Building Partnerships to Fight Malnutrition at Scale Lessons From GAIN's Experience - ADPI /ABI Annual Conference - Chicago - April 27, 2015

Transcription

1 Building Partnerships to Fight Malnutrition at Scale Lessons From GAIN's Experience - ADPI /ABI Annual Conference - Chicago - April 27, 2015

2 Describing Malnutrition 2

3 MALNUTRITION 3.1 million children under 5 die per year as a result of undernutrition and 1.1 million of these deaths are estimated to be the result of micronutrient deficiencies Over babies (1 in 4) die per year as a result of poor maternal nutrition Encompasses under-nutrition and overweight and obesity: Lack or overconsumption of macronutritients and micronutrient deficiencies

4 MICRONUTRIENT DEFICIENCES Vitamin A deficiency is the leading cause of blindness in children. It also leads to increased susceptibility to disease, and higher mortality rates Zinc deficiency contributes to growth failure and weakened immunity in young children More than 18 million children are born with impaired mental abilities as a result of iodine deficiency Vitamin A deficiency Iron deficiency Zinc deficiency

5 STUNTING Stunting: An indicator of chronic malnutrition, calculated by comparing the height-for-age of a child with a reference population of well nourished and healthy children. Malnutrition during the 1000 day window causes irreversible damage: Reduced physical growth Impaired mental development Decreased immune system

6 6

7 COMPLEMENTARY FEEDING

8 INCREASING GLOBAL OBESITY PREVALENCE Low and middle income countries are now experiencing increasing trends of overweight/obesity Overweight and Obesity Prevalence (BMI 25) Proportion OW/Ob adults increased from 28.8% to 36.9% in men, and from 29.8% to 38.0% in women 1 Prevalence (%) LMI C W LMI C M More people were OW/Ob (904 million; 250 million in 1980) in developing countries than in developed countries (557 million) 3 By 2030, projected: 2.16 billion OW and 1.12 billion ob 2 8 Source: 1 Global, regional, and national prevalence of overweight and obesity in children and adults during : A systematic analysis for the Global Burden of Disease Study Kelly, T., Yang, W., Chen, C.S., Reynolds, K., He, J. Global burden of obesity in 2005 and projections to Int J Obes (Lond) Sep;32(9): WHO Global Health Observatory. 3 ODI report.

9 CHILDREN AGED 5-17 YEARS WHO ARE OVERWEIGHT OR OBESE The latest estimates show alarming overweight and obesity in children and adolescents Germa ny France Japan Turkey Korea China South Africa Russia n Fed. India Canad a Spain Brazil United Kingdo m Boys Girls United States Italy Mexico Source: International Association for the Study of Obesity (2011).

10 THE HEALTH CONSEQUENCES OF OBESITY ARE WELL DOCUMENTED Overweight/obesity cause significant death, disability, and is costly 3.4 million deaths (5%) 3.9% YLL and 3.8% of global DALYs 44% of diabetes 23% of ischemic heart disease ~41% of certain cancers Economic cost of obesity: $2.0 trillion-an estimated 2.8% of global GDP (as much smoking or the cost of war) WHO. Fact Sheet: Obesity and Overweight. (Updated August 2014). WHO Media Centre. McKinsey 10 report 2014

11 Source: Black, R. et al. Maternal and child undernutrition and overweight in low-income and middle income countries Lancet. ESTIMATED GLOBAL PREVALENCE OF STUNTED & OVERWEIGHT CHILDREN <5 STUNTING IS DECLINING SLOWLY, WHILE OBESITY RATES IN CHILDREN ARE RISING CONCURRENTLY WITH ADULT OBESITY Numbers(in millions) Prevalence (%) Numbers(in millions) Prevalence (%) In 2011, 165 million children under 5 around the world were stunted Childhood OW 54% from 1990 (28 million children) to 2011 (43 million children), most live in developing countries (35 million) Expected to reach a prevalence of 9 9% in 2025 or 64 million children 11

