18 February 2017

Can Tanzania emulate Ghana's nutrition achievements? Don't bet against it

Small businesses need support to lower the price of nutritious foods
I was in Tanzania this week to work with our Country Representative, Enock Musinguzi and the rest of the terrific GAIN Team.  We spent a few days talking to the government and its development partners on the country’s nutrition needs and how GAIN’s next generation of projects could help advance agreed priorities. 

It has been about 18 months since I was last in Tanzania and in that time the country’s road map to improved nutrition, the National Multisectoral Nutrition Action Plan (NMNAP—which I can’t find on the net) has been published (October 2016).  

It is an impressive document: compelling in making the case for nutrition, clear about where it wants to get (yes the targets are smart—e.g. 28% stunting by 2021), comprehensive in how it is going to get there, who is going to pay for what, and all evidence based. 

But it is more than a document--all the development partners I met talked about how important a framing it was for their own action.  So it really feels like it is a roadmap for all stakeholders.  My main worry is about priorities—when there is so much to do, where to start?  And there is no study that helps to explain which determinants of undernutrition have, say, driven down stunting rates in the past 6-7 years.  At a pragmatic level we have to act and go where the political energy and the capacity to deliver are, although it would be good to have the confidence of knowing that we were helping to relax a truly binding constraint to improved nutrition. 

Other reflections:

Large scale fortification fatigue has set in, but the fatigue must be shrugged off.  I don’t think one of the development partners we spoke to (with the exception of MI and HKI) were enthusiastic about this.  I found this amazing in a context where effective coverage rates are much lower than anticipated (see the 2015 FACT survey, for example even universal salt iodisation is only at 69% effective coverage levels) and where children and women’s anemia is actually increasing.

Diet related non-communicable disease is being talked about.  Adult overweight and obesity together stand at about 26% and the numbers are rising.  The risk is that treatment for the related diseases such as type 2 diabetes, hypertension and heart disease will divert health system resources away from efforts to reduce undernutrition.  The government has featured NCD reduction in its nutrition plan and clearly some donors are beginning to wonder what they can do to make a contribution (answer: make safe and nutritious foods more affordable, keep promoting exclusive breastfeeding, and work to influence the diet and nutrition choices of adolescents, wherever they are found). They must keep working on this. 

There is an increasing recognition of what businesses can contribute to the national nutrition plan.  Mr. Obey Assery, the key driver of nutrition in the Prime Minister’s Office, has stressed this and the NMNAP counts on businesses for 10% of its budget.  But nutrition development partners are only now beginning to look for ways to engage with businesses.  After brainstorming with each of them for 30 minutes or so, together we can usually identify opportunities within value chains, or in workplace policies, or in behaviour change/demand creation for healthy foods, or in building the capacity of small and medium enterprises to comply with food and nutrition legislation.

Multistakeholder working is strong.  One example was the monthly meeting of development partners for nutrition, to which I was invited to. I was enthused by the energy and commitment of those who support the government in its nutrition plans. It is great for knowledge sharing and action coordination. Moving forward, it would be good to draw in more business knowledge and action through the SUN Business Network to complete the multisectoral loop that the NMNAP champions.

Tanzania clearly wants to be the “next Ghana” a country that halved stunting rates to 19% within a 10 year period. 

After having witnessed the leadership, energy and determination within the country right now, I wouldn’t bet against it happening.

15 February 2017

Dropping the price of healthy diets: 2 SMEs that are helping to do this because it is good business

Earlier this week I was in Maputo working with the dynamic GAIN Mozambique team under the excellent leadership of Katia Santos Dias.  It was the first time I had been to Mozambique in the past 20 years and while many things have changed rapidly, the rate of stunting has changed very slowly indeed.

Why has stunting declined so slowly?  There are lots of ideas: rapid economic growth which has bypassed all but those on high incomes, high levels of corruption, El Nino of 2015-2016, the collapse of the national currency, the return of civil unrest in the north, poor donor coordination and performance, and low levels of supporting public services (for example, 75% of the population have no access to improved sanitation, only 25% of girls are enrolled in secondary school and only 1 nurse or midwife for every 2500 people—see the Global Nutrition Report for more data). 

In a context such as Mozambique, where leadership to improve nutrition is patchy, it was really refreshing to meet with two of the Marketplace for Nutritious Food grantees that GAIN works with.  

Neither of them is primarily driven by a desire to improve nutrition, but they are driven by a desire to be a successful business, and that means finding a way to get their products (meat patties and peanut butter) to a price point where even very low income families can afford them.   I took the picture (left). It is from the wall of one of the grantees and, effectively, it is their mission statement: how to get the price point of their food to a place where low income consumers at the “bottom of the pyramid” can afford them.

In a context where trust in public agencies is low, perhaps we should put more faith in supporting small and medium businesses (including farmers) as an engine of growth.  

Yes, they will have their fair share of untrustworthy characters, but I really don’t see where else widespread inclusive growth is going to come from.  If they grow, these businesses will employ more people, drive wages up, stimulate the demand for other products, eventually generate more tax revenue to spend on public services and, if they are producing foods that are compatible with a healthy diet, they will improve nutrition status.

It seems to me that a key priority for the Government of Mozambique and their development partners is to make it easier for businesses to do business, finding the businesses that want to do positive things for nutrition—and then backing them.

14 February 2017

The EIU/Barilla Food Sustainability Index: how to get from Index to Instigation?

Food systems are driving food availability, access, affordability and food choices across the globe.  We know that about 1 in 3 people are eating poorly.  We also know that these poor diets are the number one risk factor in the global burden of disease: ahead of the consumption of tobacco, alcohol, illegal drugs and ahead of unsafe sex and poor sanitation and drinking water quality.

So the performance of food systems really matters. If they do not improve, we run the risk of moving to a world where 1 in 2 people have poor diets.  That is why I welcome the EIU/Barilla Food Sustainability Index (FSI) which ranks 25 countries comprising over 85% of global GDP.  The index covers appropriate areas: food loss and waste, sustainable agriculture and nutritional challenges.  These 3 areas are divided into 8 sub areas, 35 indicators and 58 sub-indicators.

As a researcher I would have liked it to be easier to find the methodology details.  For example, how were the indicators selected?  OK, by a group of listed experts—which includes some of my colleagues from GAIN---but why were these experts chosen?  They don’t seem very geographically diverse.  Another example of methodological fogginess: some of the sub indicators are very specific (e.g. the % of under 5’s who are stunted) but some of the others could be calculated in many ways (e.g. the quality of policies to address dietary patterns).  Also it is not clear how the indicators are combined—are all 58 sub indicators given equal weight or are all 35 indicators or are all 8 sub areas or are all 3 areas? You see what I mean—these different routes to an index have implications for the weighting of the 58 sub indicators.  Some of this fogginess can be dispersed by playing with the data and so I really commend EIU and Barilla for making the data available so we can all experiment with the sub indicators and see how different the rankings are by different ways of combining indicators. 

But while the above is not quite methodological quibbling, my three main suggestions for strengthening the index are, I think, more significant and are as follows. 

First, the index does not have enough indicators from the middle of the value chain.  There are plenty of indicators about agriculture and about nutrition and health outcomes but there are too few on food transformation, food marketing, food retailing and food advertising.  I suspect this is because the data are not so easy to dig up here, but some do exist (e.g. sales of processed foods) and they should be included.  They should be included because may of the nutrition and affordability problems are generated in the middle of the value chain and many of the solutions can be found here too.  My GAIN colleague Bonnie McClafferty makes the same point in her recent blog on the FSI. 

Second, the goals of the index are described as benchmarking performance of country food systems, measuring progress over time and offering best practices from national and city levels.   The index certainly does this, but it is not clear how the best practices are selected and whether they are backed up with some hard evidence that they actually work.  The index report needs something a bit more systematic—what works for each element of the food system and do these solutions need to all be working at the same time: where are the weakest links?  Additionally, if the index is to be used as an accountability and improvement tool, I would really like to see country scorecards with suggestions for priorities, country by country, with some kind of attempt to get a response from each country on what they will do differently in the future to try to improve their score.  With only 25 countries involved in the report, it should be possible to do this.

Third, few of the indicators relate to business structure, conduct and performance.  The food system is populated by businesses: small, medium and large.  They drive demand and supply.  Their conduct is shaped by consumer demand, government regulation and other companies’ competitive strategies.  So it is important to measure their behaviour. For example, what do we know about the compliance of businesses with the code of conduct on the marketing of breast milk substitutes or the percentage of companies (weighted by size) that have workplace policies for improved nutrition, or the percentage of companies (weighted by size) that have announced reductions in salt and sugar in their product formulations or have initiated schemes to minimise food loss and waste?

