On August 28, 2020, Times of India published “Take-Home Rations: A route to nutrition security” by Dr. Rajan Sankar of TINI Tata Trusts (read the more about Dr Rajan Sankar here) and Kalpana Beesabathuni,Sight and Life’s Global Lead for Technology and Entrepreneurship. The full article can be read here.
The disruption of food systems by Covid-19 and its impact on the availability of nutritious food in large parts of the country has brought to light the importance of the Take-Home Rations (THR) programme and its potential to deliver fortified food to the last mile in the country. The THR programme is unique in its reach and scale; it is also well resourced with a budget of Rs. 13,500 crore and hundreds of millions of beneficiaries. The current crisis presents a window of opportunity for THR to fully realise its promise and transform India’s nutrition security scenario.
India is home to one-third of the world’s stunted children (4.7 crore) and half of the world’s wasted children (2.6 crore). Nearly 41% of children less than five years old are anaemic. To combat malnutrition, the Government of India launched the Integrated Child Development Services (ICDS) programme in 1975; it offers a variety of nutrition and health services for the first 1,000 days of life. This time span is vital for preventing long-term consequences associated with malnutrition, particularly during pregnancy and also when infants transition out of breastfeeding.
I had convinced my son that “fizzy” drinks were disgusting. I told him they were bad for him, that they are full of teeth rotting sugar and that they did not taste nice. He believed me and never wanted to try one. However, eventually, children reach an age where their friends become authorities on seemingly everything, and they start to listen more to their mates than their mum.
On the school run yesterday, my 8-year old son: “Oliver says, mixing red and blue makes green.”
Me: “No, I am sure that makes purple.”
My son: “No, Oliver knows Mummy.”*
Me: “Why are you digging a massive hole in our lawn?”
My son: “Freddy said we could find diamonds in our gardens.”
Me: “Err no, darling, we don’t have diamond mining in the UK.”
My son: “Yes, we do. Freddy told me so (as he carries on digging).”
When Oliver and Freddy told my son that he should try a “fizzy” drink as they were “fun”, he no longer listened to me and my warnings. He used his pocket money to buy a can of Cola-Cola. The result – he loved it! Why do you love it? I asked him.
“It makes me smile Mummy,” he replied simply.
For me, this uncomplicated response summed up everything – unless healthy and nutritious drinks such as milk and water make my eight-year-old “smile”, he will keep wanting Coca-Cola. And although I can use a metaphorical “stick” and ban him from drinking such drinks now, without the “carrot”, I will not win the battle in the long run. As soon as he is old enough to walk to school and go out by himself, he will just choose to buy unhealthy drinks with his pocket money.
Apart from my son’s questionable trust in his friend’s advice (and their questionable art and geological knowledge), what can we learn from his Coke experience? And how can we use such insights to create demand for nutritious food and drinks?
For me, the key is this
LISTEN. Listen to your target audience – the people whose behavior you want to change. Whatever people do, even if it seems foolish to you, they will have their reasons. These reasons might not be rational (as my son’s experience demonstrates), but then we are driven by emotion, and our decisions and actions are rarely logical.
Many of you might have focused on educational interventions in the past, believing that people simply need to know what is good for them and what is not. However, do not be fooled; education does not always work.
If we always made rational decisions, none of us would overeat, smoke, salute three times to magpie birds (which I do due to a silly old English superstition), or drive like lunatics. But rest assured, when you ask and listen, your target audience will have their reasons.
When I worked at the Department of Health England, they ran the 5-a-day campaign, trying to encourage people to eat more fruit and vegetables. However, during the campaign run, consumption went down. Why? They made the incorrect assumption that knowledge and changes in attitudes are sufficient, and ignored beliefs or benefits gained from eating unhealthy foods (do carrots and broccoli make my 8-year-old smile? You can guess the answer).
The whole social marketing discipline is based on the idea of exchange, and if you want people to change their behavior, you have to offer them something in return. Often this is non-monetary – a feeling of belonging, sophistication, or security. Or, an alternative product that gives them the same or greater benefits as the product they are currently using. These benefits must be immediate, as we value these more than longer-term ones.
You only can work out what the exchange should be by listening to your target audience and understanding the benefits they derive from the negative behavior, such as consuming high-sugar soft drinks. Coke gave my son immediate happiness; how can we create that same feeling with a healthy drink?
For deeper insight on formative research, take a look at our Action in Brief on “Eat More, Eat Better”, a behavior change strategy to support improved food access and food choices for women in the northern Indian state of Rajasthan.
This summer Sight and Life are running a three-day course as part of the Swiss Lugano Summer School. The session “Generating demand for better public health goods and services: A systems and consumer-centered approach” and will explore how social marketing, behavioral insights, and innovations in behavioral science can be used to create demand for healthy products and behaviors. The course will also explore how public-private partnerships can make healthy products more attractive to consumers and develop sustainable business models. Further details and where you can enroll click here.
I hope to “see” some of you there.
*In case you are wondering, mixing yellow and blue make green.
Nutrition in the Workplace is a Winning Solution During and Post-COVID-19
Diet and nutrition of the workforce during and post-COVID-19
The COVID‑19 crisis has had a dramatic impact on the world’s workforce; partial or total workplace closures have restricted business operations and have affected an estimated 80% of the global workforce. The worst-hit workers are those working in small and medium-sized enterprises, and low-wage workers in informal employment, with limited access to safety nets. For others, adjustments in the work process and arrangements to work from home have enabled them to retain their jobs during COVID‑19.
A survey among employees highlighted the main challenges workers face to eat healthily:
1) easiest food choices aren’t always the healthiest
2) “I don’t always have time to buy and prepare healthy food”
3) “it’s too expensive”
4) “the people I’m around don’t eat healthily.”
A pre-COVID-19 survey in the UK revealed that infections, musculoskeletal problems, mental health conditions, and diabetes were among the main health reasons for sick absence. However, nutrition as a direct modifiable factor for many of these health conditions is often overlooked by employers. Higher absence rates among workers can be expected post-COVID-19 due to “suspected infections” but also as a result of increased mental problems; approximately half of the young people reported anxiety or depression since the start of the pandemic. Therefore, during and post-COVID-19 pandemic, healthy eating, and nutrition programs in the workplace are important in fostering employee immunity, physical and mental health. Centrally distributed workplace nutrition provides the opportunity to reach many workers and contribute to employees’ essential nutrient requirements.
Evidence for nutrition programs at work
Workplace nutrition programs can include “education” or “coaching” programs to encourage workers to consume more nutritious foods. Access to nutrition consultation and personalized nutrition advice has a significant potential health improvement rate. Nutrition programs can also include (subsidized) nutritious food offers at work, such as healthy lunch choices or fruits, fortified lunches, or micronutrient supplements. The evidence for the health benefits of nutrition in the workplace is growing. Micronutrients provided to workers through fortified foods or supplements significantly improved workers’ nutrition status in various workplace settings. Anemia, common colds, urinary tract infections, and work absence were reduced in Bangladeshi women garment factory workers receiving multi-micronutrient-fortified rice along with iron and folic acid supplement and nutrition counseling for 10 months. Infection-related work absence was reduced by almost two-thirds in healthcare workers consuming multi-micronutrient supplements for one year. Other reported benefits of providing micronutrients in the workplace are manifold; reduced heart rate, improved body mass index scores, bone density, perceptual and cognitive functioning, improved mood, and reduced depression.
What are the benefits for the worker and employer?
Employers bear many of the costs related to absenteeism and presenteeism. On average, employees cost businesses the equivalent of three months per year in lost productivity. Unhealthy eating (too much salt, sugar, saturated fat), as well as inadequate essential nutrient intake, raises the risk of low productivity. By optimizing workplace nutrition, workers receive the nutrition needed to stay alert and focused while employers benefit from reduced absenteeism and less presenteeism or unproductive use of time. Better nutrition also equates to improved resilience to infections and stress – other potential pathways to better work performance.
Employers’ social responsibility for the nutrition of own employees
Employers have an essential role to play during the COVID-19 crisis to provide good nutrition, especially for the most vulnerable in society. It is important that work environments facilitate good nutrition to support the physical and mental health of their workers. Investing in workplace nutrition is a high return on investment for the employer and can increase workers’ health, work attendance, morale, efficiency, and productivity. A recent report by GAIN-SUN-Eat Well demonstrated that “workforce nutrition” is a win-win for employers looking to improve both employee health and business outcomes. Moreover, it can contribute to the nutrition targets of the United Nations Sustainable Development Goals (SDGs), specifically SDG 2 (zero hunger), SDG 3 (good health and wellbeing), and SDG 8 (decent work and economic growth).
There is a growing awareness among the public and private sectors that workplace nutrition can benefit both employees and businesses. IMPAct4Nutrition (read more in our Action in Brief on IMPact4Nutrition) is an example of a public-private engagement that aims to bring together the diverse private sector interested in contributing to the Indian Government’s social movement named POSHAN Abhiyaan or National Nutrition Mission. Diverse partners are engaged including UNICEF, Sight and Life, CSRBox, Tata Trusts, and the Confederation of Indian Industries. The priority by IMPAct4Nutrition is promoting nutrition in the workplace by targeting key nutrition behaviors in the workplace in three areas; assets and core business for nutrition, cash/corporate social responsibility for nutrition, and employee engagement for nutrition. During COVID-19, IMPAct4Nutrition has developed digital training modules to support companies in promoting good nutrition across their business ecosystem with practical, easy to follow tips on how employees can maintain an appropriate nutritional status. Through these modules, the platform is reaching 10 million employees, their families, and communities in 51 companies across India.
In June 2020, IMPact4Nutrition was honored with a UNICEF global INSPIRE Award in the category ‘Best Multistakeholder Engagement’. Nearly 100 campaigns from 50 countries were nominated and voted on by UNICEF staff worldwide.
The reward is high
A successful workplace nutrition program can be part of a broader organization’s framework tailored toward health and wellness. A successful program requires buy-in from leadership as well as a dedicated coordinator and resources for implementation. Quantitative data such as surveys, nutrition, and health data will help to evaluate if the program was a success. Besides the employer, trade unions, foodservice operators, and incentives by insurance companies can further contribute to a positive nutrition environment at work.
Nutrition programs in the workplace offer a direct opportunity to workers and employers; they have the potential to improve workers’ physical and mental health, and loyalty and thereby improve work attendance, productivity, and employer reputation. The potential return on investment of investing in workplace nutrition is high. Therefore, proper nutrition in the workplace is a win-win proposition for employers and employees. Investing in workers’ nutrition should be a goal if organizations are to thrive.
There are many hungry bellies to feed around the world and we are merely scratching the surface to nourish the vulnerable populations of the world. Due to the current COVID-19 pandemic triggering lockdowns around the world, issues in nutrition such as food systems and malnutrition have been heightened and are now more of a global urgency than ever before. Here at Sight and Life, we are working on initiatives in Rwanda, South Africa and India to help improve the lives of those in need during this crisis.
“The only silver lining during this grave crisis has been how quickly and effectively we’ve been able to work together as a team and with our partner organizations to identify food insecurity hotspots and mobilize resources for emergency hunger relief. The guiding principle behind our efforts has been to look beyond just filling bellies but make sure adequate and critical nutritional needs are met,” expresses Sight and Life team members.
In India, we have partnered with grassroots NGOs across India, such as Aahawaan Foundation, based in Bangalore, and Kutumb, working in Uttar Pradesh, to donate grocery kits and nutritious food to the affected communities.
Kutumb is an organization attending to abandoned and slum children by giving them a sense of family. They are also dedicated to strengthening all units of marginalized and underprivileged families, realizing that children can be nurtured best in a family setting. Together with Kutumb, we provided nutritious food to over 1500 children with moderate acute malnutrition in 75 villages located in Uttar Pradesh.
In Bangalore, we teamed up with the Aahawaan Foundation who is committed to providing basic requirements and facilitate the development of the overall potential of people and their communities. Together, we delivered 15-day grocery kits with staples and fortified kernels as top-up was delivered to migrant workers and their families ensuring that the nutritional needs are met, beyond just filling stomachs.
“I was unsure of how I would provide for my own children and was hence, worried about feeding my neighbor’s children as well. This ration will help me cope with this crisis for some more time,” explains Sita Ben, one of the many women workers our partner reached with an essential food kit. She spoke about her difficulties during this pandemic as she is responsible for her children and neighbor’s children as they are unable to return due to the lockdown in India. Now she can sleep a little bit knowing she has the ability to feed her and her neighbor’s children.
Meanwhile, in Delhi, monthly ration kits made it to 200 daily-wage households. The kits contain additional essential supplies such as oil for cooking, grains, lentils, and an egg for a family of four in order to help ease the pain of many in unfortunate situations.
“A great number of my fellow countrymen are forced to walk a thousand miles, often hungry, just to reach the safety and comfort of their families. We are grateful for the opportunity to raise funds on their behalf and support them with nutritious meals,” explains the Sight and Life team.
We are committed to doing more however, we need support. Please donate to via our Milaap or GoFundMe crowdfunding page to further our efforts. We are also interested in partnering with organizations that have similar initiatives and are located in Rwanda, South Africa, or India.
Five-step plan to prevent an impending nutrition famine during COVID-19 in India
Srujith Lingala, Manager Technology and Entrepreneurship and Dr. Basanta Kar, Recipient of the Sight and Life Global Nutrition Leadership Award
Most Recent, Perspectives
India’s isolation measures in response to COVID-19 are having a far-reaching impact and is among one of the largest initiatives globally to impose strict limitations on its 1.3 billion citizens. People with pre-existing vulnerabilities, marginalized communities, pregnant and lactating women (PLW), daily wage earners, migrant workers, and the elderly have been the hardest hit as the protective measures disrupt the economy.
To ease the effects of the pandemic, the national and state governments have announced extensive stimulus packages and policy measures. The national government on 12th May announced a $265 billion relief package aimed at injecting liquidity into the economy. The first tranche of $ 22.6 billion included several social protection measures such as payment of ex gratia amount to marginalized populations, increased wages for workers under the National Rural Employment Guarantee Act, doubling rations for three months, collateral-free loans to women’s Self Help Groups (SHGs), the inclusion of support to COVID-19 under Corporate Social Responsibility (CSR), and financial assistance to villagers through farmer cooperatives. These aid benefits are aimed to help more than 810 million Indians and are a step in the right direction.
In addition, integrating nutrition in the current policies will be fundamental to improving nutritional status and building immunity of the population, especially high need groups like PLW and children under 5 years of age. The WHO guidance on diet during the COVID-19 pandemic states that “good nutrition is crucial for health, particularly in times when the immune system might need to fight back”. India is already battling a high prevalence of malnutrition (Table 1). As India, in unison with the rest of the world, battles an evolving pandemic of unprecedented proportions, policymakers must be vigilant, agile, and innovative to halt our population from sliding into hunger and acute malnutrition due to the COVID-19 outbreak.
Source: Comprehensive National Nutrition Survey 2016-2018, Ministry of Health and Family Welfare Govt. of India.
