Harnessing Public and Private Sector Engagement for Improved Nutrition

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“Why are things not better when we know so much more than before?” is the uncomfortable question the 2018 Global Nutrition Report leaves us with. In this blog post, we argue that part of this slow progress in improved nutrition is due to the elephant in the room which can no longer be ignored – the private sector.
 
The private sector has long been engaged in initiatives aimed at preventing and treating malnutrition, producing products to treat severely malnourished children and manufacturing nutrient-rich and fortified foods. At the same time, some private sector actors have engaged and are still engaging in harmful practices.[i] Consequently, public-private engagement remains difficult due to a lack of trust, differing goals, objectives, working cultures and timeline expectations.

 

Engaging the private sector – positive developments

There is a growing recognition that complex and multi-dimensional issues such as the double burden of malnutrition require cross-sectoral and holistic approaches. Governments must remain in the driver’s seat as the legislative and standard setting body, whilst convening and pooling together the resources, knowledge and expertise of different stakeholders. Multiple actors have varying roles in providing solutions to the burden of malnutrition and the private sector is one key player. A number of initiatives involving the private sector have made valuable contributions to improving nutrition outcomes through product reformulation, improved labeling standards, restrictions on marketing and distribution to vulnerable groups. In low and middle income countries (LMIC), these efforts have concentrated on food safety or fortification of staple foods (flour, rice, oil) and condiments with micronutrients.


Several initiatives such as Sizanani Manzi (social business originally founded by Sight and Life & DSM South Africa) and OBAASIMA (PPP), have used consumer insights and a demand driven approach to develop nutritious products for vulnerable populations. Sizanani Manzi conducted consumer research in the economically disadvantaged townships of Ivory Park and Soweto in South Africa: through food diaries, shopping tours and in-depth interviews it aimed to understand purchasing and consumption habits for instant porridge and juice concentrate, which revealed to be the most frequently consumed convenience foods and thus the easiest vehicles through which the required nutrients could be delivered to low-income consumers on a regular basis. The OBAASIMA (PPP) in Ghana applied a demand-driven approach, with the use of a ‘quality seal’ logo to distinguish products meeting nutrient profile (sugar, salt, saturated fat) and fortification standards for women of reproductive age.
 
Mobilization of the private-sector is increasingly viewed as essential to creating change in food systems and global, national and local food environments. Moreover, international agencies have repeatedly called for increased engagement with the private sector to address the double burden of malnutrition in LMICs. Sustainable Development Goal 17 in particular, encourages “global partnership for sustainable development, complemented by the use of multi-stakeholder partnerships” as a means of implementing the 2030 Agenda. It also invites states and other stakeholders to “encourage and promote effective public, public-private and civil society partnerships” that “mobilize and share knowledge, expertise, technology and financial resources, to support the achievement of the Sustainable Development Goals in all countries, in particular developing countries.”

Still…what is missing?

At present, little has happened in measuring the impact of public private engagement and their impact on nutrition outcomes. Independent impact evaluations are scarce and as reviewed by Hoddinott et al., “considerable caution is thus warranted when assessing PPPs in nutrition.[ii]” Simply put – we are uncertain as to whether or not, and to what extent nutrition PPPs actually work. Assembling the missing data, developing appropriate indicators, screening for quality and publishing it in peer-reviewed journals will better align business efforts to investments in positive nutrition actions (e.g., marketing, packaging, labeling), and boost efforts to hold businesses and governments accountable and inform on what makes for a successful PPP in nutrition.[iii] Independent evaluation mechanisms such as the Access to Nutrition Index (ATNI) are commendable initiatives that can serve as useful private sector accountability tools. Not only do we need more of these tools to help create transparent environments and initiate dialogue between both parties, but these tools also need to be more relevant to small and medium sized companies  in LMICs, who play a vital role in meeting consumers’ needs and who make up the bulk of the food system. The time has come to move from talk and advocacy to action. Being able to show the impact of PPPs on nutrition is a first step in that direction.



Additionally, there is an urgent need for evidence-based dialogue between governments, civil society and the private sector. Governance and organizational structures need to be looked at more closely – how do existing and should future PPPs manage conflict of interest? How do they manage power imbalances? Differing language and jargon? Values? Monitoring and evaluation? Is there a recipe for success? If captured in a systematic way, these learnings can support the development of a framework to enable jurisdictions to undertake an evidence-informed approach to assess partnership development opportunities with the food industry.[iv]

How do we go about filling the gap?

At Sight and Life, one of our core strategic areas is to build and support PPPs in nutrition. Through consumer insights, market research and private sector expertise, we design, test and innovate viable (business) models that will increase supply and demand for nutritious foods for the reduction of malnutrition in all its forms.

In light of this challenge and our engagement in multisectoral partnerships for nutrition, Sight and Life was invited to organize a working group) on “Harnessing public-private partnerships to improve nutrition outcomes” at the 2018 International Symposium on Understanding the Double Burden of Malnutritionin Vienna (Austria). The session served as a knowledge sharing and learning session amongst different stakeholders on better understanding the levers and the blockers for public-private engagement for nutrition. The group attempted to answer the following questions:

– How do we learn and share our knowledge on what makes public private engagement work?
– What currently exists in this regard? What is missing? How can we fill the gap?
– How do we measure the impact of public private engagement and public-private partnerships more specifically?
– What is stopping public private engagement?
– What tools can we use to evaluate the work – to understand why they worked or not?
– How can we put people at the center?
 