12 THE DOUBLE BURDEN OF MALNUTRITION Rapid economic growth causes transitioning countries to experience a coexistence of both undernutrition and overweight/obesity in the same population across the life course Can present itself at the individual, household, or at the national level. Relationship between Child Stunting and Adult Obesity by Level of GDP per capita Child stunting Low and middle income countries are hit the hardest Includes OW/Ob, stunting, and MND In other words, malnutrition in all of its forms Percentage Adult obesity GDP per capita (international dollars) Sources: Shrimpton, R. The Double Burden of Malnutrition Working Paper. WHO Stat Report 2006; 12 atareduce.pdf

13 PERCENTAGE OF WOMEN IN URBAN AND RURAL AREAS THAT ARE UNDERWEIGHT AND OVERWEIGHT IN SELECT DEVELOPING COUNTRIES High rates of undernutrition and obesity exist in urban and rural areas 13 Popkin, B. M. Global nutrition dynamics: the world is shifting rapidly toward a diet linked with noncommunicable diseases. American Journal of Clinical Nutrition 84, (2006)

14 THE MALNUTRITION MAP: ANALYZING OVERLAPPING MALNUTRITION Zambia is above the threshold for both indicators Stunting in children under 5, and under 5 overweight

15 RECOGNIZING THE PARADOX Undernutrition and obesity may seem as though they are on different sides of the nutritional spectrum, but they increasingly have common roots poor dietary quality lack of health care unhealthy environments and lifestyles 15 Source: Tanumihard, et al. Poverty, Obesity, and Malnutrition: An International Perspective Recognizing the Paradox. J Am Diet Assoc. 2007;107:

16 COVERING CRITICAL ELEMENTS ON THE PATHWAY-TO-IMPACT Evidence base on dietary gaps and for efficacy of products and foods improved Technical consensus reached for product composition and guidance developed Policy environment and regulation strengthened Strengthened enabling environment Context appropriate delivery mechanisms identified and strengthene d Quality control mechanisms developed and enforced Increased availability and access Effective behavior change interventions reach people Public sector distributes nutritious food and/or products Nutritious foods and/or products available in market where target groups shop Purchasing power increased (vouchers, cash transfer) where needed Improved feeding and care practices Importance of nutritious foods for women and children Ways to increase nutrient quantity and density of foods Appropriate care practices for women and children When and where to seek care (preventive and curative) care for women and children Use of more nutritious foods, appropriate for age and life stage Appropriate breast and complementar y feeding practices Healthy practices (hygiene, stimulation) Use of health services Direct determinants of nutrition improved Macro and micronutrien t needs met Care according to needs of age and life stage Reduced severity and frequency of infectious disease Improved functional outcomes Improved motor and cognitive developme nt Improved nutritional status Improved health Improved growth

17 FROM ISOLATED IMPACT TO COLLECTIVE IMPACT Complex nature of most social problems belies the idea that any single program or organisation, however well managed and funded, can single-handedly create lasting large-scale change. - Hanleybrown et al Stanford Social Innovation Review 17

18 PLANNING FOR COLLECTIVE IMPACT: Perspectives driving data collection and building the evidence base Systems approach: How to reflect complexity of the system and design interventions that harness that complexity? Consumer access/demand vs institutional supply/delivery Integration vs attribution Spectrum of investment vs funding Broaden evidence base to include prevention Build evidence base for food system response to malnutrition Define roles of stakeholders by opportunity and not incorporation

19 LEVERING PRIVATE CAPITAL PRIVATE INVESTMENT PRIVATE COMPANIES OFFICIAL DEVELOPMENT ASSISTANCE

20 INVESTORS IN COMPANIES AND PROJECTS Project Elements Subsidies Project Management Metrics & Evaluation Production Quality control/ assurance Distribution Demand Creation GAIN part in PM GAIN part in M&E GAIN part in production GAIN part in QA/QC GAIN part in distribution GAIN part in social marketing Asset classes Grant funding Donations Venture philanthropy Mission-related investment Cash Fixed income Listed Equity Private Equity Venture capital Increasing risk/return spectrum Investor Types Government Multi-lateral Agencies Foundations Endowments Institutes High Net Worth Individuals Venture Capital Private Equity Mutual Funds Collective Investment Vehicles Public sector Philanthropy sector Private sector

