Food insecurity dramatically increased in Madagascar over the last 10 years, hampering human development. Using most recent data and surveys conducted by UN Agencies and local authorities, this paper analyzes the root causes of food insecurity in Madagascar related to demographic vulnerabilities, multidimensional poverty, lack of education, as well as structural weaknesses in the food value chain and the lack of basic infrastructure, such as irrigation and transportation, that hamper agricultural activity development. Moreover, Madagascar is exposed to a large variety of climate shocks that climate change will likely exacerbate. This paper formulates country specific macroeconomic and operational policy recommendations in collaboration with the World Food Program to reduce food insecurity, which include i) measures to improve the emergency response and preparedness, ii) policies to address structural food insecurity, by improving the food chain and addressing challenges posed by climate shocks, and iii) measures to improve Green PFM and climate related public investment management to invest in long-term resilience and mobilize external financing.