The meeting started with a presentation by Breda Gavin-Smith (SAL) on the OBAASIMA PPP, a partnership between Sight and Life, Royal DSM, the German Federal Ministry for Economic Cooperation and Development, the Children’s Investment Fund Foundation (CIFF), Bill and Melinda Gates Foundation (BMGF), Association of Ghanaian Industries (AGI) and Ghana Standards Authority (GSA), that is driven by the common objective of improving micronutrient intakes of women of reproductive age in Ghana. Breda shared on the challenges and learnings when engaging diverse partners in a project that demands an entrepreneurial mindset to meet shifting project requirements. For more information on OBAASIMA, take a look at the infographic.

Obaasima, demand generation, Ghana, women, nutrition 
Saskia Osendarp (Micronutrient Forum) shared about the Tswaka study, a multi-sectoral partnership between Sight and Life, the North West University of South Africa, the Global Alliance for Improved Nutrition (GAIN), DSM and Unilever, which examined the effects of two lipid-based complementary food supplements on older infants’ growth, iron status and psychomotor development among children living in an underprivileged community in South Africa. Saskia revealed that the journey the partners embarked on in 2010 was not always an easy one, with many challenges, and eventually a successful completion after more than eight years! You can read the peer-reviewed publication of the study here; the infographic here; and don’t miss the soon to be published article “The Tswaka study: a journey into an innovative public-private research partnership” in the next edition of the Sight and Life magazine due in June of 2019.
 
Stineke Oenema (UNSCN) shared about the 2018 High Level Panel of Experts’ (HLPE) report on “Multi-stakeholder partnerships to finance and improve food security and nutrition in the framework of the 2030 Agenda” which provides an excellent starting point to frame the challenge at hand. The report suggests relevant criteria to enable governments and non-state actors to perform their own assessments of partnerships and identify pathways for improvements by means of a questionnaire. The proposed common methodology has the potential to strengthen transparency and accountability by improving the learning process through knowledge generation and sharing. Two key recommendations of the report and relevant to this blog’s topic are to (1) increase the impact of multi-stakeholder partnerships through effective monitoring, evaluation and experience sharing and (2) integrate different forms of knowledge and explore further areas of research on multi-stakeholder partnerships to finance and improve nutrition in all its forms.
 
In the context of these examples and in light of the PPP debate, we see three elements which we believe will help us move forward in building and supporting effective PPPs for nutrition and will ultimately accelerate our progress towards the reduction of malnutrition in all its forms.

1.Understand and share information on existing partnerships

To support further effective partnering for nutrition we must understand what makes PPPs successful, challenging, and what makes them fail. Before doing that, we first need to gather information on them. At present, it is difficult to find detailed and publicly available information on existing PPPs. A great part of the available data is self-reported with no guarantee of independent verification. An online register of PPPs[v] would enhance transparency and could serve as an excellent starting point. It is important to note that simple registration will have limited value add without clear guidance on the adequate level of information to be reported. In particular, partnerships should disclose appropriate information on goals and commitments, members and their contributions, governance and financial arrangements.

2.Translate the collected information into knowledge and learnings

Once the information has been collected, it needs to be curated and screened for quality, with the aim of establishing a research agenda that will enable us to measure the impact of these partnerships on nutrition outcomes. A curated online hub that would look to (1) increase the impact of public-private engagement through effective monitoring, evaluation and experience sharing and (2) integrate the different forms of knowledge and explore further areas of research on public-private engagement in order to finance and improve them.

3. A framework on innovative methodologies and metrics to assess the impact of PPPs

Further research could use the readily available criteria on what makes PPPs work, to develop innovative methodologies and metrics to assess the short- and long-term impacts of PPPs on food security and nutrition. For instance, the High Level Panel of Experts for Food Security and Nutrition (HLPE) Multi-stakeholder partnerships to finance and improve food security and nutrition in the framework of the 2030 Agenda report provides a potential framework to start developing metrics in the areas of transparency, accountability, trust, the partnering process and on when and how to engage.
 
Sight and Life is interested in hearing from anyone keen to invest or partner with us on PPPs for nutrition. To contact us regarding this endeavor, please send an email to breda.gavin-smith@sightandlife.org
 
Learn more about our projects/partnerships:
OBAASIMA
Partners in preventing micronutrient deficiencies – Sight and Life, DSM and JHU Case Study
DSM – SAL – WFP: A Partnership to Advance the Global Nutrition Agenda
Sizanani Mzanzi series: Part 1,Part 2,Part 3, Part 4, Part 5

References 
[i] Global Health Advocates. 2018. Ending malnutrition: what role for the private sector? From prevention to treatment.Paris: GHA.
[ii] Hoddinott, John F.; Gillespie, Stuart; and Yosef, Sivan. 2015. Public-private partnerships and the reduction of undernutrition in developing countries. IFPRI Discussion Paper 1487. Washington, D.C.: IFPRI.
[iii] GAIN & USCIB. 2018. No more missed opportunities. Advancing public-private partnerships to achieve the Global Nutrition Goals.
[iv] Multi-sectoral Partnerships Task Group. 2013. Discussion Paper: Public-private partnerships with the Food Industry. Washington DC: PAHO.
[v] https://www.gainhealth.org/wp-content/uploads/2017/10/Why-isn%E2%80%99t-there-more-research-on-public-private-engagements-in-nutrition_Lawrence-Haddad-Presentation_October-2017.pdf

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: