This report from MOMENTUM Country and Global Leadership aims to stimulate further discussions and actions on improving the integration of services to address the twin challenge of zero dose children and malnutrition in Madagascar. The publication presents a detailed assessment of the current status and challenges of integrating immunization and nutrition services in two districts of Madagascar. It also shares co-created solutions from human-centered design workshops to understand the current practices, challenges, and potential tools for reaching zero dose children through the integration of immunization program with nutrition services in Madagascar.