Sight and Life Nutrition Kiosk: Reaching the Last Mile in India

 

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The Nutrition Kiosk, a Sight and Life innovation, was conceived as a simple and effective solution to the problem of last mile nutrition in India. It aims to drive both the demand and supply of affordable nutritious foods and services for vulnerable populations.

As a new and innovative solution for low-resource settings, the Nutrition Kiosk has the potential to create demand for good nutrition and supply essential, nutritious products. Additionally, it is customizable allowing the user to adapt the stand to various contexts, conditions, lifestyles, and landscapes. There are two essential components of the Nutrition Kiosk- products and services. The Nutrition Kiosk can be equipped with products such as whole foods, fortified foods, supplements, accompaniments/condiments, and nuts while concurrently offering nutrition counseling services.

To operationalize this idea, Sight and Life used a human-centered design approach to bring the kiosk to life and piloted in Mumbai, India at the 19th IUFOST World Food Science and Technology Conference in October 2018. Those who experienced the Nutrition Kiosk confirmed the potential this idea has to improve the nutritional status of the vulnerable populations in India.

Design Evolution

The first step in the design process for the Nutrition Kiosk began with a simple question: What if healthy food was as affordable, appetizing and more importantly as accessible as fried foods?

nutrition, sight and life, healthy food

The Nutrition Kiosk was imagined as the ultimate one-stop shop for all the nutrition needs of the target consumer, in our case women and children, would include a complete portfolio of products, information, and services; with the ultimate aim to create demand for good nutrition within low and middle-income groups.

In the next step, we looked at the urban landscape around us to decide on the physical design of the kiosk.  

Pushcarts in various forms have become an integral part of the urban landscape in India. Around every corner, pushcarts are seen transporting goods in, out and around the city. They connect the last mile and are compact while in South Asia there is a strong street vending culture.  

Street vending not only provides goods and services at convenient locations and affordable prices but also self-employment to a large number of people. It links vendors to the formal sector, and keeps streets busy and safe as pushcart vendors often become the “eyes on the street”. Food and beverages companies are also adapting to this market and culture by using pop-up architecture, including using pushcarts, with new innovations to reach the target consumers.

Applying the pushcart design to the Nutrition Kiosk allows for a significant degree of adaptability, which is key in addressing the last mile nutrition in India. For example, the kiosk can be customized for a “mom and pop” store or be placed in community Push cart, urbanhealth centers, leveraging the already established public health systems. The opportunities are endless and critical to ensuring good nutrition for all, all over India.

Both the products services components of the Nutrition Kiosk was developed with the ideal user in mind, the mother.

We closely examined the needs of a mother. She is, more often than not, the person responsible for buying the food and cooking meals for the family, therefore, the Nutrition Kiosk needs to provide healthy and nutritious food options for herself and her family. Supporting her personal needs, it is also a place where she can talk to a counselor and receive actionable feedback or join a mothers’ group to share her concerns among other things. These ideas influenced the final design of the cart. 

We also spoke with street vendors who identified the following key components and challenges of pushcarts: they have four wheels on a frame, making it difficult to navigate in an urban landscape; the carts are mostly flat and do not offer variations in level so vendors have to creatively display their goods; and street conditions and crowds determine the locations and times they are active as well as their offerings.

Nutrition Kiosk, last mile, final, design

The final design of the kiosk took all of these challenges into account. We considered the need to offer a variety of products through important life stages allowing a mother, or the customer, to easily identify the products fitting the specific needs of her household. From a design perspective, this led us to the display surface having various levels making the offerings easy to be seen and visually self-explanatory in order for the mother to shop in the correct category. Optimizing the design, a table surface can be folded down when the cart is not moving and the ideal space to provide nutrition counseling directly at the Nutrition Kiosk.

Next Steps

Piloting the Nutrition Kiosk at IUFoST 2018 gave us the opportunity to gather feedback from many different groups of attendees, ranging from students and technical experts to field workers and industry. As a next step, we will be improving the prototype by incorporating the actionable feedback. We will then create a business model for the Nutrition Kiosk focusing primarily on hospitals and other healthcare facilities. Once a sustainable business model is established, we will pilot the Nutrition Kiosk.

Stay tuned for more information on the Nutrition Kiosk, including videos and a presentation from IUFoST on the Sight and Life website!

 

Below is a gallery of pictures from the conference where we tested out a prototype of the Nutrition Kiosk:

Last Mile Nutrition in India

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What is the last-mile in nutrition?

