Harnessing Public and Private Sector Engagement for Improved Nutrition

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

 

Engaging the private sector – positive developments

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


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

Still…what is missing?

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



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

How do we go about filling the gap?

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

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

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

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

1.Understand and share information on existing partnerships

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

2.Translate the collected information into knowledge and learnings

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

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

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

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

Delivering Quality and Nutritious Foods in Ghana

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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.

Gladys M. T. Sampson, General Manager of Premium Foods Limited

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.

Package Foods, Obaasima, Fortified
Finished goods at Premium Foods warehouse stacked and ready for delivery

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.

Fortify, fortified foods, obaasima, ghana
Extrusion machine working to fortify grains at Premium Foods

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.

Obaasima, demand generation, Ghana, women, nutrition

Driving Change in Nutrition

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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: Sight and Life
DA: Daniel Amanquah

Daniel, Sight Life, Obaasima, food fortificationSAL: 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.

obaasima, food fortification, quality seal

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.
 
 

Daniel Amanquah

Food Fortification Specialist for OBAASIMA

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I have always been fascinated about science and how things come into being. During my formative years, was when I first heard about food security and hunger and I remember telling my Dad that I would produce food so no one goes hungry. This early passion influenced my decision to study nutrition and food science in order to contribute to solving the complexities of malnutrition and other nutrition related problems.

Daniel, Sight Life, Obaasima, food fortification“Healthier people, equals a better nation. We cannot develop if our people are not healthy. Apart from ensuring food security, we must insist on nutrition security with emphasis on the need to fight excessive sugar and salt in processed foods that are causing serious health problems whiles encouraging the consumption of foods high in fiber and rich in vitamins and minerals. Without the right policies in place it will be quite difficult to solve the issue of malnutrition. Fortification of local food products in a scientifically proven manner should be taken up by Governments. We need a concerted approach to help drive the good nutrition agenda.’’

Leveraging on my previous work in the development space and now with Sight and Life, I bring my knowledge in the area of food science and nutrition to bear on the great work being pursued by Sight and Life around the world. At Sight and Life, our work goes beyond profit hence, I hope to impact society, especially the less privileged and the vulnerable. As a team we take issues of nutrition a step further as we seek to make sure the foods are not only safe but also highly nutritious and reaching people in need.