21 About GAIN 21

22 ABOUT GAIN GAIN believes in a multisector approach to reduce malnutrition Established at UN GA 2002 The Global Alliance for Improved Nutrition (GAIN) is an international organization driven by the vision of a World without malnutrition We focus our efforts on children, girls and women because we know that helping them have sustainable, nutritious diets is crucial to ending the cycle of malnutrition and poverty. Because no one sector alone can solve malnutrition, we act as a catalyst building alliances between governments, business and civil society to find and deliver solutions to the complex problem of malnutrition. Today our programs in over 40 countries are on track to reach over a billion people with improved nutrition by Headquartered in Geneva with offices in Afghanistan, Bangladesh, Ethiopia, Ghana, India, Indonesia, Kenya, Mozambique, Nigeria, and Singapore, as well as technical experts and other staff based in Amsterdam, Beijing, Copenhagen, Hanoi, Johannesburg, London, Ottawa and Washington DC. 22

23 Building Partnerships to Address the Multiple Burdens of Malnutrition at Scale 23

24 EXAMPLES OF HOW A MULTI-SECTOR APPROACH TAKES SHAPE SUN Business Alliance Civil society Academia Business Platform for Nutrition Research GAIN Nordic Partnership Public Sector UN agencies and IOs Private sector

25 What is the SUN Movement? The SUN movement supports national governments in their plans to design, resource and deliver nutrition strategies through a multi-stakeholder approach, involving Business, UN Agencies, Donors and Civil Society Today there are 54 countries, including the state of Maharashtra, India

26 WORKING TOGETHER TO SCALE UP NUTRITION SUN Country governments lead national efforts to scale up nutrition and sign up to the SUN Movement at the highest political level Each government appoints a SUN Focal point Technical Community The Focal Point brings people together in a multi-stakeholder platform Civil Society United Nations Donors Government Partners Business

27 SUN Global Networks The UN Secretary-General appoints the SUN Lead Group to guide the Movement. Four global networks support SUN Countries and are coordinated by the Secretary General s Special Representative for Nutrition. Country Network SUN Secretariat and SUN Lead Group Civil Society Network Donor Network UN Network

28 What is the SUN Business Network? Mission To find the solutions required to end malnutrition through business, markets and people, the Scaling Up Nutrition Business Network will mobilize and intensify business efforts in support of the SUN Movement and to ensure all people realize their right to good food and nutrition. SBN aims to build a group of progressive businesses to develop the profitable, sustainable and innovative business models required to scale up nutrition globally and within countries. Working in partnership with governments, civil society, donors and UN agencies, the SBN will support SUN countries to develop their own country-led approach to scaling up nutrition. Goals 1. Mobilize business to commit to scaling up nutrition through recruiting a broad and diverse global membership platform of food, non-food, multinational and local business to the network. 2. Support SUN countries to engage with business within a multi-stakeholder, countryowned, approach to scaling up nutrition.

29 BUSINESS PLATFORM FOR NUTRITION RESEARCH (BPNR) Platform for the identification and addressing of evidence gaps that limit businesses making more and better investments in nutritious products and services. Stream 2 Advisory Group Stream 1 BPNR Secretariat Stream 3 Stream 4 Guided by: Relevance (to business and public health /nutrition); Complementarity of efforts; Transparency in prioritization and contracting procedures; Rigorous research results, available in public domain. Research conducted by independent, best in class researchers & institutions Research results published in public domain and translated by Secretariat and others for implications for business and public sector Results shared with public via an online platform Results provided to key actors in developing countries (policy makers, researchers, etc.)

30 GAIN - Nordic Partnership: A multi-sector consortium

31 GAIN NORDIC MULTISECTOR APPROACH What: GAIN Nordic Partnership is a multi sector platform focusing on developing affordable and attractive nutritious products for low income customers through sustainable and scalable business models. Civil society Academia Who: GAIN Nordic Partnership is open to companies and stakeholders interested in promoting nutritious products in developing markets. The founding core group consists of GAIN, Arla Food Ingredients, Tetrapak, Confederation of Danish Industry and Dan Church Aid. Additional partners are joining the projects being developed. Public Sector UN agencies and IOs Private sector

32 AIM IS TO REACH DEEPER IN THE PYRAMID WITH MORE NUTRITIOUS FOOD Top income Segments usually accessible to private sector High income Middle and low income Subsistence (one day economy) Emergency New segments accessible to reach using a multisector approach