The “last-mile” indicates the distance between where we are today, and where we aim to go for any given indicator.

Malnutrition in India is a complex issue. The country grows sufficient food, has a functional democratic system with effective feedback mechanisms, the world’s largest public distribution system in place for food delivery, and an extensive network of state mechanisms to reach every citizen in the country. Substantial policy attention has also been paid to health and nutrition issues in recent years. Despite these advances, malnutrition rates remain high across the country. In response to this “silent emergency”, the Government of India launched the National Nutrition Mission referred to as the Poshan Abhiyan in March 2018.

With the launch of the National Nutrition Mission, the government of India has clearly elucidated where it aims to be by 2022 with targets set for reducing stunting, underweight, low birth weight and anemia in women, while the National Family Health Survey of 2016 provides the baseline in terms of the nutrition situation today (Table 1). 

Table 1. India’s National Nutrition Mission Targets for 2022

Indicator

Where we are today?

Where we aim to go?

Low Birth Weight

14.3%

8%

Stunting among children (0-5 years old)

38.4%

25%

Underweight (0-5 years old)

37%

30

Anemia in Women (15-49 years old)

51%

42%

Why is India still lagging behind?

With the last-mile for nutrition in India so clearly defined, many are left wondering why India is still lagging behind achieving key nutrition indicators. To answer that question, it is important to understand the three most pressing issues in the last-mile nutrition landscape in India:

1. Affordability: The availability of affordable nutritious and safe food in the market is one of the most important components to fight malnutrition in a country. However, in India, the high cost of nutritious food is further driving up malnutrition, according to the World Bank report The Cost of Nutritious Food in South Asia. As per the study, in India, prices have increased the fastest for vegetables, fruits, seafood, and meat products, and slowest for energy-dense food with generally poor nutrient content, such as beverages, sugar, and oils and fats.

2. Accessibility: Not only are nutritious foods not affordable for low-income consumers but ensuring availability through distribution and retail channels remains a challenge. In India distributing nutritious food as a public health measure is still not a political imperative and the Public Distribution System (PDS) – a large-scale government scheme for food security – does not promote dietary diversity for those relying on subsidized food. In a report issued two years ago on the role played by PDS rations in shaping nutritional security, the NITI Aayog found that families below the poverty line consumed more cereals and less milk compared to their more affluent counterparts.

3. Awareness: Lack of knowledge about nutritious food choices, or low appeal of those food products, further compounds issues of malnutrition in India. For example, there is next to no awareness on what constitutes a balanced diet on a limited budget, the age at which an infant should first be given complementary foods, the proper growth of adolescent girls and boys, adequate pregnancy weight gain, and the importance of sanitation and hygiene. This information deficit is often highest among the most vulnerable in India, such as families who work in agriculture/construction labour, where the majority of wasted children are found.

How do we get there?

To chart a roadmap for achieving the last-mile for nutrition in India, Sight and Life assembled a group of leading experts and practitioners, all of whom are innovating within both government and market-based approaches in the food system to improve the health of nutritionally vulnerable populations in India.

Three tasks were set out for these experts:

  1. Unlock the barriers and challenges in both the demand and the supply side that must be tackled to see real progress in making nutritious foods and services available to the last-mile consumer;
  2. Reinforce perspectives on successful strategies to build sustainable and scalable initiatives towards improving nutrition; and
  3. Showcase innovative approaches and collaborative partnerships which will have a bold impact in the next decade towards solving the issue of making nutritious foods accessible and affordable to all Indian citizens.

The expert group discussions culminated in a panel discussion at the World Congress of Food Science and Technology (IUFOST) 2018, which was moderated by Dr. Klaus Kraemer, Managing Director of Sight and Life, and included presentations on:

                 Dr. Klaus Kraemer, Managing Director, Sight and Life
  • What is the role of Tata Trusts in last-mile nutrition in India?: Ishaprasad Bhagwat, Program Manager of Maternal, Infant and Young Child Nutrition at Tata Trusts, a philanthropic organization facilitating programs and the implementation of different approaches, presented on how government channels can be strengthened, to reach the last-mile consumer in India.
Ishaprasad Bhagwat, Program Manager  of Maternal, Infant and Young Child Nutrition, Tata Trusts
  • What is the role of IPE Global in last-mile nutrition in India? Raghwesh Ranjan, Director of Social and Economic Empowerment at IPE Global, a key development partner, showcased how they are helping state governments effectively implement reforms in the nutrition space. They are also working with communities to create demand for good nutrition and empower them to demand better services from the state.
Raghwesh Ranjan, Director- Social and Economic Empowerment, IPE Global
  • What is the role of DSM in last-mile nutrition in India?: Ruchira Jaitly, Director of Nutrition Challenges and Strategy at DSM, a private sector company, presented on their role in investing in purely market-based innovations and approaches for last-mile nutrition. She showcased how DSM built a disruptive B2C (business to consumer) social business that has the potential to address the nutrition gap with locally relevant solutions.
Ruchira Jaitly, Director-Strategy and Nutrition Challenges, DSM
  • What is the role of Sight and Life in last-mile Nutrition in India? Kalpana Beesabathuni, Global Lead for Technology and Entrepreneurship at Sight and Life, a nutrition think tank, showcased a new innovation called the ‘Nutrition Kiosk’ which aims to drive both demand and supply of affordable nutritious foods and services. Sight and Life’s core strength lies in generating new insights into nutrition and turning them into sustainable programs and business models.
Kalpana Beesabathuni, Global Lead-Technology and Entrepreneurship, Sight and Life
  • What is the role of emerging technologies last-mile Nutrition in India?: Gurvinder Ahluwalia, Co-Founder, and COO at Digital Twin Labs/Beyond Protocol showcased how the company is leading the way in looking at how emerging digital opportunities empower last-mile households to meet their essential nutritional needs according to their priorities.
Gurvinder Ahluwalia, Co-Founder and COO, Digital Twin Labs and Founder and CEO, Beyond Protocol

“This expert group was carefully assembled by Sight and Life because we wanted to showcase pivotal actors in the entire food and nutrition ecosystem that are required to holistically nourish the last-mile consumer,” said Dr. Klaus Kraemer, at the end of the panel discussion. He noted that the involvement of this broad stakeholder base allows us to harness synergies for demand and supply across sectors.

As a follow-up to the panel discussion, Sight and Life will be sharing videos and presentations from the panel discussion on our website. Stay tuned for more information!

Creating demand for nutrition and promoting behavior change

 

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The 2018 edition of the Latin American Society for Nutrition (Sociedad Latinoamericana de Nutrición, SLAN) conference took place in Guadalajara, Mexico from 12-15 November. SLAN 2018 brought together nutrition professionals from Latin America and the Caribbean (LAC) and around the world to share experiences, disseminate research findings, and discuss relevant issues on the nutrition situation in LAC and how to improve it.

The conference included over 60 unique sessions on topics ranging from front-of-package food labeling to the double burden of malnutrition to the role of traditional food systems to improve nutrition. Sight and Life was thrilled to join in many of the discussions, as well as host our very own panel “Demand for nutrition – driving motivation, interest, and repeat purchases for more nutritious foods,” which explored the topic of demand generation for nutrition and, specifically, how to drive motivation, consumer interest, and generating demand for nutritious foods, resulting in repeat purchases or changes in nutrition behaviors across different contexts.

The panel included four presentations from thought-leaders and experts in the areas of demand creation and through practical examples and case studies from the region, they explored how social marketing and Social and Behavior Change Communication can increase demand for nutrition. The first presenter and moderator was Dr. Eva Monterrosa, Senior Scientific Manager at Sight and Life, who explained what demand for nutrition is and how it fits with other strategies in nutrition for changing behaviors.

 Next, Carlos Andres Gallegos Riofrío, Researcher at the Institute for Research in Health and Nutrition, Universidad San Francisco de Quito, Ecuador, shared results from the Lulun Project in Ecuador. The Lulun Project was a social marketing strategy that accompanied a randomized controlled trial (RCT) of a food‐based intervention that introduced eggs into the complementary feeding diet of older infants and young children in Ecuador. The strategy was designed to promote behavior change, in this case, egg consumption, through voluntary prosocial behavior, empowerment, and brand loyalty. A three‐phase social marketing strategy (design, campaigns, and evaluation) contributed to the success of the project by applying techniques drawn from marketing, publicity, design, and communications. The social marketing techniques used in the study proved successful for program acceptance and compliance and provide important lessons and a model for scaling up food‐based intervention—or others like it—in Ecuador and beyond.

