction to government ministries and NGOs (USAID,
2014). In 2012, Haiti joined the international Scaling Up Nutrition (SUN) movement which
unites stakeholders in multisectoral collaboration for nutrition improvement (USAID, 2012), and
also developed a national Nutrition Strategic Plan for 2013-2018 which adopts a community-
based, collaborative, holistic approach to preventing malnutrition (Republic of Haiti, 2013). A
working group of Haiti’s Ministry of Public Health and Population (MSPP) recently published a
concept document (2013) for the adoption and large-scale production of moringa as a strategy
to combat malnutrition, which stems from Haiti’s National Strategic Plan for Nutrition.
According to the report, a “moringa program” could make a difference on nutritional,
environmental, and economic axes (Republic of Haiti, 2013). Some particularly relevant
priorities set by the government in these documents include the nutrition and health of
vulnerable groups (pregnant and breastfeeding women and children under 5) (Republic of Haiti,
2013). There is also a written aim to promote the use of local nutritious agricultural products
(especially fruits and vegetables), and promoting dietary diversification (Republic of Haiti,
2013).
Haiti also has a specific plan for continuing recovery and redevelopment from the earthquake
and beyond. About 2 months after the earthquake in 2010, the Haitian government along with
support from several international organizations conducted a detailed post-disaster needs
assessment which outlines the losses and damages across sectors and proposes major areas for
action in the short, medium, and long-term for rebuilding a new Haiti. Some of the goals under
the nutrition and food security section are quite congruent with the production of moringa,
including putting in place a system of “multi-skilled agents” at the community level for
malnutrition prevention. Support is called for the more than 1 million small scale farmers in
order to ensure a regular food supply for rural populations. Another goal is to increase the
number of food products offered in the country (through improving input and marketing), as
well as creating rural jobs (Government of the Republic of Haiti, 2010). Moringa could be key in
carrying out these plans.

Also under the MSPP action plan, schools will grow moringa and incorporate its leaves or
powders in school lunches at least once per week. Teachers would be trained to show their
students how to grow moringa, and students could in turn bring this knowledge to their
parents, with the ultimate goal of every family having a tree from which they gather leaves for
home meal preparation (MSPP, 2013). To get the process started, a large-scale moringa
promotion day was held in June of 2013 involving over 500 schools which brought together the
Ministries of Education, Agriculture, Natural Resources, Rural Development, and Public Health
to popularize moringa among students (Le Nouvelliste, 2014). Around the same time the
Haitian Moringa Network (or “Rezo Moringa-Benzoliv Ayiti”) was formed. A public-private
platform for moringa stakeholders, the network is composed of community, NGO, and
government representatives who share information and promote the production and
consumption of moringa in Haiti (Holla, 2014; Smallholder Farmers Alliance, 2015). Promotion
through these venues has gone beyond encouraging consumption and also involved
highlighting moringa’s usefulness as animal and fish fodder, for water filtration, and in beauty
products (Smallholder Farmers Alliance, 2015). Overall, the MSPP has a goal of planting more
than 10 000 hectares of moringa by the year 2018 (MSPP, 2013).
Besides the nutritional elements of the MSPP plan, two other areas of potential were
highlighted. An environmental benefit of large-scale moringa production would be a
counteracting of deforestation and the stabilization of soil through its ability to grow on slopes
and difficult terrain due to its root structure which helps absorb water and hold soil in place
(Interlandi, 2010; MSPP, 2013). Also, an economic benefit would follow from using moringa to
feed livestock (lessening the need to import expensive animal feed) and using moringa oil
(reducing dependence on imported edible oils) (MSPP, 2013). The rapidly-expanding
international market for moringa also presents great potential, since it is becoming viewed as a
new “superfood.” Local demand in Haiti is small but growing, particularly among NGOs using it
as a tool to help fight malnutrition (Doerr et al., 2009; Smallholder Farmers Alliance, 2015).
Prices for moringa powder vary greatly, from $14 - 36 USD per pound; other products such as
moringa peanut butter, oil, and capsules are also being marketed. Some moringa is sold locally
(mostly in the capital Port-au-Prince). While the majority of these initiatives are informal
operations, there is a rising interest in growing more moringa for commercial enterprise
(Smallholder Farmers Alliance, 2015).
Moringa trees are inexpensive to obtain in Haiti (about $0.25 each), and even if seeds cannot
be funded, moringa can be propagated through direct seeding or cuttings (Holla, 2014). It is
also simple to process, without requiring expensive equipment. However there remain several
barriers to its use. Irrigation systems may be needed for large-scale production in some areas
(Smallholder Farmers Alliance, 2015) (although home gardens and smallholder farms would
not). Also, the MSPP describes a “distrust reflex” among rural populations for new crops since
they have often been offered agricultural products to cultivate for which there was no stable
commercial market (2013). And although up to 70% of Haitians know about the existence of
moringa, it is severely undervalued (MSPP, 2013) and much work remains to be done in its
promotion. As tradition plays a role in the adoption of foods, there is a possibility that the use

