Hunger-Undernutrition Blog

Renormalizing “normal”

By Cara George, with Humanitas Global Development

Genetics influence everything about how we are created –from our eye color, to whether we can roll our tongues, even our ability to smell. But what about height? Sure, genetics play a role in that as well. But a recent entry The Global Crisis You Never Heard Of: Stunting on the 1,000 Days Blog points to stunting, or stunted growth, as a dangerous phenomenon, linked to horrifying statistics on impaired brain development and mortality resulting from diarrhea, due to chronic nutritional deficiencies.

Development work consists so heavily of creating a “new normal”. One idea we’re developing here at Humanitas Global Development is how to promote behavior change in a current nutrition project underway in Central America, where the target population does not even understand that they are stunted because everyone else around them is short too. Having served as a Peace Corps Volunteer in  Guatemala, I experienced this firsthand. At 5'6" tall, I always felt at average height in the US, and once in Guatemala, it took some getting used to the feeling of towering above everyone in my town - even the men. 

How do you “convince” a population of chronically malnourished individuals that genes are not solely responsible for their height, and encourage a new way of perceiving “normal”? And how does one work to establish fresh ideas around what is healthy and normal, especially when it means working in a cultural context that does not see the problem or issue in the same way?

Since our readers work in such a variety of areas and geographical/cultural contexts, we want to know your successes and challenges in working towards a “new normal”!

Working Together is Critical for Success

Guest blog post by Robert Baldwin with the Flour Fortification Initiative

In October I was in Albania on a joint mission between the Flour Fortification Initiative and UNICEF to advance flour fortification in that Balkan nation. Throughout the week, our team met in small groups with more than 35 decision and policy makers and policy shapers in the public, private and civic sectors. We were impressed with their willingness to work together to make it happen. The Ministry of Health, acknowledged by all as the entity to lead the effort, was confident that it could embrace and engage all other sectors in working together to achieve the goal.

Albanian leaders proved once before that they could work together to fortify a staple food when in 2008 they successfully undertook a salt iodization program. At week’s end our team was confident that these folks were on the right path toward fortifying flour. While there are a number of ways to decrease micronutrient deficiencies, the Albanians recognized that flour fortification is a cost efficient, technologically simple way to improve the nutrition status of a great number of people in a short timeframe.

Their commitment to work together to accomplish that goal shows that they understand micronutrient malnutrition is a multi-sector problem that demands a multi-sector response.

Oftentimes, when speaking to a group about micronutrient malnutrition, I ask the question “Do you think that micronutrient deficiencies are primarily a health sector problem?” Invariably, more than half respond with a “Yes” answer.

My response is that it is not exclusively a public health problem, but more of a societal problem. This issue of hidden hunger impacts almost all aspects of a society’s lifecycle:

• It impacts the education sector—the intellectual development of children is impaired, creativity is diminished, inventiveness is stifled.
• It affects the labor sector—nutritionally impoverished adults can’t perform at full capacity, lose time from the job, and thus are not a productive as they can be.
• It impacts the economic sector—lost productivity leads to lower wages which restrict purchasing power— these and other factors contribute to lowering a country’s GDP.
• It does affect the health sector by contributing to blindness, lowering immunity to disease, contributing to childhood morbidity and maternal mortality, increasing the incidence of debilitating birth defects, while contributing to the overall increased cost of health care.

If you buy the argument that this is a problem across society, then it is unreasonable to expect the health sector alone to deal with and solve the problem. The public health sector often provides the leadership necessary to alleviate the problem. Yet to effectively combat micronutrient malnutrition, it must muster the collaboration of other agencies within the public sector, as well as involving, from the start, the energies, experience and skills of the private and civic sectors.

This formula soon becomes apparent to those engaged in the effort to achieve national-scale flour fortification in a country. Collaboration among representatives from multiple sectors is not easy to accomplish at first and requires great effort on the part of all involved. Working together, however, they have greater strength than any one partner working alone.

 

Fortifying Flour Where People Eat Rice

Guest Post by Scott J. Montgomery, Director of the Flour Fortification Initiative

One of the projects underway at the Flour Fortification Initiative is developing a strategy for fortifying wheat flour in Asia. When I describe this, people’s initial response is always some variation of: “Don’t they just eat rice there?”