The third presenter on the panel was Patricia Poppe, Team Leader for Latin America and Lusophone Africa at the Johns Hopkins Center for Communication Program, who shared findings from the implementation of Guatemala’s Integrated Social and Behavior Change strategy – Together We Prosper. We Dare. We Advance – focused on strengthening the household as the “heart of change” for malnutrition, where mothers-in-law/grandmothers and husbands play a key role in triggering change. In addition to identifying key influencers, the strategy also emphasized community leadership to tackle stunting and community facilitators who demonstrate the change that is possible; as well as used a variety of methods to showcase successes.

The last presenter was Lynda Barfield, Chief Creative Officer, Creative Conscience who highlighted the case of salt reduction in countries in Latin America and the role of social marketing in influencing consumers to make healthy choices. Specifically, Lynda highlighted the importance of a “Marketing Mix (‘4Ps’) to salt reduction – product strategies (such as front of package labeling and product reformulation), price strategies including taxation on high salt foods (not yet happening in LAC), place strategies (removing salt from public spaces), and promotion strategies. Policy is also an important lever to changing consumption patterns, and regulation has been shown to play an important role in behavior change in countries in the region, including in countries like Chile and Brazil where there are national regulations on food advertising.

Overall, it was an inspiring panel and we are so appreciative to all the speakers and participants who joined us! Stay tuned for more exciting work from Sight and Life in the areas of social marketing and SBCC, amongst other approaches to generate demand for nutrition!!

For more on the topic of BCC, make sure to check out the inaugural Sight and Life Webinar series focused on the BCC process from the program manager’s point-of-view. The entire series can be watched here and the presentation slide decks are also available for download on our resources page here.

Learning from an Expert 

An interview with Jeff French, Social Marketing Leader

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Here at Sight and Life, we jumped on the opportunity to interview social marketing expert, Professor Jeff French, to learn more about the history and successes of social marketing, how it differs from other disciplines, and some of the trends in the field. Jeff shared his insight derived from over 20 years of experience in the field including a position as Director of Policy and Communication at the UK Health Development Agency and a senior civil servant in the UK Department of Health. Additionally, he has published over 100 academic papers and five books. Jeff is a fellow at Kings College University London and a visiting professor at Brighton University Business School and teaches classes on topics from public health to social marketing. Currently, Jeff is the CEO of Strategic Social Marketing Ltd. As a thought leader in the field of social marketing, we thoroughly enjoyed hearing his insight and knowledge on social marketing.

SAL: Sight and Life

JF: Jeff French

 SAL: Could you just give us a bit about your background and tell us why you are so passionate about social marketing?

JF: I am a biologist by background and I worked in public health for over 20 years in the UK. About 20 years ago, I completed my MBA as part of my professional development and I discovered a thing called marketing. I found something that I could use to address some of the complex behavioral programs and challenges that I was trying to deal with in my public health role. I thought I had detected a new subject called social marketing until I started to read and learned that people have been talking about it since the 1960s. So for the past 20 years, I have been interested in applying marketing principles to create more effective and efficient social programs in health, but also in many other sectors.

SAL: How do you define social marketing?

JF: For me, social marketing is the best form of implementation science that we have. Not only is it, so, very clear cutting principles based on evidence-based practice, but its core is about a deep and respectful relationship with the people that you’re seeking to help and serve. Moreover, I think that chimes very much with not only the critical ideology accepted by most of the world, but it is something that is proven to work. If you work with people and put effort into understanding them, you can create programs that they value and will respond to. And if you do not do that, chances are your social program is not going to work.

SAL: So, social marketing would be an umbrella that catches all the tools you would use, however, it seems in the world of nutrition, most only select one of those tools to use instead of using the whole scope?

JF: It certainly is about giving good quality information and education to people, but it is also about changing the social environment in which nutritional choices are made. For example, if you subsidize healthy foods, more of them are going to get selected. So, one of the big problems I think with social marketing and the way it is interpreted, and probably not used very effectively in some places, is that it is thought of as well-crafted messaging and advertising and promotions and social media. All of these things are very important and should be used, but we need often more than that.

So there is a kind of gap between people who think our responsibility is to inform and educate and another group of people, including myself, who think we need to educate and inform people while creating the social conditions under which healthy choices are possible. I think the vast majority of social marketers fall into that category.

SAL: Why do you think the public health community, including nutritionists, hone in on the belief that the expert knows best and we just need to educate them.

JF: There are three things. The first one is straightforward; it is just the dissemination of evidence-based practice. There is a general lag adapting to innovation in any technical field – that is well documented. There are ways to kind of speed it up, but there is a lot of inbuilt resistance in any field to the application of new understanding. That is the first thing.