We propose a five-point plan to put nutrition-sensitive policy measures in place to combat the adverse effects of COVID-19:
1. Increase budget and coverage for essentials
Many state and national governments have gone beyond the entitlement provisions under the National Food Security Act – 2013 to announce a stimulus package, the key elements of which are grain and pulses, and cash transfers to lower-income households. While this is a necessary and commendable step, a much stronger nutrition-sensitive hunger mitigation and food programming scheme is crucial. A basic, nutritious diet, recommended by the EAT-Lancet Commission, would cost at least INR 33.69 per day. Accounting for a family of 4, cash transfer of INR 500 per month would only satisfy a family’s requirement for approximately four days a month! Most states’ announcement of transferring an additional INR 1,000 only satisfies their requirement for an additional eight days. India has surplus food grains to weather the current crisis. Universal access and 3x more rations, irrespective of possession of ration cards, will be effective in addressing hunger including the 70 million poor households who lack an identification document.
2. Address malnutrition through dietary diversity, supplementation, and fortification:
Current food supplies through the Targeted Public Distribution Systems (TPDS) are predominantly comprised of grain and pulses. In the current situation where farm supply chains are expected to take at least four months to be restored, essentials such as vegetables, milk, and eggs, could be sourced directly from the farmers and made available in the open markets, supplied through public distribution systems and provided as weekly take home supplies to children and PLW. A few state governments such as the Telangana government have directed Anganwadi workers to provide eggs to mothers and children. Scaling such initiatives to a national level will help improve nutrition outcomes during the pandemic.
The honorable Prime Minister of India, in his address to the nation, ‘Mann ki baat’ on 25th August 2019, announced fortification of rice that is distributed to India’s poor through the public distribution systems, Integrated Child Development Services (ICDS) and mid-day meals. This would be the right time to implement the policy and improve access to fortified products including salt, edible oil, flour, rice, and milk. The aforesaid initiative is critical in the current scenario when nutrient consumption is bound to be erratic due to cash and food shortages.
3. Create awareness about nutrition practices:
Increasing evidence suggests that malnutrition increases susceptibility to infections including COVID-19. We, therefore, need to create awareness about better nutrition practices. The National Nutrition Mission (POSHAN Abhiyaan)’s Jan Andolan movement is a platform to engage in civil society and engage people to be committed to better nutrition. The Jan Andolan initiative can be utilized to implement a social behavior change campaign addressing food safety and feeding practices at the household level. Second, front-line workers can be empowered to halt the rise of malnutrition. They can be trained and equipped with behavior change communication equipment on nutrition care during pandemics. Empowering them with the right information and communication technology (ICT) equipment will enable them to spread information through digital platforms while following social distancing norms.
4. Incentivize farmers and small enterprises to produce nutrition-rich crops and food:
The following initiatives can improve the livelihoods of small-scale farmers and enterprises while improving access to nutrition. Incentivize smallholder farmers to produce nutrition-rich crops and staple foods and thus improving access to safe and nutritious diets across the value chain. Micro small and medium enterprises (MSMEs) can be motivated to produce and process nutritious and culturally appropriate foods using millets and legumes such as lentils, chickpea, groundnut, ragi which contain many nutrients and can store for long periods. They can also be prepared by women self-help groups authorized to prepare take-home rations and then the ICDS channel can distribute these foods to PLW and young children.
5. Harness technology for better nutrition:
India has a successful history of using technology to improve socio-economic and public health outcomes. For example, the Arogya Setu app, recently developed by the National Informatics Centre, uses technology to track coronavirus infections, thus providing a valuable tool in the fight against the pandemic. The government can similarly engage entrepreneurs to develop technologies to forecast the trend and pattern of disease burden in future months, rectify supply chain management of key food and nutrition supplies, revitalize already introduced software in public distribution systems to monitor food supplies.
Nutrition is a great equalizer. It can create the right environment to stimulate growth, economic development, and progress of an entire generation, thus propelling India on a path towards excellence. India has demonstrated early successes in managing the pandemic through strict isolation measures, innovative use of technology, and public health services. As we fight a pandemic of epic proportions, accounting for the nutritional needs of the world’s most vulnerable will not only give us the strength and immunity to fight COVID-19 but also save lives and give more babies the healthy start they deserve, irrespective of their socio-economic status.
Reaching Last-Mile Communities in South Africa with Fortified Food
In South Africa during the current COVID-19 pandemic, massive food security issues have arisen in addition to the daily challenges of access to water and harsh living conditions. While under a nationwide lockdown, food distribution is critical to impoverished South African communities.
To help change the situation of many families living in South Africa, Sight and Life has provided Level Up, a fortified instant cereal full of nutritional benefits, through our longstanding partner Sizanani Mzanzi, supplier of the instant cereal. In partnership with organizations like Bambanani and Savanna Lodge, we have helped immensely in securing a meal a day for the most vulnerable members of the rural communities. These communities consist of young children and old age individuals who struggle with various health issues like HIV and AIDS, tuberculosis, diabetes, hypertension, and malnutrition. “The support and generous funding from Sight and Life allows this process to occur and provide nutritious meals to families for four to eight weeks,” states Ed Rakhorst, project manager for Bambanani.
Impact of nutrition
Typically, fortified cereals are offered in school to underprivileged and malnourished children ensuring they are consuming a healthy meal that contains all the essential vitamins and minerals required in their daily diet. Due to the lockdown putting a hold on children attending school this daily meal has not reached those who need it most.
Level Up cereal is endorsed by the South African Heart and Stroke Foundation and provides 13 vitamins and 4 minerals while also being high in fiber, energy and protein creating a nutritious meal.
In late April 2020, Sight and Life teamed up with long time partner Bambanani, a humanitarian organization based in Phalaborwa, Limpopo, South Africa, to deliver fortified food to last-mile communities, especially those children affected by school closings.
Bambanani focuses on the care, schooling, and nutrition needs of children from 0-6 years of age, including some orphaned and disabled children. Sight and Life donated Level Up cereal for children and their families to be distributed through the Bambanani network of schools.
“Most of these children are unable to receive adequate daily nutritional requirements due to the following socio-economic factors such as unemployment and overpopulated communal living,” explains Rakhorst.
At the Reneilwe School in Namakgale, there are many touching scenarios as to why these children and their families are in need. From unemployed or living on social grants to children with health concerns each story is important. For example, Blessing receives Level UP because he does not eat well, and his health is not good. Adding to this already difficult situation, his parents are unemployed and have no income or social grants for their family of six. Or there is Happy who lives in a household consisting of four uncles (one consumes alcohol), two aunts, and a total of five children all living together below the poverty line and receiving Level Up. These are just two of the many circumstances in which Bambanani can touch and change the lives of those in need.
Through Bambanani, the Level Up product is also fed to children that are diagnosed with HIV to get back on their feet, full of energy, and live their lives like normal children. These children will use the Level Up product seven days a week to maintain a healthy diet full of the needed vitamins and minerals.
Located in Mpumalanga, South Africa, Savanna Lodge is a private game farm and dedicated to helping the local villages where many of their staff live. They have been delivering Level Up cereal, donated by Sight and Life, at least once a day to vulnerable orphans and children and elderly community members providing an extra boost of vitamins and minerals needed during this time.
“We have been able to distribute a box of cereal to every child at the center (Tiyimiseleni Project) and will continue to do so for as long as the lockdown continues. Thereafter, the cereal will be used at the center itself. It has been distributed to Hlayisekani Nursing Home, and stock is being kept for Mketsi Primary School,” explains Jennifer Harman, project manager for Savanna Lodge.
Tiyimiseleni Project is a community care center run as a social responsibility project by Savanna Lodge. It supports about 250 vulnerable children and HIV/AIDS orphans, giving them a safe place to go to where they get a nutritious meal, have an adult to talk to, can do their homework, and just be children for a while.
Mketse Primary School has approximately 650 students and is situated in an area where it is estimated that around 25% of the children come from child-headed households. The vision of the passionate Headmaster and dedicated staff is to provide knowledge and skills that will enable students to carry out a productive role in society and so give back to their community. Sight and Life has a longstanding relationship with the school and contribute towards this vision through its support of the school lunch program. In so doing, we are supporting keeping these children’s young bodies healthy, active, and ready to learn.
In the communities around Savanna Lodge, the situations are less than ideal. One such example is Maria’s family consisting of seven family members and both parents have passed away. She is 20 years old and unemployed and the siblings (ages 3 to 16) are in schools and they attend Tiyimiseleni home-based are for regular meals and medical assistance. Savanna built a house for Maria and her siblings to live in as they do not have identification documents making them unable to apply for state social grants. Currently, the schools and the home-based care centers are closed due to the COVID-19 pandemic and all of the children rely on the school feeding scheme from Tiyimiseleni for their daily meal. The donation of Level Up cereal made by Sight and Life provides them with at least one regular meal a day for many weeks.
The Nyambi family of three struggles as the mother is unemployed and undergoing HIV treatment and raising two children (8 and 14 years old). Due to the two children not having identification documents they are unable to claim state social grants to help support the family. Therefore, they have no income, or extended family members to assist them. The children are reliant on school feeding programs and meals from Tiyimiseleni home-based care thus making the Sight and Life contribution extremely important.
“This is just the beginning, there is more to be done during challenging times like this pandemic and in the long-term to take on malnutrition. We are proud to support and work with partners and organizations such as Bambanani and Savanna Lodge, who care for people and their futures,” remarks Klaus Kraemer, Managing Director for Sight and Life.
The Convergence of COVID-19, Climate Change and Malnutrition
Klaus Kraemer, Managing Director for Sight and Life
Most Recent, Perspectives
When I set out to write this piece about COVID-19, climate change and malnutrition, I asked myself whether there might be anything new that I could add to the debate, given the myriad blogs, commentaries and webinars already proliferating on the subject. In my quest for lasting solutions to the global scourge of malnutrition, it is important for me not to lose sight of the big picture, to learn from the past, and not to jump on the bandwagon when global priorities change.
In my hometown in Germany, from where I am writing these lines, the lockdown following the outbreak of the COVID-19 pandemic has been relaxed slightly this week; in addition to grocery stores and pharmacies, small shops are now permitted to open again. We have not been hit really hard here in terms of food supply over the past weeks. Following the initial wave of panic buying, the supermarket shelves are now restocked, and innovations are occurring in the supply chain. Besides home delivery, a drive-in system for purchasing fruit and vegetables has been set up. You order and pay at a booth, and the guys take the pre-packed box with fresh produce from the ramp and load it into the trunk of your car. This development allows certain businesses to keep trading during this difficult time, certain jobs to be protected, and the supply of fresh produce to the population to be continued.
The potential for a new global food and nutrition crisis
COVID-19 is having its most devastating impact, however, on low-wage and migrant laborers (and their families) in low- and middle-income countries (LMICs) as a result of the lockdowns and border closures imposed to contain the spread of the virus. When these workers lose their jobs, they don’t get paid, and neither they nor their families can eat. The expected economic downturn triggered by COVID-19 will exacerbate this dire situation all around the world. It will come as no surprise that there are people already today who claim that they are more scared to die of hunger than of COVID-19. In 2019, according to the 2020 Global Report on Food Crises, 135 million people were affected by acute food insecurity, with an additional 183 million people subsisting on its fringes. These individuals are likely to slide into hunger and even starvation due to the COVID-19 outbreak this year. Moreover, according to the World Food Programme (WFP), some 300 million primary school children have been robbed of their regular, and often sole, daily nutritious meal at school due to school closures.
Although the UN Food and Agriculture Organization (FAO) expects a record wheat harvest in 2020 and reported low food commodity prices for March of this year, countries in Southeast Asia have increased trade barriers and imposed export bans on food items such as eggs (Thailand) and rice (Vietnam and Cambodia, on a temporary basis). Moreover, the lockdown has already led to rioting in the streets in some countries. There is an uncomfortable sense of reliving the 2007–2008 food price crisis when “…weather shocks, greater demand for grain-fed livestock among a growing global middle class, biofuel development from grain crops, food stock hoarding, and globalized trade in food commodities … increased prices and dwindling grain stockpiles have caused civil strife and political instability.”
‘Nutrition in the Perfect Storm’
This quote is taken from an article entitled ‘Nutrition in the Perfect Storm’ that we published in Sight and Life Magazine in 2008, raising concerns about widespread micronutrient deficiencies during the food price crisis and the detrimental consequences of this development for nutritional status, health and wellbeing. During crises such as drought, flooding and locust plagues, poor families suffer reduced dietary diversity and forgo the consumption of relatively expensive micronutrient-rich foods such as eggs, meat, fruit and vegetables in order to fill their bellies with empty calories from starchy staples and energy-dense processed foods. The recommendations provided in our 2008 paper are still relevant for the current crisis: “… support micronutrient supplementation, fortification and food-based strategies to address micronutrient malnutrition among vulnerable population groups…” to mitigate the development of “a potential ‘lost generation’ of unhealthy children, and irreversible economic loss.”
The food price crisis of 2007–2008 was a contributory factor in the Arab Spring in the early 2010s – a protest movement across North Africa and the Middle East that in many cases triggered violent crackdowns whose long-term consequences are still being felt around the world today. With its power to destroy lives and livelihoods, COVID-19 has the potential not just to damage the health and wellbeing of populations but to trigger civil unrest, violence, new wars and increased tides of migration unless it is tackled effectively not only in the wealthy West but particularly in LMICs. Its effects are insidious and its ramifications far-reaching.
In this context, it is also worrying that the COVID-19 pandemic has led to the deferral of measles immunization campaigns even in countries that are experiencing a measles outbreak. This will likely be compounded by the UN recommendation to suspend planned mass vitamin A supplementation for children under 5. It is questionable how well alternative distribution routes will work as suggested. The re-emergence of vitamin A deficiency-related blindness and mortality in children will be the grim consequences. Granaries may be full for the moment at least, but the expected supply chain disruptions caused by the COVID-19 pandemic will probably cause more severe malnutrition than was witnessed in the aftermath of the 2007–2008 crisis. Sight and Life has responded to the COVID-19 pandemic by coordinating demand for food, with a supply of fortified food and supplements to a number of grassroots NGOs in India, Rwanda and South Africa and with a GoFundMe crowdfunding page to raise additional resources.
Interest in climate-smart innovations is rising rapidly among the young entrepreneurs. At Sight and Life, we nurture and encourage such enthusiastic and passionate young professionals through the Elevator Pitch Contest by Sight and Life (EPC). Our most recent EPC attracted entries from 45 countries and three times more applications than previous contests.
The time to act was yesterday
The time to act to mitigate the consequences that the combination of COVID-19 and climate change will have on nutrition was yesterday. Many countries around the world have policies in place for micronutrient supplementation and food fortification, but in many cases these are not well implemented or effectively enforced. A considerable increase of effort is required, despite the pressing challenges of COVID-19. This will be more than a stop-gap solution: it will also be an investment for the long-term future of individuals, societies, and economies as a whole – even, I have no doubt, of the global economy itself. For all we know, adequate micronutrient intakes as part of nutritious and safe diets can only increase population resilience in the face of crises – present and future.
COVID-19, climate change and malnutrition have converged to create an unprecedented challenge for the global nutrition community. The dangers for millions of people around the world are imminent and very real. More than ever before, the knowledge, insight and commitment of nutrition professionals are in demand. In crisis, however bleak, there is always a sliver of opportunity. We may be obliged to distance ourselves physically at this challenging time, but we stand united as never before in our passion to end malnutrition in all its forms.
Our nutrition community has successfully engaged with other disciplines and sectors in the past decade, turning exciting new scientific insights into policies and programs that have the potential to deliver better nutrition for everyone on the planet. Now, as we face a universal enemy in the form of COVID-19, is the time for us to truly act as one to combat its effects.
Breda Gavin-Smith, Global Public Health Nutrition Manager for Sight and Life
Most Recent, Nourish Notes
As the coronavirus (COVID-19) is spreading rapidly across the globe, it is important to take note of the approaches that can help prevent and fight infections, particularly viral infections. Evidence already suggests that viral infections are one of the world’s greatest public health challenges (WHO, 2020). The World Health Organization (WHO) estimates seasonal influenza results in 3-5 million cases annually. Today we understand hygiene and social distancing play a key role in protecting yourself and others from contracting a virus while also slowing the spread of infections. Here are a few simple ways to reduce your risk to infections:
– Wash your hands regularly for 20 seconds with soap and water or alcohol-based hand rub.
– Cover your nose and mouth when you sneeze or cough with a disposable tissue or flexed elbow.
– Avoid close contact with people who are sick.
– Stay at home and self-isolate from others if you feel unwell.
Good nutrition is fundamental to improving immunity. The immune system is the body’s defense against disease and infection and it has long been established that several factors influence the function of the immune system including stress, sleep and nutrition (Song et al, 2019; Patel et al 2012 and Gombart et al 2020). The WHO guidance on diet, especially during the current pandemic states that “good nutrition is crucial for health, particularly in times when the immune system might need to fight back” (WHO, 2020). Providing a diet high in nutritious foods rich in vitamins and minerals supports optimal function of the immune system by providing antioxidants to slow damage of cells caused by free radicals (Lobo 2010) or assisting in T-cell production (Cohen 2017).
Although, presently, we do not have data concerning nutritional factors in relation to the risk and severity of viral diseases such as COVID-19 the role of nutrition in immunity has been well established. For example, a study on the role of vitamin A in the treatment of measles in children found a reduced risk of mortality and pneumonia when vitamin A was administered over two days (D’Souza and D’Souza, 2002). The European Journal of Clinical Nutrition concluded that “Without adequate nutrition, the immune system is clearly deprived of the components needed to generate an effective immune response” (Marcos et al, 2003). Good nutrition is thus important in supporting an optimum immune system which can reduce the risk of viral infections (Beck and Levander, 2000).
It is now recognized that the complex, integrated immune system requires several micronutrients that have essential, often synergistic roles at every phase of the immune response (Gombart et al, 2020). In fact, even marginal deficiencies in certain nutrients have been shown to impair the immune system (Gombart et al, 2020). Micronutrients are believed to work collectively to support an optimum immune system. Based on a variety of systematic and clinical data, vitamins A, B6, B12, C, D, E, folate, zinc, iron, copper, and selenium (read our Vitamin and Mineral: a brief guide) are particularly important to boosting immune response.
The chart below identifies the role of these vitamins in immunity and shares recommended amounts and sources in the diet. In a forthcoming post, we will highlight the important minerals supporting the immune system and the work Sight and Life has achieved over the past 30 years to ensure access to vital nutrients, especially for children and women of childbearing age.
*Current advice on supplementation concludes that consuming a balanced diet provides all the necessary nutrition required but where there are challenges in meeting dietary recommendations, supplements are a useful addition in helping meet our nutritional needs (EUFIC, 2020).
*Please note these are approximate values and can vary based on recommended reference values employed.
Gysin DV, Dao D, Gysin CM, Lytvyn L, Loeb M (2016). Effect of vitamin D3 supplementation on respiratory tract infections in healthy individuals: a systematic review and meta-analysis of randomized controlled trials. PloS one.11(9).[Online] Available at: https://www.ncbi.nlm.nih.gov/pmc/articles/PMC5025082/ (Accessed on 1st April 2020)
Lobo V, Patil A, Phatak A, Chandra N. Free radicals, antioxidants and functional foods: Impact on human health. Pharmacogn Rev. 2010;4(8):118–126. doi:10.4103/0973-7847.70902
Marcos, A., Nova, E. & Montero, A (2003). Changes in the immune system are conditioned by nutrition. Eur J Clinical Nutrition57, S66–S69 [Online] Available at: https://www.nature.com/articles/1601819 (Accessed on 7th April 2020)
On December 17, 2019, Devex published “Opinion: Engaging nutrition to improve pregnancy outcomes” by Klaus Kraemer, managing director of Sight and Life and adjunct associate professor at the Johns Hopkins Bloomberg School of Public Health. The full article can be read here on Devex.
Good nutrition sets off a ripple effect. It can dismantle inequity, poverty, and poor health and drive progress at every stage in life. It supports physical and cognitive development, helps prevent a number of medical conditions — from spina bifida to diabetes — and saves lives.
During and after pregnancy, nutrition demands are greater — as are the consequences of not meeting them. For mothers, ensuring a healthy pregnancy limits the risk of life-threatening complications. And for their children, good nutrition during pregnancy can be the difference between being born healthy and being born physically or mentally disadvantaged.
It is critical that we sustain our momentum on nutrition, a task that requires greater investment in cultivating a cadre of leaders to take us there, argues Klaus Kraemer, director at Sight and Life.
While diet diversity remains the preferred means for women to meet nutrient requirements during pregnancy, many nutrient needs cannot be met through diet alone, especially in resource-constrained settings. As such, it is imperative that we reach women and girls with effective interventions for improving maternal nutrition that are ready for global scale-up now. Multiple micronutrient supplementation, or MMS, during pregnancy could be one way to help meet maternal nutrition needs.
Srujith Lingala, Kalpana Beesabathuni, Klaus Kraemer and Rebecca Olson
Most Recent, Perspectives
On a quiet morning in rural Mchinji, a small district in Malawi, Grace wakes up and walks over to the house she constructed just a year ago. She inspects her 1,200 chickens carefully – they are all hale and healthy! It will soon be time for their breakfast – a specially formulated meal with the right mix of carbohydrates, protein, vitamins and minerals so they can lay healthy and fresh eggs. All of this is thanks to the egg hub – a Maeve, Lenziemill and Sight and Life project that aims to increase the income of farmers like Grace by providing high quality and affordable inputs, credit, training, and access to markets; as well as increase availability and affordability of eggs in Malawi.
Challenges to improving egg consumption in Malawi
As a source of high-quality protein, vitamins and minerals and fatty acids, eggs have the potential to dramatically improve nutrition outcomes for vulnerable populations. Yet, in many parts of the world eggs remain inaccessible to those who need it the most. At the same time, the poultry industry is growing exponentially in many low- and middle-income countries (LMICs), making it an important source of income for poor households.
In Malawi, 37% of children under five are chronically malnourished (stunted), and about 86% of the population lives in rural areas, where most people practice smallholder subsistence farming. The rural poor are particularly affected by malnutrition despite increases in caloric consumption across all socioeconomic quintiles. Although eggs have proven nutrition benefits, eggs continue to be scarce and costly in Malawi – the average per capita annual consumption is only 27 eggs, compared to 180 globally.
This is due to multiple demand and supply side challenges, notably disease and mortality among chickens, cost and quality of production inputs, and access to credit and markets leading to high egg cost (8-11x the price of cereals, compared to 1.6x in the US and 3.4x in Europe) and low availability. Cultural beliefs and taboos also undermine egg consumption. For example, in some Malawian communities, eating eggs is associated with stomach pains, or even with babies becoming bald.
Increasing egg production using the Egg Hub model
In Malawi, there is a huge unmet domestic demand for chicken meat and eggs; and the Government of Malawi is committing to improving food security and nutrition through progressive national livestock strategies.
Against this background, interventions and innovations across the poultry value chain that consider the role of poultry for society and the prevailing farming systems are increasingly being implemented. The Maeve/Lenziemill/ Sight and Life egg hub projectwas launched in 12 villages in central Malawi to set up and develop bird poultry farms with 3-year break even period.This project has brought together various partners to support poultry farmers, who are organized into groups of five. In addition to receiving specialized feed, the groups also receive all important vaccinations for the birds, which are ready to lay when they arrive at the farms, training, and continuous supervision.
Since the project was initiated in September 2018, 60 farmers have been registered, received training, established farms and started egg production; and a total of 12,000 birds were placed in these farms to start egg production. The program aims to produce 3.5 million eggs annually. Sight and Life has also built a digital platform for the farmers to track progress, program outcomes and biosecurity protocols.
Not only has the project led to increased egg production and consumption among participants like Grace and their families, but it has also increased their incomes as the eggs are also being sold in local markets.
“There has been a surge of excitement and interest in the villages to the point where we have had current farmers also asking for more chickens to meet their local demand. It is very exciting to see the overall demand and drive the farmers.” – Maya Stewart, fund recipient & Director of the Maeve project
The way forward
In addition to addressing supply side concerns, Sight and Life will also create demand through a targeted social marketing campaign, making eggs aspirational and desirable for caregivers of young children, pregnant and lactating women. Sight and Life is on a quest to end malnutrition, and we believe in the power of eggs to improve health and nutrition for all.
The Elevator Pitch Contest (EPC), founded by Sight and Life, is a competitive platform for students and young professionals to present their innovative ideas in front of a distinguished team of experts, investors, and the nutrition science community. It is an interactive approach whereby an entrepreneur must boil down their concept into a precise and persuasive pitch in order to spark interest from potential financiers – a critical part of the entrepreneurial process as competition for research and investment funds increases.
To date, there have been three EPCs held, the first in Cancun during the Micronutrient Forum in 2016, the second in Boston during the American Society for Nutrition (ASN) in 2018 and recently in Mumbai during the 19th World Congress of the International Union of Food Science and Technology (IUFoST) in 2018. Three finalists sat down to chat with us about their progress and success since the competition.
The three finalists are:
Andrea Spray, London School of Hygiene and Tropical Medicine
At the EPC in Boston, Andrea presented a dietary intake innovation called INATU that measures the impact of women’s time on nutrition.
“[EPC] is a great opportunity to hone new practical skills, and to engage with top experts in your field. It really was a great honor to participate. It was a lot of work, but I think that you get as much out of it as you put in. This type of opportunity is rare for young entrepreneurs/students/innovators.” – Andrea Spray (EPC Boston)
Anne-Julie Tessier, Keenoa
During the EPC in Boston, Anne-Julie walked away with the first-place prize for her innovative artificial intelligence (AI) based food diary.
“I would recommend EPC without a doubt! Because it is a unique and enriching experience to kick-start your company.” – Anne-Julie Tessier (EPC Boston)
Alex Warrington, Future Food Now
Pitched her solution for using aflatoxin at-risk groundnut cake as a by-product from oil crushing to be used as a feed source for insect farming at IUFoST and won. Find out more about her innovation here.
“The EPC has helped me to better define my project and given me more confidence when presenting. I also met some great people whom I continue to speak with today.” – Alex Warrington (EPC Mumbai)
How has the EPC contest helped you?
Andrea Spray (EPC Boston): Having just completed field work on the INATU pilot, the EPC helped me to quickly synthesize and prioritize key messages about our innovation, try to articulate them in a way that our target audience would find compelling, and really push the horizon of my own thinking about what comes next.
Anne-Julie Tessier (EPC Boston): My team and I had pitched Keenoa to investors, but never had participated in such an event in the context of a scientific meeting before. The EPC helped me tailor my pitch to scientists and permitted us to reach a wider audience by presenting at ASN. It was an occasion of increasing awareness of our innovation among scientists and nutrition experts and it permitted us to grow our network globally.
Alex Warrington (EPC Mumbai): The EPC gave me the impetus to make my idea happen.
What did participating in the contest mean to you personally and your innovation?
Andrea Spray (EPC Boston): For me personally, it was the first time I was presenting my PhD dissertation research to a truly public audience, and to some of my “hero” experts in the field of nutrition. It was also the first time I had done an elevator pitch, and so I put in a lot of effort into optimizing my presentation for that purpose. Finally, I had never thought of the path of entrepreneurship before; the EPC provided insight into that world that I definitely would not have otherwise been exposed to. For the innovation, it was the first time to solicit feedback and impressions from a broad audience, and it provided helpful visibility to our work.
Anne-Julie Tessier (EPC Boston): While some of my PhD colleagues were presenting their work in poster or oral sessions at the ASN conference, I was proud to attend the meeting as one of the Sight and Life elevator pitch finalist to present Keenoa. Participating and winning the EPC marked an important milestone for our company as it was the first time showcasing our innovation to international scientists.
Alex Warrington (EPC Mumbai): Before participating, I just had a concept which I was not sure I could see to fruition, but through participating I began to realize how important my project had become to me. I wanted to succeed and make my idea a reality.
Did you find the entire EPC experience useful? Why?
Andrea Spray (EPC Boston): The platform to present my research in such a dynamic format was the primary benefit of having participated in the EPC. The preparation alone prompted numerous conversations about the work that I otherwise would not have had at such an early point in the research process. I found the in-depth engagement with various Sight and Life colleagues enriching, as was the opportunity to learn about related work of my peers.
Anne-Julie Tessier (EPC Boston): The overall EPC experience was useful on many levels. One of the highlights of the EPC experience was our inspirational meeting with Simone Frey, Managing Director at Atlantic Food Labs GmbH and EPC judge. I could highly relate to her career path; it was refreshing and motivating to learn from a woman in entrepreneurship who also has a doctorate degree. It was also an honor to meet with other students from various universities who all work towards improving nutritional assessment; sharing our ideas and learning from their experience was enriching. The overall discussions with mentors, students and the incredible Sight and Life team, without whom this experience would have not been possible, were insightful with regards to entrepreneurship, graduate studies, intellectual property and much more.
Alex Warrington (EPC Mumbai): We had some great coaching on presentation content and delivery from Nirjhor Rahman of YGAP Bangladesh. I really appreciated meeting fellow finalists who were all so inspiring, and it was exciting to talk about possible solutions to problems such as aflatoxin contamination with like-minded entrepreneurs. The social media coverage and videos also provide me with quality future marketing materials for my project.
What lesson(s) did you learn from your experience?
Andrea Spray (EPC Boston): So many things! First and foremost, I learned a lot about presenting research with an entrepreneurial mindset. The experience also reinforced for me how very different the circumstances are in low-income and high-income country settings for nutrition assessment. Several of my EPC “competitors” are working with state-of-the-art technology, whereas working in rural low-income settings we’re interested in low-tech solutions that can be transformative for the field. Our challenge is less the technology and more the overall system.
Anne-Julie Tessier (EPC Boston): I grasped the importance of networking with entrepreneurs and students; it is key in creating future collaborations and getting surrounded by insightful mentors.
Alex Warrington (EPC Mumbai): How to successfully pitch in only five minutes! I also had not been involved in filming before so I hope I have learnt some skills for being in front of the camera!
What is the current status of your idea/project?
Andrea Spray (EPC Boston): I am currently writing up results of the validation of using our innovative approach (i.e. wearable cameras and image-assisted 24-hour recall) to assess diet diversity and time allocation. That combined with results of our feasibility and acceptability research will be crucial in identifying next steps.
Anne-Julie Tessier (EPC Boston): Nutrition is key in chronic diseases prevention. Our mission at Keenoa is to empower dietitians by giving them state-of-the-art technologies to maximize their impact on the health of the population. We have reached a product market fit in Quebec, Canada. Now our goal is to expand commercialization in Canada and United States. We have initiated validation of Keenoa as a tool to assess dietary intake in research, results should be published soon!
Alex Warrington (EPC Mumbai): I am currently in discussions with universities and business to determine the best feed source and location for the pilot insect farm in Africa. I am slowly teaching myself WordPress and have created a website where you can follow the project’s progress: futurefooodnow.co.uk
How has the funding from EPC help further your innovation?
Andrea Spray (EPC Boston): EPC funding covered my travel expenses to attend and participate in the ASN conference in Boston, thus enabling exposure to an audience of experts we would not otherwise have reached. With that exposure, I received truly valuable bits of feedback that I suspect will be incorporated into future work.
Anne-Julie Tessier (EPC Boston): The monetary award from the EPC helped us creating what we call food builders to be integrated in the Keenoa mobile app. These are to further facilitate data entry by the end user and increase accuracy of dietary assessment; it was the natural prolongation of food recognition from pictures of meals.
Alex Warrington (EPC Mumbai): The funds are going to be used for the initial costs of research into the food safety of insects fed on the chosen aflatoxin contaminated feed source.
What are your future plans?
Andrea Spray (EPC Boston): With the conclusion of the validation research, I am wrapping up my PhD dissertation. I hope to defend that by the end of the calendar year. In the meantime, I am also ramping back up my nutrition consulting/research work, including a follow-on Drivers of Food Choice grant. It has been an incredibly challenging few months trying to get this research done, so in the near future I am looking forward to some much-needed R&R.
Anne-Julie Tessier (EPC Boston): With Keenoa, we aim to fundamentally change dietary assessment in dietetics practice and research field. My vision for Keenoa is to see all dietitians and nutrition researchers use it to accurately and precisely quantify the impact of nutritional interventions on the health of individuals and communities. Our future plans are to accelerate commercialization worldwide. To do so we will grow our team. On the tech side, as we collect data, we train our algorithms to get better at predicting food items from pictures.
Alex Warrington (EPC Mumbai): Once the food safety research has begun, I intend to apply for more funding to ensure that the business model is viable – exploring market opportunities for insects as food and feed.
On August 6th, at the 2019 Asian Congress of Nutrition in Bali, Sight and Life organized a symposium on the topic of eggs, which represents one of its flagship programs. The session entitled “Achieving Improved Nutrition in a Sustainable Way – The Case of Increased Egg Consumption” gathered experts in the field of nutrition, sustainable business models, environmental sustainability, science and research and was skillfully moderated by Dr Regina Moench-Pfanner (ibn360).
The session made an important case on how crucial it is to go beyond nutrition and to increasingly account for externalities in our way of thinking and in the way we implement programs and projects. This shift in thinking has become necessary in light of pressing global issues such as climate change. Eggs provide a useful example to start unpacking some of these challenges.
The science can no longer be EGG-nored
The days where eggs were blamed for driving up cholesterol levels are thankfully over. Evidence is mounting regarding the benefits of eggs for child nutrition and potential benefits for women during pregnancy and birth outcomes. This power food is at last getting the attention it deserves.
Think of it – there is no food such as the egg. Dr Jeya Henry of the Clinical Nutrition Research Center in Singapore reminded the audience of the astonishing properties of this functional food: “from gelling, to emulsifying, to thickening and foaming properties, eggs’ form of proteins is simply incredible” he adds that “an average egg is roughly 50-60 g in weight. No other food on the planet has almost all the micronutrients and the most significant amino acid patterns packed in such a small quantity”.
Ms Gulshan Ara from icddr,b shared the recent and fascinating results from a trial conducted in Bangladesh where the effect of an egg-based nutritious snack was tested on child growth. Results showed that on average, intervention children became 2.55 cm taller compared to control children. Egg based nutritious snacks contribute to improving both linear growth and cognitive development in children <2 years of age.
Yet, although eggs’ nutritional value is undebatable, it would be presumptuous to assume they are the magic bullet…
Indeed, there is an array of known and unknown externalities that come along the way and must be understood; acknowledged; and addressed.
“Eggs have the potential to be considered in 2020s as a sustainable and irreplaceable animal source food for improved nutrition.” Dr Klaus Kraemer
Environmental consequences of egg production
One of the key obstacles relates to the environmental consequences of the production of eggs, but also animal welfare issues. Using Life Cycle Assessment (LCA) methods, a recent study by Abín et al, conducted in Spain revealed that natural land transformation, terrestrial ecotoxicity and freshwater ecotoxicity were the top three most notably affected categories and that the highest source of environmental impact was production of hen feed (specifically soybean and palm oil cultivation), but also the breeding of young chicks to replace the exhausted laying hens. Such findings encourage the development of innovative triple duty solutions addressing the environmental externalities, without failing to address the over and under nutrition components.
“It’s time for nutritionists to design and adapt their solutions in the context of the entire supply chain and the environmental consequences of it.” Dr Martin Bloem
Luckily, there are solutions. During the session, one of these solutions was shared by Srujith Lingala from Sight and Life. Through its Eggciting project, Sight and Life is working on making eggs available and affordable to low income households by supporting the introduction of innovative poultry business models in Ethiopia, India, Indonesia, and Malawi.
The Egg Hub
The ‘Egg hub’, one of Sight and Life’s recent innovations, is a centralized unit offering farmers high-quality, affordable inputs, extension services, training and market access. Through aggregation, egg hubs solve the supply-side challenges typically faced by small- and medium-
scale poultry farms. They can help countries with low-yield production systems make the transition to the efficient, high-yield systems that are associated with much lower market prices.
In Malawi, where the egg hub model was tested, initial findings point towards the fact that the egg hub has enabled 60 farmers to receive inputs and produce 4.5 million fresh eggs every year, but also to resell them within their communities. Each farmer makes a net income of USD 922 per year, 2.3 x the minimum wage in Malawi. Innovative farming models such as the egg hub are an effective and sustainable means of improving nutrition and increasing incomes of small and medium scale farmers.
In the present landscape where commitment for nutrition is at its peak and where the climate change debate is ever increasing, economically viable and sustainable solutions are welcomed as the interest to invest in these is significant.
Filling the egg gap
Public solutions exist as well. Dr Saskia de Pee (Fill the Nutrient Gap, WFP) shared the example of Indonesia where a social safety net program called Bantuan Pangan Non-Tunai (BPNT), that enables poor households to buy 15 kg of rice per month at a very low price, is transitioning to a commodity specific e-voucher. Following a cost of the diet analysis, FNG analyzed which locally available foods should be included in BPNT’s pre-determined local food basket to meet the household members’ recommended nutrient intake in the most cost-effective way. The results showed that the cost of a nutritious diet was approximately 1.2 million IDR/month per household, and the voucher value of 110 000 IDR/month per household (10% of the cost of nutritious diet). Eggs, rice, and green leafy vegetables were identified as the foods able to meet the most nutritional requirements for the lowest cost. Since then, they have been selected for the ‘Nutritious Package’ that was modeled for the BPNT program.
Watch out for unknown EGG-sternalities
What about other readily solutions that are coming to the market, such as JUST Egg and Impossible Burgers? Dr Martin Bloem, Director of the John Hopkins Center for a Livable Future, warns that “there are many unknown unintended consequences related to the production of these types of alternative forms of meat, particularly in terms of their nutrient composition, their use of antibiotics and water, as well as other chemical properties”. From a nutritional and environmental perspective, these alternative forms of meat need to be critically assessed.
Prioritize and compromise
Whilst animal welfare may be a priority in higher income countries, Environmental Enteric Dysfunction (EED) for instance, is more prevalent in lower resources settings and therefore present a higher priority to address. “At this stage, cages are critical to help reduce contact with feces and other hazards” explains Dr Klaus Kraemer from Sight and Life. “Chicken feces can affect the gut microbiota of children, and the difficulty of avoiding contact of children with feces can lead to chronic inflammation causing the gut to leak whereby the body burns the nutrients instead of using them for growth”. Klaus argues for the need to price externalities and to innovate even further for improved caging to successfully separate chickens from the children. It is our duty as nutritionists not only to help decision makers prioritize actions but to ensure the access of this power food to those who need it the most.
Are eggs EGG-citing?
Last but not least, consumer insights are primordial. Cultural factors play a role in many nutrition practices, including taboos or beliefs around egg consumption. Some of these insights were uncovered by Dr Maria Adrijanti from World Vision Indonesia, who throughout her presentation, made the case of increased egg consumption in Indonesia. The Eggciting project, a collaboration between Sight and Life, World Vision and DSM aims to increase availability, accessibility and consumption of eggs in Indonesia at the household level by addressing bottlenecks in the supply chain and boosting consumer demand. In terms of consumer demand, the project uses a social marketing approach to better understand some key issues including but not limited to: understanding household food purchasing power and decision-making; understanding how eggs are used in the daily diet; examining the awareness, knowledge, attitudes and beliefs around egg consumption; identifying key community influencers, their role and motivations in offering dietary advice, and specifically their view on eggs.
One initial insight regarding the traditional Indonesian diet and Sulawesi diet and egg consumption revealed that there are two kinds of chicken eggs that are popular in Indonesia – the native egg and the ‘broiler’ egg. The former is perceived as more delicious, and fresher compared to the broiler eggs and is usually used as medicine.
Thinking in systems
Daring to think beyond our current actions, daring to imagine the far-reaching and unintended dramatic consequences of our actions can be daunting and uncomfortable. A systems way of thinking isn’t easy for those of us who’ve been programmed to think in siloes, but our attitude of denial is catching up with us. The nutrition community can no longer play deaf towards the ever-increasing global environmental cries and concerns of the planet, which must go hand in hand with what we are trying to achieve. The fight against malnutrition is a complex one, which requires innovative solutions which can address that complexity. Learning from our mistakes isn’t just the cumbersome thing to do, it’s the ethical thing to do. This session was an egg-cellent example of the kinds of conversations we should increasingly be having – conversations that aim to understand the perspectives of the different sectors involved, and whose objective is to not only design new solutions but to adapt and re-adapt existing ones to the current context.
The egg isn’t unbeatable, it’s adaptable
“The illiterate of the 21st century will not be those who cannot read and write, but those who cannot learn, unlearn, and relearn” – Alvin Toffler
The 2019 summer conference season opened in an intense way for me. With barely one intervening week, I had the privilege of attending two fascinating conferences that differed in most aspects but converged on the complementary pathways towards the common and ultimate goal of a better-nourished and healthier world.
Reflections from Baltimore
The first conference was Nutrition 2019, the annual meeting of the American Society for Nutrition, hosted in Baltimore, home to Johns Hopkins University, one of the leading nutrition research institutions in the world. Five intense days with hundreds of lectures, presentations, panels and posters organized in themes ranging from cellular and physiological metabolism to global and public health nutrition. As expected, great learning and networking, accompanied by the recurring wish one could multiply oneself so as not to miss one or more exciting parallel sessions. Nearly 3,500 participants from scores of countries, albeit with diminished participation from Africa and Asia compared to last year’s edition. I had the opportunity to present a poster on complementary food safety and quality in Rwanda (poster shown below), the detailed content of which was recently published in Maternal & Child Nutrition.
A few topics stood out. Perhaps the most emergent was the microbiome, a theme that has now migrated from the margins to the center of clinical and translational nutrition. The most thought-provoking microbiome presentation in my view was by Dan Knights from the University of Minnesota. In a panel titled “You Are What Your Microbes Eat” exploring the interplay between diets and the gut microbiome, he borrowed from physics the metaphor of dark matter to describe the countless compounds present in foods that are not captured on any nutrition label yet strongly influence microbiome composition and metabolism. Intriguingly, responses of specific gut microbes to the same foods are often different from person to person, pointing to the need for a personalized approach to the microbiome and nutrition and mirroring the emergence of nutrigenomics and personalized nutrition, another salient topic in the conference.
Sustainability was another theme on the move towards the mainstream of nutrition, certainly influenced by the EAT-Lancet Food in the Anthropocene report[i]. The challenges of nudging consumers and food systems towards healthy diets and sustainability, and the multiple tradeoffs involved, were highlighted in several sessions, including a dense panel discussion moderated by Klaus Kraemer, Managing Director of Sight and Life, and Eileen Kennedy, Dean of the Friedman School of Nutrition Science and Policy at Tufts University.
A special event, rich in historical perspective and fond memories, was the Kellogg Prize for Lifetime Achievements in International Nutrition Lectureship. Marie Ruel, Director of IFPRI’s Poverty, Health, and Nutrition Division, was this year’s prize recipient, recognized for her outstanding work of more than 25 years on policies and programs to alleviate poverty, food insecurity and malnutrition in developing countries. What made the ceremony particularly touching was the presence of many other leaders in the field who were mentors, colleagues, or mentees of Marie’s, a testimony to the expanse and depth of her contributions.
My overall perception of the field, partly from having attended both the 2018 and 2019 editions of ASN, is that it is currently in a stage of incremental and relatively modest advances; areas such as the microbiome and personalized nutrition show tantalizing promise, yet they involve complex science in its early stages, which likely implies a translational pathway a few years long, not to mention translational challenges to low-resource contexts.
Impressions from Hyderabad
The second conference was the Agriculture, Nutrition & Health (ANH) Academy Week 2019. Held in Hyderabad, the bustling and sprawling high tech hub of Southern India, this was a much smaller and more intimate event of about 400 participants from a broad array of food system-related disciplines. It was the Academy Week’s fourth edition, the previous ones having been held in Addis Ababa, Kathmandu and Accra. The first two days were dedicated to learning labs, followed by a three-day research conference. Overall, a superb interdisciplinary and cross-sectoral gathering that stretched participants’ world views and thinking across boundaries.
And it was the progress in the interdisciplinary dialogue on food systems that impressed me the most. We have been talking about ag-nutrition integration for a few years now, but the road has been bumpy and uphill, with dissonances ranging from language to priorities and expectations. It felt so much smoother and fluid at this Academy Week. To me, this gathering was one among a number of signals that we are now reaching an upland in which we can switch gears towards more integrative thinking and holistic approaches to the food system. These refined approaches incorporate not just nutrition and health but also sustainability – now inextricably linked with agriculture –, equity and socioeconomic development, while acknowledging the need for inclusive governance to co-create win-wins and negotiate inevitable tradeoffs with fairness. The good research presented at the conference included innovative tools (such as Agrifood) to facilitate the complex and consequential decision-making involved.
I thus stepped into the second half of 2019 with renewed optimism from these two conferences and the complementary and increasingly convergent learning agendas they represent. Health system-based approaches and the first thousand-day focus remain vital, but are insufficient to address the multiple burdens of malnutrition. Food system-based approaches can benefit the whole population from cradle to grave, spanning the food insecurity-malnutrition spectrum and addressing other dimensions also relevant to nutrition outcomes. With these two wings in tandem, we will be able rise faster towards a better-nourished, healthier, fairer, and more sustainable world.
For additional pictures from ASN visit here and for ANH visit here.
[i] Willet et al., “Food in the Anthropocene: the EAT–Lancet Commission on healthy diets from sustainable food systems”. Lancet 2019; 393: 447–92.
Harnessing Public and Private Sector Engagement for Improved Nutrition
Breda Gavin-Smith, Global Public Health Nutrition Manager & Kesso Gabrielle van Zutphen, Knowledge and Research Manager
Most Recent, Perspectives
“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?
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 email@example.com
Breda Gavin-Smith, Global Public Health Nutrition Manager & Kesso Gabrielle van Zutphen, Knowledge and Research Manager
Most Recent, Demand Creation
With most food consumed across the world being obtained from the marketplace, from large, multinational companies to small street vendors, businesses have a significant influence on the food people eat. However, we know that businesses are interested in promoting their own products, thus there is a need for wide ranging market development for more affordable, accessible, and nutritious food.
There is increasing recognition on the role of demand creation for improving consumption of nutritious foods. Food purchase drivers, and subsequent purchase decisions, need to be addressed to adopt healthy eating behavior and improve diets. Yet, for that – fundamental questions have yet to be addressed:
What motivates consumers to buy and consume more nutritious foods?
How can we make nutritious diets and foods more desirable to consumers?
On March 2019, during the 4th Hidden Hunger Congress in Stuttgart, Germany, Breda Gavin-Smith, Sight and Life’s Global Public Health Nutrition Manager, co-chaired a session with Alessandro Demaio, CEO of EAT on “The role of demand creation in addressing the double burden of malnutrition”. The session brought together four visionaries in order to further understand the significant role of demand creation in improving the consumption of healthy nutritious foods.
The role of demand creation across the food system in addressing the double burden of malnutrition – setting the scene
Rowena Merritt, Head of Research at the National Social Marketing Centre, examined the principles underpinning demand creation and provided an overview on how it can address the double burden of malnutrition. Knowledge is not enough to change the behavior of beneficiaries and target consumers because rational decisions are overrated when it comes to food. When creating demand for nutritious foods, it is therefore imperative to link desired behavior change with something the consumer cares about. What is it that they value? What moves them? What motivates them? There is much the public sector can learn from the private sector when it comes to communicating promises and benefits (as opposed to facts, figures or product features as is often does) and there are successful examples showcasing this. The key and challenge is to offer consumers/beneficiaries immediate benefits that outweigh the barriers of changing their behavior. When this is done, we can start seeing a change in behavior.
“It would be easy to give the public information and hope they change behavior, but we know that doesn’t work very satisfactorily. [If it did] none of us would be obese, none of us would smoke and none of us would drive like lunatics.”
– Ian Potter, Director New Zealand Health Sponsorship Council
Identifying opportunities to increase supply and demand for nutritious foods – the Fill the Nutrient Gap
Natalie West, Nutrition Consultant at Fill the Nutrient Gap (FNG), looked at how the FNG assessment identifies opportunities to increase the demand for nutritious foods. The FNG situation analysis for decision making identifies context-specific barriers and entry points for food, health and social protection systems to improve nutrition through increasing availability, access, affordability and choice of healthy, safe, nutritious foods. It does so through the review and analysis of secondary sources of information on access to and availability of nutritious foods, and Cost of the Diet analyses and modeling that assess affordability of a nutritious diet, and possible improvements thereof. Stakeholders from multiple sectors (food system, health, agriculture, food processing, marketing, retail, and social and behavior change communication) are engaged throughout the process. Based on the FNG results, they formulate recommendations around improving nutrient intake, and supply and demand stimulation for nutritious foods. Demand creation is not only about consumer demand, but also about awareness and push by policy makers, to ‘enable’ or ‘allow’ consumers to have demand (i.e. making nutritious choices available and affordable).
An example of a double duty in action – incorporating demand creation as a key component in improving micronutrient intake in Ghana – the case of OBAASIMA
Daniel Amanquah, Food Fortification Specialist for Sight and Life, reviewed OBAASIMA which is a demand driven approach to address micronutrient deficiencies in Ghana. Consumer demand for nutrient-dense foods has a greater chance of success if foods fit the underlying consumer values that inform and guide consumption decisions and purchasing choices. Factors that drive demand for nutritious foods are convenience, affordability, and the aspirational value of nutritious foods. OBAASIMA recognizes the importance of consumer values and conducts insight research to help understand the target population. The OBAASIMA demand creation strategy draws on deep consumer insights and deploys above and below-the-line marketing to ensure continued consumer awareness and affinity for the OBAASIMA seal. The seal trademark is awarded to products that adhere to the minimum fortification content, as well as nutrition criteria on maximum allowable levels of sugar, salt, fat, and trans-fat. This helps inspire healthy food choices by making products easily identifiable and recognizable.
Chef’s Manifesto – leveraging chefs to create demand for healthier foods
Paul Newnham, Director at the SDG2 Advocacy Hub, spoke on the importance of engaging diverse actors in creating demand for healthier foods. New voices must be brought into nutrition conversations that are struggling to reach their target audience. As food influencers and the bridge between farm and fork, chefs have an important role to play in helping us to rethink food– what we eat and how its produced – with conversations that prioritize taste and language that inspires action. Present in our schools, neighborhood gardens, community projects and businesses, chefs can speak to farmers, consumers, politicians and communities alike with a message of sustainable, nutritious food for all to deliver the Sustainable Development Goals by 2030. Adding greater food diversity to our plates is a first step in making Agenda 2030 a reality, as biodiversity not only adds nutritional value to our diets but also strengthens food systems and builds climate resilience. The Chefs’ Manifestois an initiative that works to bring new voices into the food system debate, raise awareness about key challenges and solutions, and bridges the gap between high-level UN debates and the general public.
Food Forever and the Chefs’ Manifesto are joining forces to launch the 2020FOR2020 campaign whose aim is to inspire 2,020+ chefs from across the world to champion biodiversity by 2020. Chef actions will be showcased online and at global food events throughout the year to demonstrate how chefs can inspire better ways of cooking, eating and advocating for biodiversity conservation.
Find out more about demand generation and this Sight and Life session by checking out the presentations of each speaker:
The Society for Implementation Science in Nutrition (SISN) began on a wintery, New York evening in February, 2014. Eva Monterrosa, formerly Sight and Life’s Senior Scientific Manager, and Klaus Kraemer, Director of Sight and Life, together with Jessica Johnston and Rolf Klemm, met at Jean-Pierre Habicht and Gretel H. Pelto’s home to discuss a presentation by Eva on the role of context in fostering, developing and implementing nutrition interventions. Based on their previous experiences, they were concerned there was not a venue where the important ideas in the presentation could be published. The conversations began with the idea of creating a working group focused on implementation science, but quickly moved to consider a more formal, long-term institution, such as a scientific society.
The group appointed itself as a six member Secretariat. The first goal of the Secretariat was to identify a group of founding members for a meeting in Addis, Ethiopia during the Micronutrient Forum in June 2014. “The enthusiasm and broad support from the nutrition community for SISN and its role in convening and shaping the discussion for implementation research in nutrition was an exciting moment and positive affirmation we were headed in the right direction,” described Eva Monterrosa, who led the Secretariat. SISN was gaining momentum. Commitments came quickly from thirty-one experts with diverse experiences and the first meeting with the founding members in Ethiopia was a success.
The founding members all had years of experience in nutrition implementation and research and encompassed a range of organizational experiences, national perspectives, academic and cultural backgrounds, and program experiences. The list, in alphabetical order, consisted of: Mandana Arabi, Jean Baker, Gilles Bergeron, Martin Bloem, Howarth Bouis, Namukolo Covic, Luz Maria De-Regil, Stephan German, Stuart Gillespie, Jean-Pierre Habicht, CJ Jones, Klaus Kraemer, Karin Lapping, Rolf Klemm, Anna Lartey, Robert Mwadime, Banda Ndiaya, Lynnette Neufeld, Eva Monterrosa, Juan Pablo Pena Rosa, Gretel Pelto, David Peters, Juan Rivera, Marie Ruel, Werner Schultink, Meera Skear, Rebecca Stoltzfus, Emorn Udomkesmalee, Cesar Victora, Patrick Webb, and Stan Zotklin.
Understanding the Ambition
Implementation science was not in Sight and Life’s wheelhouse until Klaus Kraemer, Managing Director of Sight and Life, reviewed and was mystified by the data in the 2013 DEVTA trial, which was published in The Lancet. Previously, randomized controlled trials conclusively demonstrated that high-dose vitamin A supplementation of children under five years of age reduces mortality by 24%. However, the DEVTA trial in India showed a non-significant 4% reduction in child mortality. Jean-Pierre Habicht observed that “This randomized controlled trial, as is typical of such trials, was carefully designed to interpret positive effects as due to the supplementation. However, it was not designed to interpret a lack of effect”. In particular, it did not have plausible evidence of wide spread effective implementation.
The massive study had bare bone supervision of the intervention with only 18 monitors overseeing the work of over 8,300 Anganwadi workers and the participation of a million children. It also remained unclear how well mothers were counseled, how many and how often children received the intervention, how much of the supplement was wasted or shared, and what other socio-biological factors could have affected program utilization. Gretel Pelto pointed out that “understanding the behavior of implementing staff is as important as understanding household behavior” neither of which were studied by the DEVTA trial. The disconnect between the DEVTA trial and disconnect between all of the previous work, which had established the importance of Vitamin A supplementation for child survival and child health was the tipping point and motivation for Sight and Life’s commitment to implementation science. As Klaus Kraemer explains, “This drastic fluctuation in understanding the results of field trials clearly demonstrates the importance of implementation science and was a significant driver behind Sight and Life’s push to further implementation science.”
With a mission to convene, advocate, disseminate and promote dialogue among scientists, policy leaders, government officials, funders and practitioners to advance the science and practice of nutrition implementation world-wide, SISN headed into its first operational year (2015) with a full agenda. Following a two-day meeting in Castel Gandolfo, Italy, SISN was officially established with the proclamation of the Lazio Declaration. By the end of 2015, the inaugural board was nominated, elected and set to meet that December.
Meanwhile, the Lazio declaration served as a culmination of the efforts of many people, and highlighted the importance of implementation science. Read more on this important milestone here.
In 2016, Sight and Life committed to continue supporting financially by funding the Secretariat activities and advocating for implementation science. “Creating a new institution was a challenge,” explains Eva Monterrosa. Recently she said, “We are incredibly grateful for the generous support of Sight and Life funding the Secretariat and operations for SISN over the last three years.” The 2016 calendar year featured a strategic plan for SISN to increase awareness, build membership, and continue to build a solid foundation. Putting the plan into action began with a symposium on implementation science during the Experimental Biology conference in Chicago, and the Micronutrient Forum in Cancun where SISN developed the following symposia:
The interest in the topics was apparent as the sessions drew crowds with an overflow of people listening from outside the room. “The especially keen interest of students, seeing the value of implementation science and hungry to learn how to do it,” describes David Pelletier, Past President of SISN.
Behind the scenes the SISN team had been diligently working to develop a robust website, implementnutrition.org. The site launched in the spring of 2017, activating new members and providing a wealth of information about implementation science. At the same time, the final paperwork was also approved and SISN became incorporated in the USA as a non-for-profit education corporation. While internally several working groups including methods, membership, and communications, as well as a finance committee were formed.
As the structure of SISN builds, so does its exposure. On November 7th, 2017, SISN along with the International Food Policy Research Institute (IFPRI), and the Scaling Up Nutrition (SUN) secretariat co-hosted a workshop session at the SUN Global Gathering in Abidjan, Côte de Ivoire, on “Sharing Knowledge, Methods, and Experiences on Implementation: How can SUN Countries Better Implement Priority Actions?” The workshop was organized as part of the ongoing Knowledge for Implementation and Impact Initiative (KI3). An initiative jointly implemented by these three organizations, with the overarching goal of closing the knowledge and communication gap among nutrition knowledge generators, policy planners, and implementers in SUN countries.
Also in 2017, at the International Union of Nutritional Sciences – International Congress of Nutrition (IUNS-ICN) in Argentina, a SISN and Nutrition International (NI) co-sponsored symposium entitled “Evidence-based integration of nutrition across multiple sector programs: how can this be done?” was presented and very well attended. Additionally, outreach to the CDC, USAID, the USG Interagency Working Group on Implementation Science was established and SISN received a sub-award for implementation research in Kenya and Uganda in partnership with 3ie.
“It’s been a journey from a small group of highly committed founding members to 200 global members. And we are still growing and establishing our organization,” described Eva Monterrosa as the year came to an end, “The ideas, and dedication of inaugural Board and members has positioned SISN an institution leading the implementation research space.”
Importance of SISN
SISN’s vision is a world where actions to improve nutrition are designed and implemented with the best available scientific knowledge and practical experience that promotes effective actions. Policy makers, funders, and community members will benefit when scientists and practitioners work together to answer ‘how to implement effective nutrition actions’. “We are currently enjoying an unprecedented window of opportunity to address nutrition through national policies and large scale programs,” states David Pelletier, Past President of SISN, “Now we must deliver the goods by showing results, or the window may close and remain closed for another generation. Implementation science and research is vital for showing those results.”
SISN looks to support and positively impact global nutrition outcomes. “Achieving 2025 global target set by the World Health Assembly (WHO), will require a concerted effort,” explains Eva Monterrosa. “SISN, as a convener, can bring together various stakeholders and assemble and organize different types of knowledge, methods, and approaches that are required to advance how we implement effective nutrition actions to meet our targets for anemia reduction, low birth weight, exclusive breastfeeding, and wasting.”
At SISN, diversity is valued and there is a strong belief that scientists and practitioners are co-producers of implementation knowledge, and both play incredibly important roles in shaping the field of implementation science in nutrition. David Pelletier explains, “The world is awash with evidence and knowledge to improve implementation and impact but facing a major non-utilization crisis; SISN is dedicated to enhancing utilization of existing knowledge in addition to generating new knowledge that is useful at local, national and global levels.”
Everyone is welcome! As SISN continues to forge ahead, the members need to include visionaries, doers, and people who are undaunted by the task ahead, which is to create a new institution that will benefit millions of people around the world as well as our scientific and practitioner communities. Being a member-based organization, SISN is as strong, innovative, and creative, as its membership.
SISN provides a global platform for members to learn, share, and network with like-minded people while paveing the way for professional development opportunities. Becoming a member is a great way to be a part of shaping the future of implementation!
OBAASIMA is a trusted trademark for fortified foods aiming to increase the availability of and access to affordable, safe andnutritious food products for Ghanaian women. This engaging initiative has been making waves when it comes to developing fortified food products in Ghana.
Recently, OBAASIMA has collaborated with Premium Foods Limited, an agro-processing company with a focus on breweries, poultry farmers, and food distributors. Over the past 20 years they have worked with smallholder farmers, addressing nutritional needs through local food staple fortification for industries, including rice, cassava, maize, soya beans, millet, and sorghum to meet the micronutrient requirements of Ghanaian’s. Premium Foods has a strong focus on nutrition, making sure nutritious and affordable foods are available to everyone, especially for their target market. Here at Sight and Life, we had an opportunity to speak with Gladys M. T. Sampson, General Manager of Premium Foods Limited, about malnutrition in Ghana and their collaboration with OBAASIMA.
GS: Gladys M.T. Sampson SAL: Sight and Life
SAL: What is the key reason Premium Foods has decided to align its products with the strict nutrient profile required for the OBAASIMA seal?
GS: In the past, Premium Foods has been a business-to-business company adding nutritional value to grains and other staple foods in order to meet micronutrient deficiencies in Ghana. The OBAASIMA label is authentic; it shares the same mandate and supports our target consumers to meet their micronutrient requirements. To the Premium Foods brand authenticity is important, so when we have an authentic label, like OBAASIMA, associated with the brand it is ideal. This is what convinced us to collaborate with OBAASIMA.
SAL: What was the biggest issue you faced when signing on with OBAASIMA?
GS: Initially, we had a different micronutrient formulation in our product than the nutritional requirements of OBAASIMA. This was the only thing that we were discussing and we decided to include the whole spectrum of the micronutrient requirement in our product. It was a positive discussion leading us to change our micronutrients composition to adapt to the OBAASIMA label.
SAL: What are some of the biggest challenges you face in providing nutritious products to consumers? Moreover, how does the OBAASIMA seal help resolve those issues?
GS: The only challenge on my end is that being a business-to-business company, we need to learn the most effective ways to market and distribute our new consumer products. However, working with OBAASIMA, which focuses on consumer products, enabled us to tap into their experience and ensure we can move into this area.
SAL: Can you share any details about your first product for OBAASIMA?
GS: It is a porridge. The product is called “LOVIT,” a blend of maize and soya beans fortified with minerals and vitamins meeting the requirements of the OBAASIMA seal.
SAL: In your opinion, what makes the OBAASIMA seal stand out from other options?
GS: There are various products on the market and OBAASIMA, in our language, stands for the perfect woman, a holistic woman. So the label itself sends a positive message and is appealing to consumers, well that is what I think. It is something positive.
SAL: What has exceeded your expectations by using or working with OBAASIMA?
GS: Looking back at the product development process with Daniel and Jonson from OBAASIMA, we received a lot of technical inputs from them. Their willingness to contribute and ability to advise on technical issues is something that is a plus and a benefit I cannot quantify.
SAL: What is the main reason you would recommend to others to use the OBAASIMA seal with their products?
GS: I think as a nation (in Ghana), we have a problem with hidden hunger, which means a low intake of many important micronutrients. I think that if we are looking to fight hidden hunger together as a nation, then we need to create more of these products with the OBAASIMA label. To consumers this authentic label guarantees your food product can help meet your micronutrient requirements. Although, Premium Foods cannot do it alone.
SAL: Well, this sounds like a fantastic partnership. Thank you for doing wonderful work and collaborating with OBAASIMA.
Sight and Life Nutrition Kiosk: Reaching the Last Mile in India
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.
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?
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 health 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.
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.
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:
Can the Food and Beverage Sector Contribute to a Healthier Society?
Despite the progress made over the past few decades, malnutrition remains a leading global challenge and a major obstacle to achieving the Sustainable Development Goals. 88 percent of all countries face a serious burden of at least two of the three forms of malnutrition – undernutrition, micronutrient deficiencies, and overweight/obesity1. Worldwide, stunting still affects 155 million children, and 52 million children are wasted. 2 billion people are micronutrient-deficient, while another 2 billion adults and 41 million children are overweight or obese. The global community is off-course to meet the agreed-upon global nutrition targets.
Fueling the Dilemma
Central to the challenges of malnutrition in its three modalities, as well as to the approaches to address them, are food systems. Food systems – the set of processes of production, processing, marketing, distribution, purchasing, and consumption of food, together with the consumer practices, resources, and institutions in these processes – are major determinants of food quality and choices and consequently nutritional status and health. The private sector – from multinationals to smallholder farmers – is the engine that drives food systems, with the food and beverage (F&B) industry playing a unique and powerful role. The F&B sector has a disproportional impact on nutrition and health outcomes as the “nutrition transition” in low and middle-income countries (LMICs) has shown, with increased consumption of sugar, fats, refined grains, and highly processed foods2. In LMICs, F&B industry products represent a growing share of local diets, driven by urbanization, rising incomes, maturing supply chains, and increasing demand for processed foods due to their convenience and extended shelf life. Though taking place at a faster pace in cities, this transition is increasingly reaching rural areas.
The associated global obesity epidemic3, which has engulfed developed countries and LMICs alike, is costing the world an estimated US$ 2 trillion annually. Noncommunicable diseases (NCDs) now account for 68 percent of all deaths worldwide, with three of the four most prevalent ones – cardiovascular diseases, cancers, and diabetes – being associated with diets4. The global community may well have reached a tipping point with the accumulating evidence on the global and serious nature of overweight and obesity and their major contribution to the increasing burden of NCDs and premature death. Urgent, comprehensive, and systematic action is called for now to reverse this tide.
Unraveling the Issue
Together with consumer choices and lifestyles, the F&B sector’s influence on these trends and burden is undeniable. Moreover, the industry’s contribution to reducing undernutrition and micronutrient deficiencies has been insufficient, with numerous missed opportunities to help address these burdens across countries and markets.
Five key levers can be employed by society to improve the F&B sector’s contribution to improved nutrition and health: incentives, a favorable enabling environment, consumer education and demand, safety net procurement, and direct pressure and accountability from consumers, grassroots organizations, high-value employees, and investors. Incentives through various policies can be strong inducers of positive action by private sector actors. Tax policy, for example, can both incentivize increased availability of affordable nutritious foods and discourage production and consumption of poor quality foods. A favorable enabling environment, primarily instituted by the public sector, can reward F&B players which contribute to public health and discourage or penalize those that don’t. Consumer education and demand can pull the whole food value chain towards sustainable diets and compel companies to offer a nutritious, sustainable, and ethical product portfolio. The recent clean label movement in high-income countries5 illustrates the power of consumers to catalyze major industry shifts. As institutional buyers such as national governments and multilateral agencies step in to ensure the poorest of the poor are covered, they contribute to the viability and sustainability of nutrition-minded companies. Last but not least, the voice of society through various actors and channels can both inhibit the most egregious corporate actions in the short term and promote long-term steering and investment in a nutrition-positive direction. An auspiciously growing trend are right-minded nudges on firms from large individual and institutional investors, including asset managers and pension funds, as highlighted by the recent letter from the CEO of BlackRock, the world’s largest asset manager, to his fellow executives.
A number of industry initiatives and public-private partnerships have made valuable contributions to improving nutrition outcomes through product reformulation, improved labeling standards, restrictions on marketing and distribution to vulnerable groups, and disincentives to consumption of poor nutritional value products of such as sugar-sweetened beverages through taxation. In LMICs, these efforts have concentrated on food safety or fortification of staple foods (flour, rice, oil), and condiments with micronutrients. Some of them, including the OBAASIMA program in Ghana, have applied a category branding approach, with the use of a “quality seal” logo to distinguish products meeting nutrient profile (sugar, salt, saturated fat) and fortification standards.
Evolving Over Time
Today, LMICs grapple with the full spectrum of malnutrition challenges, with a persistent burden of undernutrition and micronutrient deficiencies combined with a rising tide of overweight and obesity. The aforementioned tipping point of awareness may well represent a leapfrogging opportunity for LMICs as their food systems develop and their F&B sectors mature and can better align their strategy and investments with societal needs, thus avoiding the enormous burden this misalignment has imposed elsewhere. Key to this alignment is a systemic approach that encompasses all three modalities of malnutrition, includes actions that both promote the consumption of nutritious foods and reduce that of poor quality products, and addresses the critical areas in which F&B companies can make the greatest difference to nutrition outcomes: product portfolio and labeling, marketing communications and practices, and availability and affordability for low-income consumers.
Aligning the F&B sector with societal needs is a long, winding, and overdue journey, which will ultimately benefit all individuals in all countries, as consumers, suppliers, employees, or shareholders, as well as the planet. Let’s embark on this likely bumpy ride and step on the gas – a healthier, happier and more productive world awaits us and our descendants.
1Global Nutrition Report 2017. 2Hawkes, Corinna; Harris, Jody; and Gillespie, Stuart. 2017. Changing diets: Urbanization and the nutrition transition. In 2017 Global Food Policy Report. Chapter 4. Pp 34-41. Washington, DC: International Food Policy Research Institute (IFPRI). https://doi.org/10.2499/9780896292529_04. 3WHO, Controlling the global obesity epidemic. Available at http://www.who.int/nutrition/topics/obesity/en/. 4World Bank, An Overview of Links between Obesity and Food Systems; Implications for the Food and Agriculture Global Practice Agenda.June 2017. 5Kerry, Beyond the Label: The Clean Food Revolution. Available at https://go.kerrycleanlabel.com/cleanlabelwhitepaper/?.
An engaging initiative called OBAASIMA has been making waves when it comes to developing fortified food products in Ghana. OBAASIMA is a trusted trademark aiming to increase the availability of and access to new affordable nutritious fortified food products for Ghanaian women.
The inspiring team behind the OBAASIMA seal is dedicated to changing the food environment in Ghana by creating healthy food options for women. At Sight and Life we are passionate and supportive of OBAASIMA’s pursuit and wanted to learn more about what drives the group behind the OBAASIMA seal. Therefore, we sat down for an interview with Daniel Amanquah, OBAASIMA’s fortification specialist, to find out what makes him tick and much more.
SAL: Tell me a little bit about your background in nutrition.
DA: I attended the University of Ghana in Legon and graduated with a Master of Philosophy in food science and a Bachelor of Science in nutrition and food science. During university, I had an internship in a factory working with a couple of companies to help introduce new products to the market. Following school, I worked with a colleague to develop our own food product in which we wrote, “Development of a Tigernut Based Ready–to-Use Therapeutic Spread” which was published in the International Journal of Agricultural Policy and Research.
SAL: Describe your current role at OBAASIMA.
DA: My current role at OBAASIMA is as the food fortification specialist working on behalf of Sight and Life in Ghana. One of my key focus areas is supporting companies who sign onto the OBAASIMA seal. This work involves modifying the product to include the vitamin and mineral premix and examining the nutrition profile to ensure it fills the criteria developed in the OBAASIMA seal code of conduct. This stipulates acceptable levels of sugar, fat and salt level for products to carry the OBASSIMA seal. We then test the premix with a scientific analysis to make sure we are on track to develop quality food products.
What I love about my role is visiting the factories, sitting down with the key players, and working through the product development phase.
SAL: How did you hear about OBAASIMA?
DA: My first job was with the GIZ in 2014 and I was part of the inception team for OBAASIMA when the project was called “Affordable Nutritious Foods for Women (ANF4W)”. I was the technical officer for the project and collaborated with Sight and Life, Children’s Investment Fund Foundation (CIFF) and colleagues at GIZ to get the pilot phase of the project up and running.
SAL: In two words how would you describe OBAASIMA?
DA: One word is innovative. The second, I would say, is complex. OBAASIMA is a very good model for a lot of companies in low- to middle-income countries to alleviate micronutrient deficiencies and encourage healthy eating.
SAL: What do you like most about working for OBAASIMA?
DA: What I like most is the team, teamwork, and authenticity.
SAL: What is the biggest challenge for OBAASIMA?
DA: Acquisition of companies to join the OBAASIMA seal has been quite tough especially with the level of sugar required as part of the seal. Sugar is a driving factor for companies, particularly juice and beverage companies that have a lot of sugar in their products. We have not been able to engage any of them yet, but we are still working hard to get them on board. The OBAASIMA seal has quite stringent qualifications, so it is quite difficult for a company that is not nutrition sensitive to join the seal.
I mean you speak to people about nutrition and they know about good nutrition. However, the industry tells you, “But, this is what is on the market, this is what people are buying. So why do you want me to change the formulation? Why do you want me to make it more healthier?” Therefore, it is interesting and complex to convince companies to include the OBAASIMA seal on their products. They know it is beneficial to reduce sugar and fat while including micronutrients, they know it is going to help reduce malnutrition and the double burden of malnutrition, specifically in Ghana where you have high obesity rates. So they know this and they appreciate it but they tell you, “the market is not like that, and the customers want this.” Albeit, we do have successes and the momentum is growing.
SAL: In your opinion, what makes the OBAASIMA seal stand out?
DA: The innovation that comes with the OBAASIMA seal has not been done or piloted anywhere in the world, at least not that I know of. Currently, Zambia, through the SUN Business Network, has a similar seal, however, it is a general seal for good nutrition not for a specific target group. OBAASIMA is unique. It is only for processed and package foods, which are ready to eat and includes 18 essential vitamins and minerals for women of childbearing age. We believe the focus on the first 1,000-days is crucial to addressing malnutrition in women and children. This is the first time we are doing something like this in Ghana, and I am proud to be a part of it. The results that will emerge will be a good model to demonstrate what can be done and replicated in other places as well.
SAL: What does the future look like for OBAASIMA?
DA: To broaden it, not just for women of child-bearing age, but for all segments of the populations and to go beyond Ghana. I see in a few years several multi-national companies signing on to the OBAASIMA seal and a global movement of eating healthy and getting healthy processed foods onto the market. We have a lot of work on our hands.
The landscape is changing and we will get to a time when people will demand healthier foods for their children and themselves and enforcement of healthier product profiles will being to happen. Companies will be forced to cut out the less desirable ingredients such as sugar. Once we get multi-national companies to come on board, adaption will follow, every other company will follow, and the OBAASIMA seal will become big. So I believe there is a future for this seal, it needs more advocates! We will get there.
SAL: Well, you have a mighty large task ahead of you to recruit many of these companies to join the OBAASIMA seal. Sight and Life supports and applauds your efforts to make these changes and wishes you much success on furthering this great, great initiative.
On June 7th, 2018, only three-days after starting my summer internship with Sight and Life, I found myself on a long-haul flight traveling to Boston, Massachusetts, from Switzerland. I was invited to join the Sight and Life team at the American Society for Nutrition’s (ASN) Nutrition 2018 conference – what an incredible opportunity! I could not have been more excited for this perfect introduction into the world of nutrition, particularly since I am interested in applying my current academic background in economics and law to the field of nutrition.
Initiation as an Intern
On the first day, I participated in a team workshop where I met the global team of Sight and Life – such an interesting mix of people! As a complete newbie, I quickly observed that the team is held together by their passion for nutrition, as their backgrounds are quite diverse. Besides nutritionists and scientists, I was stunned to discover there is an assortment of business, communications, marketing, and architecture degrees amongst the group. Additionally, I gained insight on how Sight and Life operates. The team of twelve is spread across four different continents – India, Egypt, Switzerland, South Africa, and USA – completing the majority of their work remotely and therefore making team retreats of great importance.
The workshop focused on ‘design thinking’ and was a great opportunity for everyone to learn a new method of problem solving. Additionally, having a team with a wide variety of knowledge and experiences presented interesting and rich discussions the during group exercises. The most valuable take aways, for me, were learning the importance of a broad stakeholder analysis, defining a high potential but underdeveloped stakeholder, and how you can engage with an assortment of stakeholders within a complex interdependent system. This mirrors the importance of a multi-sector and multi-stakeholder approach to solving the complicated malnutrition puzzle. The day culminated at Fenway Park cheering on the Boston Red Sox’s as they played the Chicago White Sox for a Sight and Life team outing.
A Peek into Nutrition
For the next three days, I participated in ASN’s Nutrition 2018 at the Hynes Convention Center. As I have never been to a conference, let alone one focused on nutrition, and I was eager to see how it all worked. With over 3,500 participants registered, it was shaping up to be the largest ASN conference so far. When I walked through the main entrance for the first time, I thought something probably quite typical of a European in America, “Oh my god, this is so big!” Sight and Life showcased a booth in the gigantic exhibitors hall, but there was also several floors of meeting rooms where I would spend the coming days in listening to interesting presentations.
Eager to learn, I attended as many sessions as I could possibly fit into my schedule covering a wide variety of nutritional topics. I didn’t know what to expect when I saw the list of speakers for each session, naively I thought they would all sit in front and have a panel discussion. However, they were mostly individual presentations sharing the results from their recent research. I learned about behavior change communication, nutrition education, heard about different nutrition strategies and their implementation, and community health interventions that were completed in India and one in a refugee camp in Beirut.
For me, the most interesting session was “Demographics, Diversity and Disparities in Nutrition Science”. A few speakers presented research that was focused on a specific region in Hawaii, USA, and an ethnic group of American indigenous people while others presented nutrition issues and development on the global level. The most shocking session I attended was, without doubt, about the nutrition situation of Native Americans by Dr. Donald Warne, a member of the Oglala Dakota tribe from South Dakota, USA. He provided extensive evidence that one does not have to travel far to find health issues as they exist in native communities in the United States of America. He argued that it is almost perverse that in America you are automatically eligible for dialysis in the case of kidney failure; yet, a child is not automatically eligible for healthy food. An anecdote that resonated with me was a story Warne shared of three sisters illustrating the importance of targeting health problems at their roots.
As three sisters walk along a river, they see there are children in the river who cannot swim and are about to drown. One of the sisters says, “Something needs to be done.” She jumps into the river and tries to save the children. The second sister disagrees with the first one saying, “We just need to teach them how to swim!” The third sister has not said or done anything, and the other two are furious with her. “Why aren’t you helping us?” they exclaim, “These children need to be saved!” The third one turns away and starts to walk up the river saying, “I will find and stop the person who is throwing these children into the water.”
Experiencing the Conference
During the three days, my time spent at the Sight and Life booth was both busy and truly engaging. I found it most interesting to talk to students, researchers, journalists, and scientists from all over the world and explain what Sight and Life stands for. It was intriguing to visit the other exhibitors at the conference presenting a variety of nutrition topics from non-profit organizations fighting malnutrition to private corporations offering vitamin supplements. One booth representing a company called Allulite Rare offered samples of chocolate and gummys made with a new kind of sweetener that tastes just like sugar, but without all the disadvantages such as calories, glycemic effect or digestive upset. At the InBody exhibit, I had a body measurement analysis done free. This machine provides individual results for weight and body fat percentage as well as the distribution of lean muscle mass in less than a minute.
A highlight for Sight and Life was the Elevator Pitch Contest, where selected students and young researchers presented their innovative ideas on nutrition assessment to a panel of experts. It was fascinating to hear about these cutting edge concepts and that many people my age share the passion for nutrition. Many of the presentations introduced fascinating new mobile applications for measuring food intake. One of my favorite pitches was from Andrea Spray of INATU, standing for ICT’s for Nutrition Agriculture and Time Use. By attaching a tiny camera to women’s clothing, the device provided in-depth research for nutrition assessment as the device automatically takes a picture every minute. Her project in Africa proved that the gadget was generally well received in communities and proved to be a good option for measuring nutrition behavior remotely without much paperwork – this was an interesting idea. It is impressive to see the tremendous progress that can be made in a relatively short time when one is focused on a goal and teams up with the right people.
After spending a sunny day sightseeing in Boston, I once again found myself onboard a flight back to Zurich. It was an incredible experience. I learned so much about nutrition, the broadness of the worldwide nutrition issues currently at hand and the importance of bringing all stakeholders to the table. I would like to thank the Sight and Life team and my boss, Klaus Kraemer, for making this possible and for welcoming me into the Sight and Life family.
Ever wonder what happened to the first Sight and Life Elevator Pitch Contest finalists from 2016? Sight and Life had the privilege of catching up with four of the ten finalists from Elevator Pitch Contest to find out what they are up to now and reflect on their experience.
During this competition, graduate and post-doctoral students were invited to submit their ideas on the theme ‘The Future of Micronutrient Innovation’ across diverse categories in nutrition-related products, services and technologies. We received over 90 submissions from students in 18 different countries. With the support of a distinguished jury, we narrowed the selection to ten bold ideas for presentation. The finalists were sponsored by Sight and Life and Tata Trusts, who mentored them as they prepared to present their ideas to a panel of experts, in front of an audience of conference participants during the Micronutrient Forum in Cancun, Mexico. Read more about the 2016 Sight and Life Elevator Pitch Contest here.
The first and second place winners, Muzi Na and Nicholas Myers, share their status and weigh in on the Elevator Pitch Contest along with finalists Nicholas Myers and Sambri Bromage.
Concept: Empower Grandparents – A mobile application using SMART feeding messages that empower senior caregivers, such as grandparents, to better feed their grandkids in rural China.
Na was the first place winner of the 2016 Elevator Pitch Contest with her innovative mobile phone application and persuasive pitch. Today, the idea is on paper with plans to write grant allowing her to collect data about acceptability regarding the idea among the target population. Currently, Na is on faculty at Penn State University as an Assistant Professor in Nutritional Epidemiology.
Concept: Next Generation Supplement Design – A novel nutritional supplement to optimize the mother’s micronutrient status in early pregnancy to better regulate infant epigenetics and decrease future disease risk.
A future full of potential, James caught the attention of the jury panels with his inventiveness in 2016. The nutritional supplement has now been designed and is currently in the process of setting up a clinical trial in Gambia to test its effectiveness in correcting micronutrient deficiencies. James and histeam is also looking at how nutrition in pregnancy, particularly at the time of conception, has the potential to influence the way an infant’s genes are expressed, and the implication this may have for the health of that child over his or her life.
Concept: Paper Analytical Devices – A lab-on-paper that measuresiodine levels in salt and urine samples to monitor iodized salt programs at a low cost in real time.
Myers has found support through The Black Lion Hospital, in conjunction with the Ethiopian Food, Medicine, and Health Care Administration and Control Authority, and is performing an implementation study in Ethiopia. If the study is successful, health agencies and governments may use the test card to monitor the quality of iodized salt in marketplaces.
With a shift from the nutrition field to public health, Myers has adapted the chemistry of his iodine test card to instead quantify the amount of penicillin-class antibiotics present in finished pharmaceutical pills with greater than 95% accuracy. His hopes are that the test card becomes a field-friendly technology that governments use to detect breaches in medicine compliance.
Concept: Leveraging Academic Networks for Dietary Survey (LANDS) – A global student-centered network for collecting, analyzing, sharing, and applying dietary data from populations in low-and middle-income countries.
Today LANDS is used in Mongolia with interest to expend it internationally. Bromage is currently finishing his dissertation on “Epidemiology of dietary and micronutrient deficiencies in Mongolia” and beginning the search for a post-doc position or job. In tandem, he is working on new and interesting projects that he will be able to share in the future.
1. What did participating in the Sight and Life Elevator Pitch Contest mean to you personally and your innovation?
Na – The Sight and Life Elevator Pitch Contest meant a lot to me! Personally, the contest provided an opportunity for me to meet and know manyyoung innovators working in diverse fields all over the world. From the innovation’s perspective, the elevator pitch style is very different from writing a proposal or a manuscript, as there is a short window of time to articulate an idea, including the rationale behind the idea and the potential impact. I really want to thank Sight and Life for organizing this fantastic event, in which I discovered new possibilities to share and sell novel ideas that aim to tackle nutrition problems.
James – It was a privilege to be short-listed for the contest. Being able to attend the contest at the Micronutrient Forum enabled me to meet so many people from different fields in nutrition, to network with people who were interested in my team’s project and to be able to benefit from everything else happening at the Forum.
Myers – As an inventor, I welcome any chance to disseminate information about my invention. At the competition, I pitched an idea about an inexpensive paper test card that quantifies iodine levels in fortified salt with greater than 90% accuracy and how it can be used in low- and middle-income countries. At the time of the contest, my invention was making its way through the “Valley of Death,” which is a relatively low funding period between R&D and commercialization. The contest provided a platform on which I, a chemist, reached hundreds of experts in the micronutrient sector, and these multi-disciplinary connections are critical to push an invention through the “Valley of Death” and to commercialization.
Bromage – Participating in the Sight and Life Elevator Pitch Contest helped me realize the international potential of my innovation. Personally, it exposed me to nutrition innovation, a part of nutrition I have not had much experience with as I mostly work in research.
2. What was the biggest challenge you experienced through the creation process of your innovation?
Na – I guess there were many challenges but the biggest one for me probably was to identify the ‘big’ problem that maybe solved by a ‘small’technology, which I understood. Once a niche target population was identified, the process to identify and design an intervention, applying feasible technology to serve the population was straightforward.
James – The field of nutritional epigenetics is still rapidly developing, so consolidating the evidence base to design a supplement was an interesting but challenging piece of work.
Myers – The biggest challenge for me was overcoming small but daily setbacks. I had to rapidly prototype dozens of devices with relatively minor changes, most of which did not work. I came to term this ‘Edisoning’ as Thomas Edison had to follow a similar process as he trialed 2000+ materials to develop the light bulb. My technology and I survived the research and development phase because I saw the benefits of the final product outweighing the emotional, physical, and monetary costs to create it.
Bromage – My biggest challenge is getting other people interested in my innovation because I am not really a natural born salesperson.
3. What was the most memorable moment from the Sight and Life Elevator Pitch Contest?
Na – It was the moment I decided to stay among the audience and not to give the pitch behind the podium. It was a completely random thought, mostly because I was very nervous. Once I started my pitch right next to the first row of listeners, I immediately felt a connection with the audience. It was an amazing feeling and my nerves immediately disappeared.
James – The session when we delivered our presentations was a great experience. It was so good to hear everyone’s pitches, get inspired by the creativity in the room, and to have the support of a room full of interested people. It was also encouraging afterwards to network with people who had further questions and advice.
Myers – The moments I enjoyed the most happened behind the scenes when all the innovators had the opportunity to get to know each other personally. We are not just a bunch of mad scientists- we are a group of seemingly ordinary people with a shared desire to improve health, and with the motivation to do so.
Bromage – Getting to meet the other contestants and the Sight and Life team including Kalpana Beesabathuni, Kesso Gabrielle van Zutphen, and of course Klaus Kraemer.
4. What lesson(s) did you learn from your experience?
Na – Be bold, be confident. No idea is too small to share. Lastly, but not least, it is important for any speech-based contest to practice, practice, and practice.
James – It was a great opportunity to learn how to explain an idea succinctly and avoiding technical jargon. An elevator pitch is a very different style of communication than I was previously used to and this was the ideal setting to learn more about how to develop those skills.
Myers – Even though I was one of the winners, investors and buyers are not knocking down my door to advance the technology. The lesson I learned is that perseverance is needed at all steps of product development and that I will have to keep pushing just as hard as I did through the research and development stage to survive the commercialization phase of my invention. It took a lot of hard work and gumption to achieve what I have so far, and it will take at least as much to reach the next level.
Bromage – Some of the greatest innovations are not devices but rather new ways of thinking about the world.
5. Where do you see the future of nutrition?
Na – I see a lot of potential for the future of nutrition is from the interdisciplinary perspective, where technology, engineering, biology, and other disciplines interact with nutrition making groundbreaking discoveries as well as solving critical nutrition and health problems.
James – I see a future where nutrition continues to be integrated with other sectors and disciplines. In my field that means analyzing nutritional biomarkers together with metabolomics, genomic, and epigenomic data to broaden our understanding of the complexities of human metabolism.
Myers – The future of nutrition relies on all of us being citizen scientists making information-based health decisions. Ordinary people need to be provided easy-to-use and robust technologies to help them with these choices. We saw this at the competition, especially with the technologies presented by the three winners.
Bromage – Dealing with the effects of climate change.
Interested in learning more? Read the about the next group of EPC alumni here.
Expand your Knowledge
Recommended Reading on Behavior Change Communication
At Sight and Life, we are pleased to share knowledge and recommend resources that we find useful in our work. This is certainly the case with behavior change communication (BCC).
To expand your knowledge about the steps in the Sight and Life BCC Process we shared during the webinar “Assessing the Situation: What you need to know” in our BCC webinar series, we have collated an array of books, websites, and papers that are valuable resources. This is just our opinion but we hope these recommendations can deepen your knowledge on BCC and provide though-provoking ideas and inspiration as it did for us.
During this second webinar in the series, we discussed Step 2 and Step 3 in the Sight and Life BCC Process; the desk review and client research.
The key takeaways from this webinar are:
– The BCC principle ‘know your audience’ lies at the core of developing successful nutrition communication campaigns.
– Defining your knowledge needs, or simply what you need to know, is the first critical consideration.
– Step 2 in the BCC process isabout assessment, analysis, and synthesis of information to effectively answer questions on the broader context, thedrivers and constraints for the target behavior and communication efforts previously employed to change the desired behavior.
– Client research, step 3 in the BCC process,involves gaining valuable insights from the target audience and communities that you seek to change.
Watch the video of webinar 2 below and find the complete slide deck from the second Sight and Life webinar HERE.
In this paper, PSI, a leading social marketing and behavioral change communication NGO describe how they improved the use of research to gain better consumer insights and plan better interventions. It offers a practical perspective through the lens of an organization where research is core of the business.
Why do we like this?
We think this paper is insightful for any organization wishing to strengthen their qualitative research capacity for improved target audience insight generation. The paper lays out how an organization focusing on behavioral change, has sophisticated their approach to qualitative research to improve their programmes over time.
Why do we like this?
The Health COMpass provides evidence-based, easy to understand tools – ready to take and apply to a real-life context for beginner and specialists in behavioral change alike.
3.The UK National Social Marketing Center
This former non-profit and now agency offers a comprehensive step-by-step guide on developing a behavioral change intervention. Of specific interest is the section on generating insights, in their planning guide as well as the real-life examples of behavioral change interventions, in the showcase section, you can learn how insights were derived from research to development.
4. Innovative Research Methods – Roleplay
As we often conduct research on topics that can be sensitive such as personal health or child feeding practices, creating an environment where the interviewee feels comfortable and at ease, enough to open up to the interviewer is often a challenge. The choice of a research method that best fits the environment is key. Using roleplay for research is an innovative way to allow the interviewees to ‘act-out’ their behaviors, concerns, beliefs, and barriers with others rather than be interviewed. IDEO, a social innovation consultancy, uses this method successfully and provides free tools to download.
Why do we like this?
Innovative research methods to tailor how we approach our audience and adhere to their needs and contexts is an important part of ‘knowing your audience’. Roleplay provides an applicable research method and in this blog post the author and practitioner of roleplay provide great insight into how this methodology works in practice.
5.Thinking Fast and Slow by Daniel Kahneman
Drawing on decades of research in psychology that resulted in a Nobel Prize in Economic Sciences, Daniel Kahneman takes readers on an exploration of what influences thought example by example. System 1 and System 2, the fast and slow types of thinking, become characters that illustrate the psychology behind things we think we understand but really don’t, such as intuition.
Why do we like it?
In webinar 2 we talked a lot about the BCC principle ‘know your audience’ and this book is an interesting examination of human behavior and how we think. It is a comprehensive explanation of why we make decisions the way we do and how the decision-making process can be improved. An interesting tidbit is our decisions are strongly colored by how we frame questions in our minds. Simply re-framing a question can easily cause people to reverse decisions. We need to understand these framing issues in order to avoid bad decisions. This provides useful insights for BCC interventions aiming to influence the decision-making process.
Webinar 2 Sources And lastly check out these great sources our experts referred to during webinar 2!
6. Merritt, RK. Bsc, D.Phil (2011). Developing your Behaviour Change Strategy ‘How To’ Guide. On behalf o f NHS East London & the city. Tower Hamlets PCT.
7. Dickin, Kate and Marcia Griffiths, The Manoff Group, and Ellen Piwoz, SARA/AED. Designing by Dialogue. Consultative Research to Improve Young Child Feeding. Support for Analysis and Research in Africa: Washington, D.C.: AED for the Health and Human Resources Analysis (HHRAA) Project, June 1997
Recently listening to TEDxCSU Talk on behavior change led by Professor Jeni Cross from Colorado University, I was immediately struck by how we routinely rush the planning stage of a behavior change communication (BCC) intervention. Taking time to understand where we are, where we want to go, and what will enable us to reach our goal is essential in devising a successful nutrition communication campaign. Resonating with this topic is the second webinar in Sight and Life’s Webinar Series “Assessing the Situation: What you Need to Know.” It is a valuable and timely reminder on the importance of understanding your target audience during the BCC planning process.
During this enlightening dialogue Professor Cross spoke candidly about the existing myths regarding behavior change. For example, does education change behavior? What we know about education is how the information is presented, rather than the information itself, creates behavior change. Making learning tangible, personalized, and incorporating social interaction provides the greatest impact in behavior change.
Another misconception is that one needs to change attitudes to change behaviors. Attitudes do not predict behavior! A more effective strategy is to connect to people’s values to set behavior expectations. The last myth is that people know the triggers that motivate them. Professor Cross argues this is not the case, as social norms have, by far, the greatest influence on human behavior. For instance, if you see someone select a healthy option at lunch, then you are more likely to follow suit. Understanding these constructs in human behavior is important because they are the core of developing successful nutrition communication campaigns. Watch the TEDxCSU Talk below:
Keep this principle thought in mind as you embark on the next steps in the BCC process presented in Sight and Life’s second webinar in the BCC Webinar Series.
The Journey to Understanding your Audience
Here are the questions to ask as you embark on step 2 and 3 in the BCC process:
– What is it that I really need to know about my audience and the environment in which they live?
– What works and does not?
– How do I get to the core of what matters to my target audience?
Webinar 2 walks through the typical knowledge needs required for a BCC intervention in nutrition, examines how to get the most out of each knowledge source and suggests approaches that enable a deep understanding of the target audience.
BCC Process Step 2. The Desk Review
Before beginning the desk review, be sure to answer the question, what is the purpose of this information and how do you plan to use it?
The desk review encompasses three elements:
– Exploring the broader context
– Reviewing the effectiveness of past experiences
– Understanding program context (reaching your target audience)
In summary, elements 1 through 3 of the desk review help define the scope of your communication strategy. These identify the broad parameters and constraints to use when designing and delivering the intervention while also supporting the critical decisions when creating a communication strategy.
BCC Process Step 3. Client Research
The next step in the BCC process involves acquiring valuable insights from the target audience and communities you seek to change. We are again reminded of the BCC principle; know your audience!
During webinar 2 we share three key components in client research which support the gathering of comprehensive information on the target audience and factors that influence behaviors and practices; the inquiry framework (what do you need to know about the behaviors), applicable research methods (how to extract that information), and insight generation (moving from understanding behavior to finding deep, shared truths). Consider the questions posed at the start of this blog: what do I need to know about my audience and the environment in which they live, what works or does not, and how do I get to the core of what matters to my target audience? Steps 2 and 3 help you answer these questions.
Key Takeaways from Webinar 2
– The BCC principle ‘know your audience’ lies at the core of developing successful nutrition communication campaigns.
– Defining your knowledge needs, or simply what you need to know, is the first critical consideration.
– Step 2 in the BCC process is about assessment, analysis, and synthesis of information to effectively answer questions on the broader context, the drivers and constraints for the target behavior and communication efforts previously employed to change the desired behavior.
– Client research, step 3 in the BCC process, involves gaining valuable insights from the target audience and communities that you seek to change.
Essential Reading on Behavior Change Communication (BCC)
At Sight and Life, we are pleased to share knowledge and recommend resources that we find useful in our work. This is certainly the case with behavior change communication (BCC)! To continue learning about BCC while waiting for the upcoming webinar, we have collated an array of books, websites, and e-learning modules that are valuable resources. This is just our opinion but we hope theses recommendations can deepen your knowledge on BCC and provide though-provoking ideas and inspiration as it did for us.
– BCC is a communication approach with distinct underlying principles, which make it a valuable part of nutrition programming.
– It is complicated but can be managed by taking a systematic approach.
– Consider the Sight and Life BBC process cycle as a tool to support planning your nutrition communication campaign.
Find the video and the complete slide deck here from the first Sight and Life webinar People eat food not nutrition: Integrating BCC into nutrition programsHERE.
On May 15th we will be hosting our second webinar Assessing the situation: What you need to know(please register HERE). In this webinar we will identify the typical knowledge needs for BCC intervention in nutrition. We will discuss how to get the most out of the knowledge sources, including written material (program reports, scientific papers), experienced program stakeholders, knowledgeable service providers, and of course, your target audience. Additionally, learn tips for tailoring formative research to generate insights on the factors driving eating behaviors.
Lamstein, S.,T. Stillman, P. Koniz-Booher, A.Aakesson, B. Collaiezzi,T.Williams, K. Beall, and M.Anson. 2014. Evidence of Effective Approaches to Social and Behavior Change Communication for Preventing and Reducing Stunting and Anemia: Report from a Systematic Literature Review. Arlington,VA: USAID/ Strengthening Partnerships, Results, and Innovations in Nutrition Globally (SPRING) Project.
3. Behavior Change Toolkit – for International Development Practitioners
This behavior change toolkit is a useful, well written and simple introduction to BCC. A great resource for those starting their learning journey on BCC. The toolkit can be downloaded HERE.
4.Nudge: Improving Decisions about Health, Wealth, and Happiness, Richard H. Thaler, and Cass R. Sunstein.
A book from the winner of the 2017 Nobel Prize in Economics, Richard H. Thaler, and Cass R. Sunstein: it is a revelatory look at how we make decisions. The authors examine the process of how people think and suggest that we can use sensible “choice architecture” to nudge people toward the best decisions for ourselves, our families, and our society, without restricting our freedom of choice. Nudge is really about the small, subtle pushes that our modern-day world makes to sway one’s opinion or real-world choices.
Why it’s on our Kindle’s To succeed in behavioral change we must be able to offer people better, more favorable and less costly choices to what they are currently doing. To reduce the consumption of junk food in teenagers for example, we must be able to design alternatives that are equally desirable. Therefore, we must build an architecture that will encourage people to change their habits and follow our behavioral goals. We loved reading the real-life examples in this book and learning how simple, thoughtful ‘nudges’ can help people change a variety of behaviors. Find it HERE.
5.The Power of Habit, Why We Do What We Do in Life and Business, Charles Duhigg
In The Power of Habit, award-winning New York Times business reporter Charles Duhigg takes us to the edge of scientific discoveries that explain why habits exist and how they can be changed. It uses research to explain how habits are formed and changed. At its core, The Power of Habit contains an exhilarating argument: The key to exercising regularly, losing weight, raising exceptional children, becoming more productive, building revolutionary companies and social movements, and achieving success is understanding how habits work.
Why we think it’s an essential read for BCC We recommend The Power of Habit as an easy and fun to read introduction into the science of habit formation and the art of attempting to change them. As nutrition program managers, most of the time, our challenges go beyond changing people’s behaviors. Changing what and how people eat requires us to understanding people’s daily habits and then help them to adopt new routines. This book an excellent foundation to understand the particulars of habits. Buy your copy HERE.
6. The Tipping Point, Malcolm Gladwell
The tipping point is that magic moment when an idea, trend, or social behavior crosses a threshold, tips, and spreads like wildfire. The Tipping Point explains the phenomenon of why some products, businesses, authors, etc. become hugely successful (tip) while others never seem to break apart from the masses as anything special. Buy your copy HERE.
Why we think it’s relevant to BCC We think The Tipping Point is a great read to understand how change happens and what makes a behavior tip. Successful interventions and campaigns aimed at changing people’s routines have certain critical characteristics in common: They manage to gain followers, naturally mobilize the audience, and make the behavior contagious instead of imposing it. These initiatives succeed in making the behavior desirable, the message exciting and memorable – like a jingle that naturally ‘sticks’ – and they understand that ‘little things’ in people’s lives matter.
Incorporating Behavior Change Communication (BCC) into Nutrition Programs
If you are reading this blog then, in one way or another, you are interested in changing people’s behavior for better health outcomes. The Sight and Life Inaugural Webinar Series on behavior change communication (BCC) might be just the informative source you are looking for to expand your knowledge.
What is BCC?
BCC is a communication approach, one of many communication approaches available to nutrition professionals. It is distinct from other approaches, such as nutrition education or health promotion, for the following reasons:
– It is an emergent process that culminates with the implementation of a BCC strategy
– The process draws heavily on research and evidence
– The BCC strategy is focused on what the audience needs to do (versus what the audience must know)
– The BCC strategy is integrated with programs and services.
For a program manager, BCC might seem like a complicated undertaking, and for many of you, it is about managing others to do this work. BCC is complicated but it can be mastered if you have a systematic approach. Throughout this webinar series we follow an 8-step process cycle for BCC and share tips, checklists, tools, and resources to help you succeed in managing BCC. Completing the webinar series will not make you a BCC expert, however, it will make you BCC literate.
The first webinar introduces step one of the BCC process, setting your BCC goals and behavior objectives. Straightforward, right? An important learning, from our experience, is to separate your program goal from your BCC goal, as they are not necessarily the same. Your BCC goals will focus on practices or behaviors while program goals might focus on a specific health outcome, such as anemia.
Another learning has been to distinguish between “practices” and “behaviors”; practices consist of multiple behaviors and actions. Once you have distinguished practices from behaviors, setting your BCC goal and behavior objectives is easy. We have developed a behavior chain tool to help you detect the multiple behaviors in a practice.
Behavior chain is a simple tool used to identify the factors or activities required to achieve a target behavior.
For example a micronutrient powder (MNP) intervention, where the BCC goal might be appropriate use of MNP (a practice), the behavior chain tool would look like this:
[START] 1. Aware of MNP 2. value the MNP 3. get to distribution point 4. ask for MNP at distribution point 5. mix MNP with child meal (at the right consistency) (as per frequency indicated on package) [FINISH].
Asking for MNP at a point of distribution would be a behavior, as would mix with meals. Voila – two behavior objectives emerge. The objectives are not set in stone. You can modify them as you gather evidence and clues about your target audience in steps 2 and 3. Remember- only set a few objectives because less is more!
So how do you feel about BCC after reading this blog – empowered to tackle BCC? Eager to learn more? Register for the Sight and Life Webinar Series on BCC below:
Some key learnings as we begin our first webinar in the series:
– BCC is a communication approach with distinct underlying principles, which make it a valuable part of nutrition programming.
– It is complicated but can be managed by taking a systematic approach.
– This series provides a high-level analysis of BCC that enables you, the participant, to become BCC literate.
Hello, my name is Shannon King and I am working with Sight and Life as an intern while completing my Masters of Science in Public Health with a focus in human nutrition at Johns Hopkins Bloomberg School of Public Health.
The Assignment in India
During the late summer of 2017, I spent 2 months in India where I was working with our local partner, Karuna Trust, to conduct research on the implementation of the PATH “Feeding the Future through Fortified Rice Program”. Within this intervention Sight and Life has designed three school-based nutrition and WASH strategies to develop healthy eating habits while improving hygiene and sanitation behaviours. The intervention uses peer role modeling and cues to action; games and helper crews; and problem-based learning within the school environment to promote behaviour and attitude change.
The study required visiting 50 schools in four different areas of Karnataka in order to understand how the program is being implemented. Our observations allowed for us to examine to what extent each school had executed program activities- such as having soap available for the students, and how the program materials are being used around the school. Further, in-depth discussions with the implementing teachers provided detailed descriptions of how the program is being used and their experiences thus far.
Impact of my Experience
Overall, it was an incredible experience allowing me to engage first-hand in the entire research process from protocol design, to ethics review, data collection, and data analysis. As a graduate student, I have had the opportunity to work on studies in the past; however, this was the first time I have been given ownership of a study and the ability to work on it from initiation to conclusion. It has been very rewarding to work through each step of the process and overcome all the associated challenges and roadblocks.
During my time in the field, I found it fascinating to see a wide range of implementation processes used in the schools despite the fact that each school was provided with the same program materials and instructions. As researchers, a better understanding of the factors influencing implementation allows us to develop programs in a manner that will optimize delivery.
While the research did not involve any formal data collection from the school children, I will always cherish the moments I was able to engage and play with them. The opportunities were few and far between, however, at one school we arrived early and the teachers were having lunch so the facilitators and myself played one of the nutrition and WASH games with the children. Despite needing a translator to help facilitate the process, it was an hour filled with laughter and joy. It was also an incredible opportunity to see the program in action and how much the children were enjoying to learn.
Working through Barriers
The biggest challenge, and the most eye-opening experience of the trip, was working as a young female researcher. In several different contexts and settings, comments and suggestions made by females were treated less seriously than those put forward by males. Or sometimes women’s opinions were simply ignored, and it was eye-opening and aggravating to experience. Witnessing an individual’s esteem being judged primarily on their gender and seniority is quite the contrast to a working environment where your capabilities are judged primarily on your education, experiences and work ethic. It provided me with an even stronger appreciation of the efforts made to promote gender equality. India has an incredible, young female population with the potential to be strong leaders and change-makers, if given the opportunity.
Lastly, this experience highlighted the need for implementation research to better understand how the nutrition community can optimize the delivery of nutrition interventions rather than purely conducting before-and-after data collection to assess the success of a program. I look forward to sharing the results with both project partners, in the hopes of allowing for mid-course corrections to improve program implementation, and sharing the findings with the greater research community to help build the literature base of implementation research in nutrition.
Enjoy this gallery of pictures showcasing my visit to Indian schools.