The Beginnings of The Society for Implementation Science in Nutrition

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The Outset

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.

Founding Members

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 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.

Momentous Journey

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.

Lazio, gandolfo, SISN, implementation science, sight and life
SISN was officially established with the proclamation of the Lazio Declaration after a two-day meeting in Castel Gandolfo, Italy.

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:

Plenary session – Implementation Science in nutrition: purposes, forms, functions, and country examples.

Symposium session sponsored by Sight and Life – Implementation research to improve implementation outcomes (coverage, adherence, quality, and equity) of micronutrient/nutrition programs and policies.

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.

SISN Members

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!

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

 

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

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

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

Design Evolution

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

nutrition, sight and life, healthy food

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

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

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

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

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

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

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

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

Nutrition Kiosk, last mile, final, design

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

Next Steps

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

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

 

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

A Jump-Start into the World of Nutrition

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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. 

ASN, Sight Life, Nutrition2018, conference, malnutrition

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. 

Sight Life, Elevator Pitch Contest, EPC, Finalists 
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.

Take a look through the picture gallery from ASN: 

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Breda Gavin-Smith

Global Public Health Nutrition Manager for Sight and Life

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As a child growing up in rural Ireland, you are continually reminded of the impacts of the great famine. This instilled the importance of food availability, diversity, and politics in determining food security and in turn a country’s ability to prosper economically. These factors certainly influenced my decision to study public health nutrition.

My chosen career path allows me to utilize my knowledge in nutrition to support and implement programs that have a real impact in the lives of millions of malnourished children. Having access to a diverse, safe, secure, and healthy food supply is a basic human right. We need to put politics aside and work together to end malnutrition in all its forms. It is one of the greatest challenges of our generation. 

Breda Gavin Smith

“Poor nutrition has devastating impacts on a child’s ability to grow, learn, and thrive while also having a lasting impact on a country’s growth and development. We know the first 1,000 days are critical to reversing this trend. We now need to focus our approaches more on the ‘how’ than ‘what’.” – Breda Gavin-Smith

Throughout my career, I have worked within both the public and private sectors, a non-governmental organization (NGO), and multi-stakeholder platform; providing me with a diverse foundation of experiences in the nutrition field. Now at Sight and Life, I am able to bring my nutritional science background together with my expertise in engaging partners across sectors to improve nutritional outcomes. Sight and Life is unique in the nutrition sphere in its ambition to link science with implementation know how to support a broader understanding on the dynamics of successful nutrition interventions. This truly lies at the heart of achieving real impact in nutrition. 

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Anne Milan

Architect and Design Specialist

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Growing up I spent the summers at my grandmother’s home in India and fondly remember a daily ritual of picking vegetables from the garden, eggs from the henhouse and picking up fresh coconuts from the storeroom. Even as a child I was cognizant to only take what is needed from the garden – two eggplants, four chilies, and the ripe tomatoes. The feeling of fullness not only came from the meal but also from the fact that the whole meal – from farm to the plate – was a series of mindful actions.

My family was lucky to a have a well-rounded meal every day, from the fresh cow’s milk and a clean source of spring water to a garden providing nutritious fruits and vegetables. Compared to the hardships face by Durga and Apu, characters from the moving tale of Pather Panchali, my life was a dream. In the story the mother, Sarbajaya, would struggle every day to feed her children Durga and Apu by rationing meals of puffed rice and a few vegetables. This hardship has forever been etched in my mind and is an unfortunate reality for many. 
 
Working for Sight and Life, I am honored to be applying my skills as an architect and designer to bring stories, concepts, experiences and voices to life and help improve lives of children like Durga and Apu!