Yes, the main cereal grain consumed in Asia is rice. But in many regions, wheat consumption is also high enough that fortifying wheat flour has the potential to deliver essential vitamins and minerals to millions of people.

Consider Malaysia, a country of 28 million people. The daily food supply quantity of rice is 314 grams per person, according to the Food and Agriculture Organization of the United Nations (FAO). That is high, as expected, but the amount of wheat in the daily food supply is also high at 181 grams per person per day.

The following table shows the rice and wheat daily food supply quantity for eight other Asian countries where the wheat in the daily food supply is more than 75 grams per person, based on FAO data.

Daily Food Supply (grams per capita per day)
Country	Rice	Wheat
Brunei Darussalam	1006	100
China	315	185
India	291	164
Japan	233	122
Maldives	178	180
Nepal	321	104
Republic of Korea	312	139
Sri Lanka	400	121
Source: Food and Agriculture Organization of the United Nations, 2007

These countries would be wise to use a multi-faceted approach to improve the nutritional status of their people. And the amount of wheat in their food supply is high enough that flour fortification should be considered in their approach. Flour can be fortified with iron, zinc, vitamin A, vitamin D, folic acid, and other B vitamins such as niacin and riboflavin. Together these vitamins and minerals increase productivity, reduce neural tube birth defects, improve maternal health, and strengthen immune systems.

Some may counter that rice fortification would be more appropriate in these countries. Currently the technology for rice fortification is evolving and is not widely practiced. Flour fortification has been practiced for decades, and modern mills already have the technology to implement the process. In countries where wheat flour is frequently consumed as a secondary cereal, flour fortification could make a health impact now while the technology to fortify rice is being developed and adopted.

Another reason we encourage flour fortification in Asian countries is that wheat consumption is increasing throughout the region. Instant noodles, made with wheat flour, are so popular that a cup noodle museum recently opened in Japan.

A study of wheat flour consumption in Indonesia shows that people are eating more flour products such as instant noodles, sweet bread and biscuits. Average national consumption of flour increased from a 15-year low of 45 grams per capita per day to 51.5 grams per capita per day in 2008. The study concluded: “This trend in increased consumption of wheat flour is accompanied by a decline in rice consumption as Indonesian’s diversify their diet as a result of economic development.”

If flour fortification becomes standard milling practice now throughout Asia, then the addition of vitamins and mineral to flour will be routine business as people diversify their traditional rice-based diets with more flour-based foods.

In Nepal, flour fortification had been voluntary, but in August this year the government made it mandatory for industrial mills to add iron, folic acid, and vitamin A to wheat flour. Now three countries in Asia – Nepal, Indonesia, and the Philippines – require fortification of wheat flour. The strategy we are developing with our partners in the public, private, and civic sectors will help provide the advocacy and technical resources needed for other countries in Asia to follow these examples.

Nutrition Takes Center Stage in the Battle Against Non-Communicable Diseases

 
Secretary-General Ban Ki-moon addresses high-level meeting on the prevention and control of non-communicable diseases.

Guest blog post by Fokko Wientjes, with DSM

Will history judge last week’s United Nations Summit on Non Communicable Diseases as a watershed moment in the battle against malnutrition?

Quite possibly, yes. The fact that the summit took place is an achievement that should not be underestimated. As this blog reported last week, this year represented only the second time in its history that the UN has discussed a health issue at its General Assembly, yet the resulting discourse between the political, non-governmental and business worlds has led to an unprecedented consensus forming around the role nutrition can play in reducing the burden of NCDs and spurring development.

This consensus is built on the understanding that a child’s diet in the first thousand days (between pregnancy and age two) is crucial. Crucial because, with the right kind of nutrition, it is possible to reduce the risk of an NCD, such as diabetes, heart disease, obesity and certain cancers, later in life. Crucial because essential nutrients early in a child's life allow the brain to develop, giving children a chance to grow to their economic and social potential.

These benefits are so acute that the Copenhagen Consensus, the think tank, has calculated that making sure a population has the right kinds of micronutrients could increase a country’s GDP by 2%.  This analysis reinforces that micronutrients are among the most cost-effective interventions a government could make in terms of generating an economic return on investment.