33 VARIOUS BOTTLESNECKS ARE ADDRESSED BY THE CONSORTIUM PARTNERS How: To create solutions that can reach out to poor producers and consumers, requires us to work together to solve the bottlenecks that impede market-based solutions Public funds used for investment in removing bottlenecks This creates systemic change, which does not only benefit one company, but a whole industry Public sector Policies and standards Civil society Environment and climate Women s role Awareness Needs and aspirations Price level Value chain solutions Quality control Financing Distribution and sales channels Impact Training and education Academia Technology Product innovation Private sector UN and International Organizations

34 FOCUS AREAS Countries IAIN Nordic Partnership visits to Ethiopia 2014 Traditional cattle giving under 2 l/day East Africa and South East Asia Themes Adolescent girls and women of reproductive age and children under 5 Nutritious value chains (e.g. dairy, quinoa and other small grains) Teff and maize mill Cows at Genesis Farm produce 20 l/day (some up to 30 l/day) Agriculture and nutrition linkages (e.g. inputs and post harvest solutions that have a positive impact on increasing the nutrition value of the end product) Injera in supermarket Hilina best practice processing Quinoa in Ethiopia 34 Teff flour

35 FIRST FOCUS COUNTRY: ETHIOPIA Public Sector Civil society Private sector Academia Copenhagen University Hilina Horra Food Complex PLC SEED Farm input Small holder farmers Village Collection Centers UN agencies and IOs Central Collection Hub Processor (packaging) Ethiopian government Distribution Unicef Supply BoP Outlets Addis Ababa Chamber of Commerce and Sectoral Association STOMACH Introduction of quinoa as nutritious crop Nutrition for small holder farmers QA/QC optimization along the dairy value chain Dairy Hub connecting small holder farmers to processors to become professional farmers Affordable nutritious milk and yoghurt Healthy biscuit for adolescent girls and young women RTD F100/F75 Milk-based emergency products Multi nutrient supplement powder for infant and PLW porridge Integrated nutrition intervention for factory workers

36 A COMPREHENSIVE PROGRAM OF PROJECTS HAVE BEEN DEVELOPED A comprehensive portfolio of projects taking a value chain approach has been developed with the potential to create sustainable development Improving quality and safety of milk to ensure local supply Ensuring supply of high quality milk based products (could be partly based on locally produced quinoa) QA/QC optimization along the dairy value chain Dairy Hub connecting small holder farmers to processors to become professional farmers RTD F100/F75 Milk-based emergency products Increase safety and quality of product to treat SAM in stabilization centers by providing a ready-to-use aseptic solution Affordable nutritious milk and yoghurt Fulfill demand for Affordable nutritious drinks fortified to meet nutrition gaps of children and women Establishing of the quinoa value chain and use as nutritious ingredient in various types of products giving access to markets Improve smallholder farmers health through an integrated nutrition intervention including ensuring consumption of own produced nutritious food Introduction of quinoa as nutritious crop Nutrition for small holder farmers Increase demand of nutritious food through behavioural change education on hygiene, possible supplementation of nutrition gap with processed products using the workplace as outlet (via dairy hub or garment factory) Integrated nutrition intervention for factory workers School Nutrition Increasing school attendance and learning through (pre)school children Multi nutrient supplement powder for infant and PLW porridge Healthy biscuit for adolescent girls and young women Bridge nutrition gap for by supplementing current food used for infants and PLW by providing an affordable locally produced supplement Key focus will be put on innovative distribution channels and BCC Use an already widely consumed product as a vehicle to reach target consumer groups 36

37 USING BISCUITS TO SHOW HOW THIS WORKS Price level very cheap, reaches all segments Technology Basics are in place, easy to add nutrition Policies and standards Need to consider fortification of stables Vat on ingredients Womens rolle As caretakers, consumers, producers Product innovation adding nutrition to fulling and cake reverse engineer to keep price point Whey protein VitA VitD Fe Environment and climate sustainable solutions Quinoa flour Effect Nutrition impact Needs and aspirations address nutrition gap ensure taste and appreance Value chain solutions market for quinoa flour Trainig and education Knowledge transfer and building capacity Distribution and sales channels consider adding to school feeding and lunch for women workers

38 Thank You 38