The second thing is one of the real problems with the public health field is that those people that do know about implementing or influencing behavior, be it from social marketing or other fields, tend to be positioned in public health organizations in second or third order positions. An example, if you take a commercial sector organization, its director of marketing would be on the board. In addition, about one-third of CEOs in commercial companies come from marketing backgrounds. If you look at public health institutions, how many people or CEO’s come from a kind of implementation science or marketing background? None, or at least very few. That is about the worth that it places on different kind of skill sets. Those people that understand implementation science, social marketing, behavioral change, they are not positioned at levels of authority in organizations as they should be.

Moreover, the last kind of reason for that frustration, I feel it deeply also, is an ideological one. The ideology that some people believe it is about influencing individuals, and they have just a very narrow view about how you do that and what should be ethically ok. They prefer to inform and educate and leave to people to make their own choice, so it is an ethical position. You know, I have had conversations with colleagues in terms of immunization. My view is I want everybody to be immunized and the program goal should be about getting over 95% of people immunized. While some say, “No, no, it’s not about that. It’s about making sure that everybody is well-informed and makes a good decision.” Therefore, it depends on your perspective about what your responsibility is. In addition, there is some pushback amongst some governments and public health professionals being worried about the ethics of influencing behavior. Therefore, they do not want to go that far, they see their job as informing and educating.

SAL: Can you highlight one example of where you have found in your experience a successful nutrition campaign in social marketing?

JF: I think that one good program, well I’ll mention two, is the Change for Live in the UK and the EPO program which started in France and now kind of spread to a number of other countries. However, just focusing on Change for Live, which is an ongoing program. Why is it successful? One reason is that it is conceived from day one as a social marketing program and not an education or informational campaign. In fact, it was a direct response from advice that planned education and informational campaigns would not work and should be scratched, and we needed to have something different.

The second reason was it was based on a huge amount of insight research and segmentation development of the population. The UK came up with six different subsets of the population, and that lead to six different intervention strategies and intervention mixes for those different groups, based on a deep understanding of why they made healthy choices and food choices that they did and what could practically help them to change their behavior.

The next, or third element of why it was successful was that a clear set of measurable behavioral objectives was included in the program, again based on a deep understanding of what was possible with the populations. The objectives were set out very clearly and mechanisms for measuring progress towards them were included.

The fourth element contributing to the success of the campaign was that that program was set-up in a way that made it sustainable and could transition from one government administration to the next. It is now going through four different government cycles, election cycles, and survived and continues. And the reason for that is that it is based on a lot of research, evidence, and data analysis and evaluation continues, evaluation feedback, that proves to ministers who make decisions about these things, that this is a good investment and it’s working.

For me, it clearly connects elements that you want to build in any nutrition program. One more that I would add is, maybe as crucial, is that the program set out with the intention of creating a coalition of like-minded people from the public sector, but also from the NGO sector and the commercial sector, to work together on that program, pushing in the same direction in a coordinated way. I think that is a big reason for it being so successful.

 

SAL: Tell us about some of the trends that are happening in social marketing right now.

JF: Big trends, they are all towards the more strategic application of social marketing. Social marketing is a great kind of methodology for understanding problems, creating solutions that are kind of you know co-developed with partners and members of the target audience. However, it is also increasingly being applied to helping inform the kind of social policy selection process and strategy development process. So social marketing is going upstream if you like, it’s going to be making a contribution and has done for many years at the operational level by governments and agencies to inform what policies should be undertaken and how they should be developing them around.

The other two big things are one – it is breaking out of its homeland of health and environmental issues. There is a lot of research being done in those two fields, it’s now being increasingly being applied in many other fields like you know energy, conservation, animal conservation, endangered species, that kind of thing, crime, and transport.

The third one would be that social marketing is using systems thinking approaches to understanding problems and coming up with solutions. So that’s about working across sectors, working you know interdisciplinary ways again, through the strategic approach.

 SAL: What steps do you recommend for someone looking to learn more about social marketing?

JF: Join the online community, like at George Washington University for example. Become a member of your local social marketing or an international social marketing association. Take a social marketing course, there are many around the world now, short courses, and more extended like post-graduate courses you can attend. Buy some books and read all the free material that is available, there is a lot of academics in social marketing providing free material. Additionally, speak to some other social marketing people and attend conferences.  

Recommended Reading Materials

Social Marketing and Public Health.  Jeff French

Strategic Social Marketing. Jeff French & Ross Gordon

European Centre for Disease Control (ECDC) Technical Guide to Social Marketing