We have known this for some time, which is why we at DSM have been involved in a number of initiatives aimed at making sure some of the world’s most hard-pressed populations have access to adequate nutrition. We underlined this commitment in New York last week, when we launched Future Fortified, a program aimed at delivering food fortification to nutrition black spots in the Nile Delta and elsewhere, along with our partners GAIN and Herbalife.

Future Fortified is just one of a number of ambitious and worthy projects aiming to alleviate nutrition deficiency and improve food security in the developing and developed world. The UN’s Scaling Up Nutrition (SUN) program and the 1,000 days campaign, launched last year at the tenth anniversary of the Millennium Development Goals, received wide-scale backing from UN Secretary General Ban Ki-moon, U.S. Secretary of State Hillary Rodham Clinton and others last week. We continue to work with our partners in the private and public sectors on other initiatives, including Project Laser Beam, a US$50 million, five-year partnership to tackle child malnutrition.

A second, and perhaps equally critical, consensus also developed in New York last year. This was the acceptance that the private sector can and should play a role in providing the solution. Business must engage in this challenge, together with stakeholders in the public sector. We believe that only through such a cross-fertilization of know-how, innovation, experience and resources, a lasting solution can ever be achieved.

This Rubicon has now been crossed and there now pervades a real belief that, beyond providing short term remedies, the goal of long term, sustainable nutrition security for all is a genuine possibility. These are inspirational times and all of us involved in this quest are united in a commitment that we will not let this opportunity pass.

Finding the Path Forward: The Case of Grameen Danone

By Priya Bapat, Humanitas Global Development

What should implementers do when a celebrated development project turns out not to be as successful as originally hoped?  Or better yet, what can they do to prevent the project from failing in the first place?

  In my previous blog post, I described the issues that Grameen Danone faced during their roll out of the Shokti Doi product.  When Grameen Danone became aware that their initial project design was not working, they had to make a choice on how to proceed.  In the previous post, I also described how the Case Foundation responded when confronted with the problems of the Play Pump system.  Jean Case, CEO of the Case Foundation outlined three options for an organization with a non-functioning program:

1. To ignore the evidence and continue on,

2. To stop the program and channel resources into more effective programs, or

3. To reassess the project and make changes in hopes of improved outcomes

Despite operating under losses, Grameen Danone appears committed to making this project work.   In 2009, in order to maintain subsidized prices in the rural areas, the company began to sell the yogurt in urban markets at a higher price.  They also began to offer diversified products such as mango yogurt and marketed their products through mass media.  The company also sought to stabilize prices by developing their own dairy storage facilities in Bangladesh.

In rural communities, Grameen Danone held promotional events to increase awareness and demand for the yogurt.  The company later reintroduced the sales lady component of the program with a redesigned approach.  Grameen Danone is also developing an additional product for the rural market – a plant-based yogurt product called Shokti +pocket that is less expensive than full-milk yogurt and does not require refrigeration.  A second yogurt production factory is slated to be built this year, despite reports that the current factory in Bogra is operating well below capacity.  The company aims to earn profits on its operations by 2013.

While we all hope that the Grameen Danone joint venture will turn out to be successful in the end, it is clear that there were some major challenges in the conceptualization of the project.  The most obvious obstacle was that Grameen Danone failed to design their intervention based on end-user needs. 

A thoughtful blog post examining the case of the PlayPump highlights how it is essential to integrate end users in the design phase of development projects.  A recent paper points out that the Grameen-Danone venture designed their interventions around the strengths of the implementing organizations, rather than the particularities of the problem of rural malnutrition. 

Despite Danone’s knowledge and capacity for yogurt production and consumer research, yogurt was not the wisest choice for a fortified food product given its need for refrigeration and consumer habits.  The famed Grameen ladies may have been a successful distribution channel for other Grameen initiatives (such as microloans and phone services), but the “Shokti ladies” scheme did not generate enough profit to support the yogurt business.  Because they did not take these issues into account, Grameen Danone faced the unnecessary challenge of distributing highly perishable dairy products in areas without refrigeration.  An alternative product, such as biscuits or powdered milk, may have been a more appropriate choice.