Finally, I congratulate EIU and Barilla for zeroing in on cities with their “City Monitor” pilot on urban food systems.  This is entirely appropriate for several reasons.  First, countries are actually characterised by several food systems, not one.  We tend to default to one because most data are not disaggregated below the national level, but a move to characterise cities is a good first step at unpacking a country’s food systems.  Second, the world is urbanising and, unfortunately, malnutrition is urbanising with it, so urgent analysis and action is required in these domains.  Third, cities may actually be able to be more decisive than national governments.  They may have more control and authority to act to change food systems.  Finally a focus on cities brings in new actors such as municipal leaders and those who tend to be more densely represented in urban spaces such as the tech sector, impact investors and social media aggregators.  These new actors bring new ideas, energy and relationships to the table.

The above issues are not easy to address and they are ones we are all struggling with.  The Global Alliance for Improved Nutrition (GAIN), which I lead, is no different.  Our aim is to improve the availability, affordability and realisation of healthy diets for all people, especially the most vulnerable.  Because most people buy their food in the marketplace and because more and more of it is processed, this inevitably involves working with businesses that are responsible, ethical and have values consistent with GAIN’s. Where we see irresponsible behaviour by businesses and other stakeholders we call it out.  The index could do more of this at the country government level.  Let’s be clear: we don’t have time for anything that takes away from improvements in diets and nutrition if we are to end malnutrition in all its forms by 2030 as the SDGs challenge us to.  People’s diets, health, productivity, wellbeing, and sometimes their very survival depend on it.  

02 February 2017

Why should businesses invest in better nutrition? It's smart, sustainable and the right thing to do.

Earlier this week I was invited by the Food Safety and Standards Authority of India (FSSAI) to give a presentation to a gathering of CEOs of companies located in India on how to make businesses and markets work for nutrition. 

I structured my talk around answering 2 questions: 

Why bother to make markets and businesses work for nutrition? and What do CEOs need to do?

First, why bother?

1.     It is the smart thing to do

·       The medium term market opportunities are enormous.  The Business and Sustainable Development Commission’s new report estimates that globally about $1 trillion of business opportunity is embedded within 4 areas

* Develop food markets that help low income households get access to nutritious foods
* Reformulate products for enhanced micronutrients, lower sugar, salt and transfats
* Reduce food loss in the supply chain
* Reduce consumer food waste in the home

India would be home to a significant chunk of the $1 trillion.

·       The short term wins are significant. Improving nutrition environment in the workplace will

* Reduce absenteeism and presenteeism by about the same percentage
* Reduce staff turnover also

In a highly competitive environment, these margins are highly significant

2.     It is the right thing to do

We know that healthier and more productive consumers will purchase more goods and services, so there is a smart rationale for businesses to invest in nutrition.  But there is also a moral case.  

Malnutrition is very high in India as the Global Nutrition Report notes.  

* Poor diets are the number one cause of the global burden of disease and a top 5 factor in India
* 38% of Indian under 5’s are stunted
* 48% of Indian women suffer from anaemia
* 22% of Indian adults are overweight or obese

This is too much for the government or foundations or international development partners to address on their own—responsible businesses have an obligation to add their know how, resources and skills to the fight.

3.     It is the sustainable thing to do

* Making businesses and markets work for nutrition is a way of rebuilding trust in CEOs. International evidence suggests that it is at an all time low

* There is evidence from Unilever and others that brands with a social purpose command higher margins

* Whichever country you are in, the pressure from consumers, health professionals and governments is going to lead to more regulation, taxes, and subsidy removals—all in the name of better nutrition.  For example, see Mexico and the UK on soda taxes.  The CEOs that quietly get ready for these changes will have a competitive advantage.

So if making businesses and markets work harder for good nutrition is the smart, right, and sustainable thing to do, how to do it?

1.      Be champions for improving nutrition: better nourished citizens are better customers

2.      Work with peers in business to get governments to create a level playing field at the sector level by developing:

* Standards: e.g. promulgating and enforcing standards on food safety and quality around large scale food fortification for example

* Policy: e.g. reducing import duties on fortificants and reducing taxes on companies that are developing healthier products

* Finance: e.g. blended financing instruments, e.g. preferential credit facilities for more nutritious foods, matching funds

3.      Incorporate nutrition goals into your corporate strategies

* Be aligned with the way the world is moving: be on the right side of history
* Make the ideas of creating shared value a reality
* Walk the talk, get consumer sentiment on your side, attract value investors

So, making markets work for nutrition is the right thing to do, but it is also the sustainable and smart thing to do.

As an international NGO, this is one of GAIN’s core goals, and that is why we are delighted to work with organisations like the host, FSSAI under the strong leadership of their CEO Mr. Agarwal.