of moringa may be challenged. Some in Haiti view moringa as a food for “poor people,” and are
therefore reluctant to be seen eating it (MSPP, 2013), and many others are unaware of its
nutritional value (Holla, 2014). This highlights the need for education on the nutritional,
environmental, and economic benefits of moringa; indeed the MSPP has recognized this and
recommended a promotional campaign targeting the public, decision-makers, and the media
(2013).
The MSPP also aims to encourage and engage those who have taken initiative with moringa and
supporting its diffusion (MSPP, 2013). Several organizations are working to promote its small-
scale use including Haiti Reconstruction (haitireconstruction.ning.com), the Haitian Sustainable
Development Foundation (sustainablehaiti.org), Signa Haiti (signahaiti.com), and Smallholder
Farmers Alliance (smallholderfarmersalliance.org), to name a few. There is a need for
assessments of moringa use among the Haitian population and to evaluate outcomes of any
moringa-related programs currently running. This research will be necessary to understand
pathways between production, consumption, and nutrition outcomes involving moringa in
Haiti, as well as potential effectiveness for targeting specific micronutrient deficiencies such as
vitamin A and iron.
Food-based Approaches to Addressing Malnutrition
The traditional focus in addressing malnutrition in the developing world had been simply
providing enough food to prevent hunger, until attention turned to micronutrients and the
“hidden hunger” that deficiencies of them bring about (Goplan and Tamber, 2003; Kimura,
2013). This led to the rise of supplementation, fortification, and biofortification as methods of
reaching malnourished populations by providing them with quality food, not merely sufficient
quantity. Great success was shown in several areas such as vitamin A capsules reducing both
vision problems and child mortality and iron supplements helping to reduce incidence of
anemia and related effects (Kimura, 2013; Thompson and Amoroso, 2010). Supplementation
has saved many lives and abated much human suffering (Thompson and Amoroso, 2010).
However, these are sometimes seen as “drug-based” approaches which usually involve
imported ‘remedies’ (Goplan and Tamber, 2003; Hillocks, 2011), emphasizing technical
interventions above social and political change (Kimura, 2013). While there exists a need for
food assistance and nutrition supplements in Haiti for some populations, it is equally urgent to
support long-term development of agriculture, infrastructure, and education.
As an alternative approach, more and more attention has been given to using locally-available
food as a sustainable means to nourish populations and prevent micronutrient deficiencies. A
recommendation in the 1992 joint WHO and FAO International Conference on Nutrition, for
example, is to ensure food-based strategies are given priority because they are sustainable,
“particularly for populations deficient in vitamin A and iron, favoring locally available foods and
taking into account local food habits” (FAO/WHO, 1992). In addition, agricultural food-based
approaches allow more community ownership and self-reliance, and are often more culturally
acceptable while offering an opportunity for marketing surplus for additional income (Hillocks,

2011). The use of locally-grown moringa would be certainly aligned with this food-based
approach to increase dietary diversity and quality. Promoting moringa could help reduce both
micro- and macro-nutrient insufficiency while helping to address some of the root causes of
malnutrition by providing economic benefits and sustainability.
If the people of Haiti were provided the right tools and education in nutrition, agriculture, food
processing and marketing, program management and evaluation, as well as government
support, the potential of moringa to transform lives would be promising. The fact that the
leaves can be ground into a powder opens up doors of opportunity for storage, shipping, and
sale of this product. While farmers could use moringa for family food, they could also sell its
products (such as leaves, oil, or powder) as a means of economic income. With sufficient
market infrastructure, over time, marketing powder to other communities or countries could
even be a possibility. In this way, growing moringa can become a cycle of increasing assets.
Data from several countries show that well-designed food-based strategies can relatively
quickly and sustainably improve the diets of vulnerable populations (Thompson and Amoroso,
2010). Moringa trees could in this way feed not only stomachs, but futures as well.
The Value Home Gardens
As there are over a million small-scale farmers in Haiti, examining how moringa may be
produced through this vast network would be useful. Additionally, there could be even more
potential for home gardens – low-cost small plots close to the home and managed by
household members – as a way of improving dietary diversity and reducing malnutrition.
Closely related to the use food-based strategies and extensively promoted the FAO and NGO’s
in developing countries (Shetty, 2011), home gardens can take a variety of forms. Backyards,
containers, rooftops, and the edges of fields can all be made into home gardens producing
herbs, fruits, vegetables, and other foods to supplement dietary staples (Berti, Krasevec, and
FitzGerald, 2004). This can all be done without involving much additional labor from the
farmers since it involves improving the quality (not necessarily quantity) of food produced
(Hillocks, 2011).Their success and positive impact on nutrition has been well-documented
(Chadha and Oluoch, 2003; Farber and Benade, 2003; Bushamuka et al., 2005; Phillips, Sanghvi,
Suarez, McKigney, and Fiedler, 1996).
According to Hillocks (2011), home gardens can make a significant contribution to dietary
diversity. However, as growing nutritious food doesn’t automatically lead to improved nutrition
status of the growers and their families (Hotz, C., personal communication, May 15, 2015),
access to the necessary agricultural starting materials and technical support must be combined
with education about the value of keeping some of the crops for family consumption. While it
is important to ensure commercial potential and market opportunities as an incentive to begin
home gardens in the first place, it can be tempting to sell all produce (not just surplus) for
income for greater income generation (Hillocks, 2011; Hotz, C., personal communication). It is
also essential to particularly support women in home garden initiatives since it is known that
women make the majority of family feeding decisions, whereas males tend to see greater value
in selling what’s harvested for greater income (Harvest Plus, 2012; Hotz, C., personal