A second issue is that Grameen Danone did not sufficiently inform rural consumers about Shokti Doi before the product was released.  Although yogurt was not regularly consumed in rural areas, marketing campaigns carried out in conjunction with the campaign could have helped boost awareness and demand for the product during the initial phase of the project.   An awareness campaign would have prepared the community for the yogurt product and would have most likely boosted rural sales.

The changes implemented by Grameen Danone greatly improve the program’s likelihood for success.  However, by neglecting a few key steps initially, the company created a number of problems that could have been avoided.  The importance of designing interventions based on end-user needs and preparing them for the interventions prior to project roll-out cannot be understated.   It is essential that donor and project design communities keep in mind the lessons learned from the Grameen Danone case.

Photo Credits: http://www.flickr.com/photos/danone-communities/1543902034/sizes/m/in/set-72157602368737535/

Failure or Success Waiting to Happen?: The Case of Grameen Danone

By Priya Bapat, Humanitas Global Development

Anyone working in development knows that ideas that seem amazing on paper do not always translate into highly successful programs once implemented.  All field programs, particularly new or pilot programs, require a great deal of fine tuning and adjustments to account for unforeseen issues that inevitably arise.  Innovative programs that face difficulties in implementation become hard to judge.  When is a program worth saving and when is it time to direct funds elsewhere?  In this first of two blog posts on the subject, we will examine the case of Grameen Danone and the challenges it faced when operations began in Bangladesh.  

Grameen Danone Foods Ltd. was founded by Grameen Bank in  Bangladesh in partnership with Danone, a French  company well-known for its dairy products.   The primary objective of the company was to combat the widespread problem of malnutrition in rural Bangladesh through the production and sale of fortified yogurt called “Shokti Doi” – or strengthening yogurt.  The yogurt was priced well below the market price for unfortified yogurts in Bangladesh, making it more affordable for low-income consumers. 

When the Grameen-Danone venture was announced, it received near-universal acclaim and was hailed as a ground-breaking partnership.  The social enterprise combined the strengths of the private sector and non-profit sector to create a profit-generating business that would also address the major problem of child malnutrition in Bangladesh.  In addition to combating rural malnutrition, yogurt production operations would provide numerous jobs to dairy producers, factory workers, and the Grameen sales ladies – women who would operate as local distributors in rural areas.  Since yogurt sales were targeted exclusively for the rural population, the Grameen ladies were the only distributors of Shokti Doi.

Despite early praise, there have been some troubling criticisms of the project.  While Shokti Doi is more affordable than other yogurts on the market, this did not translate into high sales within the Base of the Pyramid (BOP).  This was due to several factors, including the following: 

• There are some indications that suggest that yogurt is considered a luxury item and is not regularly consumed by low-income people. 
• In South Asia, yogurt is more commonly made in the home rather than purchased from a store. 
• Yogurt requires proper storage in order to retain the same level of quality.  Although the Shokti yogurt remains safe without refrigeration for a period of time, the yogurt becomes more liquid in consistency and is less appealing to consumers. 
• Grameen sales ladies did not treat yogurt sales as a full-time income generation activity, but rather as a source of supplemental income.  This could be a result of personal preference, a potential overestimation of the demand for yogurt in the BOP/rural markets or a combination of the above. 

As a result, Grameen Danone operated at a loss.  The sales lady program was dropped and the yogurt was marketed solely through established retail channels which were located in more urbanized areas, far from the targeted rural demographic.

The case of Grameen Danone is similar to another now infamous project – the Play Pump.  In short, the Play Pump was an innovative approach towards improving access to water by combining the water pump mechanism with playground equipment.  The project was initially hailed as a revolutionary idea towards ensuring adequate access to water in developing countries and received positive attention from the media and endorsements from high-profile celebrities such as Jay-Z and Kirstie Alley. 

Critics, however, accused Play Pump distributors of addressing the wrong aspect of water security – the pumping mechanism.  In some cases, the installation of the Play Pump made it more difficult to access water than it had been previously (a video on using the Play Pump versus a traditional hand pump can be seen here).  There were countless blogs and articles written on the issue which led to a public admittance by the Case Foundation/Water for People that the project was not as successful as they had initially hoped.   They have since drastically scaled back the program and now use the Play Pump technology in specific sites, such as the playgrounds of large schools.

As mentioned in a previous blog post, innovative programs are highly prized in the development community.  However, as the Case Foundation CEO Jean Case points out, failures are often treated harshly, which can create harmful results.   Organizations are less likely to acknowledge when a project has been unsuccessful and may engage in wasteful attempts to save a project that should rightfully be halted.  If we are to encourage creative solutions to development challenges, we must be willing to accept that mistakes can and will be made along the way and promote the opportunity to constructively learn from them.

Grameen Danone, when faced with evidence of the project’s weaknesses, chose to alter the company’s strategy in order to save the program.  The Global Alliance for Improved Nutrition (GAIN) is currently conducting a study with Johns Hopkins University to assess the yogurt's impact on health and welfare of malnourished children in Bangladesh.  However, a significant challenge for the company is finding a way for the yogurt to reach its intended beneficiaries and having that understanding early on – before programs are implemented.  In the next post, we will look at what steps Grameen Danone has taken and what lessons can be learned from their experiences.

Priya Bapat is an Associate at Humanitas Global Development
Photo Credits: http://www.corporate.sipa.com/report/5_envir/DanoneGrameen/DanoneBangladesh-5.jpg

A Golden Opportunity

Guest blog post by Nancy Haselow, Helen Keller International’s Vice President and Regional Director for Asia. The post also appeared on the Bill & Melinda Gates Foundation website and HKI's blog, Seed to Sight.

Imagine living in Bangladesh and eating little more than a bowl of rice or two each day.  Rice has been part of your diet since you were a child, and you feed it to your children because it’s filling, inexpensive and accessible.  Aside from small helpings of vegetables or legumes or the occasional piece of chicken, rice is your primary food source.

Rice has calories, but it has minimal additional nutritional value. A diversified diet that includes nutrient-rich fruits and vegetables (and, preferably, animal source foods such as chicken and eggs) is necessary to prevent sight- and life-threatening deficiencies, including vitamin A deficiency.  Vitamin A deficiency is the leading cause of childhood blindness, leaving approximately 350,000 children blind every year. Young children with vitamin A deficiency also have impaired immune systems; a condition which increases the risk of death from certain common childhood infections and claims the lives of 670,000 children each year who live in less developed countries.

I have been working with Helen Keller International (HKI) for over twenty years to design, implement and test vitamin A delivery programs. I’ve seen a lot of successes over this time, especially our work to distribute vitamin A capsules to children and post partum women in the developing world. When we first promoted this intervention, it was considered controversial but now has become recognized as one of the most vital, cost-effective public health interventions in the world.

At HKI, we are committed to identifying and delivering high-impact interventions to improve nutrition in developing countries. We are also committed to ensuring that all women and children who need micronutrients to survive and thrive, including vitamin A, get it in adequate amounts.  This has not yet been achieved globally. Yet now there is another option to explore: Golden Rice.

 
Golden Rice, which is somewhat controversial, has been genetically modified so that it contains beta carotene, which the body converts into vitamin A. It has the potential, therefore, to be another tool in our efforts to control vitamin A deficiency.  Lots of people consume rice, so Golden Rice could have broad-scale reach and eventually play a significant role in ending vitamin A deficiency for those most in need.

HKI’s role in this project is to make sure that Golden Rice is efficacious – that it actually improves vitamin A status, before it is promoted in communities. We, with some key partners, will test to what degree daily consumption of Golden Rice improves vitamin A status under controlled community conditions. If it is shown to work, HKI will then develop and test delivery systems to ensure that Golden Rice reaches those who need it most, the poor and disadvantaged living in developing countries.

While there is no single cure-all for vitamin A deficiency, Golden Rice could become an important complementary intervention to ensure that all those who need vitamin A get it, including those families in Bangladesh subsisting primarily on rice. In these days of increasing food prices and consequent “hidden hunger,” that’s a golden opportunity.

 

Accelerate Africa

Guest Blog Post by Sarah Zimmerman with the Flour Fortification Initiative

Unless diets have changed dramatically in 11 years, people in Tonboronkoto, Senegal, rarely eat commercially processed foods. I was a Peace Corps volunteer in this village in 2000, and people there mainly ate the maize, sorghum, peanuts and rice that they grew, such as the rice and corn pictured at left. They would occasionally buy sugar, tea and perhaps cooking oil, but their staple food never entered an industrial mill where it might be fortified with additional vitamins and minerals.

Villages like this dot every paved road and dirt path throughout Senegal and much of Africa. Should these countries exclude food fortification from their public health strategy, since so many residents do not eat commercially processed foods? Absolutely not. Food fortification is a viable part of a comprehensive approach to improving the health and well-being of a country’s population, even in Africa.

Earlier this year, the Flour Fortification Initiative (FFI) completed a six-month analysis on the prospects of fortifying wheat and maize flours in Africa. Knowing that people living in and near cities tend to eat more foods made with commercially milled flour than their rural peers, urbanization was a key factor in the FFI analysis. Here are some of the facts discovered:

• In 18 countries in Africa, the urban population is more than half the total population.
• From 2005 to 2010, the urban population in every African country increased from 1 to 7 percent.
• The following six countries increased their urban population by 5 percent or more from 2005 to 2010: Burundi, Liberia, Eritrea, Malawi, the Democratic Republic of Congo, and Burkina Faso.
• Seven countries are successfully fortifying commercially milled flour in Africa. The urban population of these countries accounts for 43 percent of the continent’s total urban population.

Senegal is one of the seven countries with a flour fortification program. Admittedly, flour fortification will probably have very little impact in villages like Tonboronkoto. But 42 percent of Senegal’s 12.8 million people live in urban areas such as Dakar, St. Louis, Tambacounda, Kedougou, and Thies. That’s more than 5 million people living in cities where baguettes are commonly consumed with breakfast. Fortified flour here will very likely improve the population’s iron status and reduce the number of children born with disabling or fatal neural tube defects such as spina bifida.

Senegal requires fortifying flour with iron and folic acid, fortifying vegetable oil with vitamin A, and it promotes the use of iodized salt. Working with international partners, Senegal leaders obviously realized that they need multiple strategies to improve the nutritional status of their diverse population.

Micronutrient powders, supplements, bed nets, deworming, and safe drinking water programs are all pieces of a comprehensive health improvement strategy in countries with a large rural population. Food fortification is sometimes overlooked in such countries where many people do not get their staple foods from the market, but these same countries very likely have large numbers of people in or near cities. As their urban population increases, so should the emphasis on food fortification as a public health intervention.

See a summary of the FFI analysis and a detailed presentation.

Sarah Zimmerman is the communications coordinator for the Flour Fortification Initiative, a network of public, private, and civic sector partners working together to make flour fortification standard milling practice around the world.

 

Sneak Preview: State of the World 2011

Cross posted from Worldwatch Institute’s Nourishing the Planet.

In just a few short weeks State of the World 2011: Innovations that Nourish the Planet will be launched! We're excited to share with you a sneak preview of Chapter 1 entitled, "Charting a New Path to Eliminating Hunger," authored by co-project directors Brian Halweil and Danielle Nierenberg.

State of the World 2011: Innovations that Nourish the Planet will illuminate a new generation of innovative approaches to hunger alleviation that has emerged from farmers' groups, private voluntary organizations, universities, and agribusiness companies. After traveling to 25 countries in sub-Saharan Africa, and visiting over 200 projects, groups, and individuals, we found that while these organizations span a large variety of industries and disciplines, they all share the common goal of equipping farmers with the tools to improve their livelihoods and feed their communities while also protecting local ecosystems. And many of their solutions are working.

These projects and voices from the field have been combined with expert input from over 60 contributing authors, creating a roadmap to help guide policy-makers, farmers, NGOs, agribusiness, and development agencies in making more informed decisions regarding food production and food security goals.

Our research has illustrated that there is no one single solution. The first chapter of State of the World 2011 describes three major shifts to be made within the food system, moving beyond new seed development as the default solution to hunger and poverty and focusing more broadly than just increasing production to find the solutions in making better use of what we already have. Click HERE to download Chapter 1 and read them for yourself.

We'll be launching the book in New York City at WNYC Radio's The Greene Space on January 12th, followed by a State of the World Symposium on January 19th at the Carnegie Endowment for International Peace in Washington, DC. We hope many of you can join us at both events, which will also be broadcast live on www.nourishingtheplanet.org. Stay tuned for more information.

For information on how to pre-purchase the book now click HERE.

Thank you for reading! As you may already know, Danielle Nierenberg is traveling across sub-Saharan Africa visiting organizations and projects that provide environmentally sustainable solutions to hunger and poverty. She has already traveled to over 25 countries and visited 200 projects highlighting stories of hope and success in the region.

If you enjoy reading this diary, we blog daily on Nourishing the Planet, where you can also sign up for our newsletter to receive weekly blog and travel updates. Please don’t hesitate to comment on our posts, we check them daily and look forward to an ongoing discussion with you. You can also follow us on Twitter and Facebook.

It's Good for you, so why Don't you Want it? - Disruptive Assumptions in the Fight Against Malnutrition

In hunger and malnutrition alleviation, we've tended to make assumptions that can sometimes impede the progress of initiatives.  A few of the more dominant ones that I've observed include:

1.  If it's good and can solve a hunger and malnutrition problem, beneficiaries will easily adopt it.

2. If you have evidence and data that show positive results, leaders will apply the data and evidence into field work.

3. If we have funding to design and understand the right interventions, scale up of these interventions will be achieved.

4. If decision makers are informed and brought into the process, they will see the light and do right by their people.

The reality is that sometimes these assumptions have been barriers - not only in the widespread application of effective malnutrition interventions, but also across development as a whole. And, they are assumptions that we must avoid for future implementation and scale of innovative interventions. This was top of mind for me as I listened to distinguished speakers take the stage at the Global Biofortification Conference. 

The greatest challenges to the successful introduction and scaling of biofortified crops and other nutrition interventions are the very people these interventions are meant to help.  Shame on us if we try to take innovative and safe approaches to hunger and malnutrition alleviation to the masses, and they are rejected because we didn't simultaneously cultivate a culture of understanding and acceptance while the "lab work" was being done. 

Today, Keith West from Johns Hopkins University, gave a compelling speech about the importance of evidence and leveraging that evidence into application.  He said that we need to bring people up the "readiness ladder" as we look for the adoption of biofortified crops. 

I was inspired by human rights and nutrition security advocate, Ruth Khasaya Oniang'o who said that the "more we know, the less we do." She said we assume that if we come up with the right interventions and put research and discoveries out there, people will do something with them. But that is a very wrong assumption to make.

Lawrence Haddad, Director of the Institute of Development Studies based in the UK, who spoke yesterday at the Conference, reinforced the need to remember that performance of work must be evaluated from a people-centric perspective.  The take-away from my visit with Lawrence, which was an invigorating meeting of the minds, was that great products and great interventions only get us so far - it's the people who will adopt such innovations that get us the rest of the way.

While I don't want to make all of this sound grim, because there is tremendous progress and promise to help eradicate hunger, there are a few important steps the biofortification world can take and apply as it rolls out crop varieties that are nutritional powerhouses.

1. Communicate the market and commercial value and benefits of new varieties to seed producers and farmers.

2. Understand what habits are in the household and get communities to understand, within the context of their own practices and beliefs, the benefits of an orange-fleshed sweet potato or an iron-fortified rice, for example.

3. Figure out what will matter to policymakers, funders and other in-country decision makers, and reverse engineer your advocacy and awareness building strategy around biofortified crop adoption.

4. Stop looking at beneficiaries as just beneficiaries.  Convert "beneficiaries" - especially mothers, grandmothers and mother-in-laws - into powerful advocates and agents for change. 

5. Understand the landscape before you introduce an intervention.  Are there competing initiatives?  Are there policy challenges that will affect the introduction of biofortified crops?  What is on the agenda of consumer watch-dog groups and other activists?  What parallel sector leaders and influencers are trusted by the public, where do they stand on biofortification and how can we bring them into the fold?

6. Have a contingency plan.  You can't anticipate every scenario, but have a plan of action in place to anticipate problems and tackle them proactively if possible.

I'm sure I've missed a few and would love to hear your thoughts or adjustments on this.  There have been millions of dollars poured into finding effective interventions, and very talented brain power focused on bringing innovations to the table.  We can't afford these innovations to lay dormant simply because we didn't bring the communities that matter up that readiness ladder.