communication, May 15, 2015). Karanja et al. add that a supportive social network is essential
for the success of agricultural production among the rural poor, and that households should be
free from “social, institutional, legal, or political barriers to food production and marketing”
(2010).
One of the longstanding model successes of home gardening to improve nutrition is that of
Helen Keller International’s Homestead Food Production (HFP) program introduced over 20
years ago in Bangladesh to help combat vitamin A deficiency (Hillocks, 2011). Since then, the
HFP program has spread across Asia and Africa, providing hands-on training to women in
gardening, farming, and entrepreneurship, working with community leaders and established
local organizations to promote growing and eating leafy green vegetables, among other
agricultural products (Helen Keller International, 2014). Impact studies have shown that
families involved with HFP have much higher rates of consumption of green leafy vegetables
(Hillocks, 2011). Unfortunately this program does not yet exist in Haiti.
Multisectoral Approach
Much of the literature regarding moringa production, promotion, and utilization (as well as
parallel studies on other nutritious foods) emphasizes the need to approach this with a
multidisciplinary and multisectoral mindset. Nutrition professionals or agricultural experts
alone cannot make the social change necessary for uptake of moringa in Haiti or any other
setting. As articulated by Upadhaya (2011), nutrition is not a stand-alone field, but rather one
that needs to partner with those from health, economics, agriculture, politics, environmental
sciences, social sciences, the private sector, and NGO’s to deliver successful policies and
programs. The Haitian government as well, through the MSPP report, demonstrates desire to
adopt holistic approaches to malnutrition, addressing various determinants of health in a
preventative manner, and involving those at the community level for greater effectiveness
(MSPP, 2013; Republic of Haiti, 2013).
Social Marketing of Moringa
Thurber and Fahey (2009) describe the diffusion of moringa innovation to be a lot like social
change, with adoption beginning with innovators (for example, traditional healers) and
knowledge spreading to “early adaptors” (such as NGOs) who would spread the word farther
and a steady rate of adoption would ensue. One of the next steps for helping moringa to “catch
on” in Haiti is to promote it through social marketing and behavior change communication,
providing Haitians with the understanding and motivation to grow and consume this ‘wonder-
tree.’ Social marketing has proved effective in many global public health initiatives including
smoking, contraceptive use, and oral rehydration therapy (Unite for Sight, n.d.). In a systematic
review of social marketing in global health conducted by PSI (2014) encompassing 18 years of
published studies, results about behavior change are significant. For example, 28 studies show

social marketing interventions related to child survival significantly increased knowledge,
attitudes, and consumption of nutrient-rich food which lead to significant reductions in
outcomes such as anemia and diarrhea.
Several countries have had success in using social marketing for changing eating behavior in
order to reduce nutrient deficiencies. In Micronesia, for example, a creative awareness
campaign promoting local food was successful through the use of mass media, print materials,
photography, workshops, displays, farmers’ fairs, youth clubs, slogans, and even national
postage stamps. In particular, consumption of carotenoid-rich banana varieties increased
significantly (Englberger et al., 2011). Also, in Senegal, radio broadcasts and training by dynamic
health workers helped increase awareness and consumption of moringa both within and
beyond the project’s target area (ECHO, 2007).
Social marketing for opening eyes in Haiti to how valuable moringa is, highlighting international
market demand, and thereby increasing perceived value of the tree. This could lead to a greater
appreciation and desire for moringa, especially if paired with information about how it can be
easily incorporated into traditional meals and improve health without adding cost (Hotz, C.,
personal communication, May 15, 2015). This could be done through agricultural workshops,
media marketing, cooking demos, recipe distribution, and in other ways supporting and
furthering the Haiti school promotions as outlined above. A review of healthy food campaigns
by Cavicchi et al. (2011) provides some valuable evidence of best practices and
recommendations for social marketing for the purposes of nutrition, and could be consulted for
direction in Haiti.
Conclusion
Haiti is a country facing immense nutrition-related challenges, but which also holds great
potential for overcoming those challenges through its own natural resources such as the
powerful Moringa olefiera tree. Growing, consuming, and selling moringa could empower
Haitians with a means of income as well as food security. This sustainable, doubly-strong
strategy could strengthen not only bodies, but also individual decision-making power,
community capacity, the Haitian economy, and ultimately help provide a bright and future for
Haitians. Steps towards the promotion of moringa will provide a large return on investment.

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