GAIN Working Paper INFANT AND YOUNG CHILD ... Working Paper INFANT AND YOUNG CHILD NUTRITION: PAPER 1 IMPROVING COMPLEMENTARY FEEDING: ASSESSING PUBLIC AND PRIVATE SECTOR BUSINESS

GAIN Working Paper

INFANT AND YOUNG CHILD NUTRITION: PAPER 1

IMPROVINGCOMPLEMENTARYFEEDING: ASSESSINGPUBLIC AND PRIVATESECTOR BUSINESSMODELS

GAIN Working Paper

INFANT AND YOUNG CHILD NUTRITION: PAPER 1

IMPROVING COMPLEMENTARY FEEDING:ASSESSING PUBLIC AND PRIVATE SECTORBUSINESS MODELS

February 2015

Acknowledgements:We acknowledge the important contribution of a great number of people that have worked with the Global Alliance for Improved Nutrition (GAIN) over the years and who are too numerous to mention by name. We thank all the experts who have enabled the organization to accumulate expertise in the area ofcommercial and social business models to improve the quality of complementary feeding. Our sincere gratitude goes to our government, civil society and business partners in the countries in which we work, who have worked with patience and persistence towards a collective goal. The authors wish to thank all GAIN staff who have beenengaged in the Maternal, Infant and Young Child Nutrition (MIYCN) projects during the past years, and who havecontributed to this paper.

Above all, GAIN would like to thank the Bill & Melinda Gates Foundation for its visionary approach and for thesubstantive support that it has given to the development of GAIN’s MIYCN program. We are grateful to other donorswho have followed their example and who have invested in GAIN projects to improve availability and accessibility of affordable high quality nutritious complementary feeding, including the Children’s Investment Fund Foundation(CIFF), Ireland’s Department for Foreign Aid and Trade (Irish Aid), the Khalifa bin Zayed Al Nahyan Foundation (KBZF),the Netherland’s Directorate-General for International Cooperation (DGIS), the UK Department for InternationalDevelopment (DFID), and the United States Agency for International Development (USAID).

GAIN Working Paper

INFANT AND YOUNG CHILD NUTRITION: PAPER 1 IMPROVING COMPLEMENTARY FEEDING: ASSESSING PUBLIC AND PRIVATE SECTOR BUSINESS MODELS

3/38

ABOUT THE GLOBAL ALLIANCE FOR IMPROVED NUTRITION (GAIN) The Global Alliance for Improved Nutrition (GAIN) is an international organization that was launched at the UN in 2002 to tackle the human suffering caused by malnutrition.

GAIN is driven by the vision of a world without malnutrition. We act as a catalyst — building alliances betweengovernments, business and civil society — to find and deliver solutions to the complex problem of malnutrition. Today our programs are on track to reach over a billion people with improved nutrition by 2015.

We focus our efforts on children, girls and women because we know that helping them have sustainable, nutritiousdiets is crucial to ending the cycle of malnutrition and poverty. By building alliances that deliver impact at scale, we believe that we can eliminate malnutrition within our lifetimes.

This paper forms part of a series of three papers exploring the enabling environment, business models, and behaviourchange components of GAIN’s MIYCN portfolio, all of which are available from: www.gainhealth.org

For more information regarding this paper, contact Marti van Liere at [email protected]

Global Alliance for Improved Nutrition (GAIN)Rue de Vermont 37-39, 1202 Geneva+41 2 2749 1850

Contributing authors to this report:Marti J van Liere, Romeo Frega, Dessie Tarlton, Dominic Schofield

mailto: [email protected]

www.gainhealth.org

GAIN Working Paper


4/38

TABLE OF CONTENTS

1. Executive Summary 5

2. Infant and Young Child Nutrition Program Design 7

3. Key findings 15

Lesson 1: Translating global evidence into robust normative and regulatory guidelines is crucial to creating a favorable enabling environment for nutritious products; working with strategic multi-stakeholder alliances provides the necessary base of credibility, trust and transparency 16

Lesson 2:Market analysis of new product categories for low-income consumers shows more conservative (slower) return-on-investment than industry benchmarks utilized for more mature markets 18

Lesson 3: Reducing barriers to market sustainability and success for private sector producers can be stimulated by financial and technical support along the value chain 20

Lesson 4: Product innovation requires deep consumer understanding, and is paramount in responding to consumers’ needs and drive appropriate use of IYCN products 25

Lesson 5: To create access for target consumers and drive demand for IYCN products, a mix of traditional and alternative public and private sector delivery channels must be used 26

Lesson 6: Sufficient investment and innovation in demand creation and aligned behavior change interventions are a prerequisite to guarantee trial, uptake, and adequate use 30

4. Measuring the success of a market-based model to improve nutrition 32

5. Conclusions and ways forward 35

References 37

Glossary 38

GAIN Working Paper


5/38

ContextThis paper condenses evidence and learning from aportfolio of innovative private and public models thathave sought to improve the consumption of nutrient-dense and vitamin-rich and mineral-rich complementaryfoods in children 6 to 24 months of age alongsidebreastfeeding. The portfolio consists of a diverse set of 23projects in 17 countries in Africa, Asia, and Latin Americacarried out over a 6 year period between 2008 and 2014.With an initial target reach of 20 million, by December2014 a total of 19 million beneficiaries have beenreached, and cumulative coverage is expected to bealmost 25 million by the end of 2015.

Poor complementary feeding is a significant driver ofmalnutrition and infant and child mortality globally, with3.1m annual child deaths due to malnutrition (45% of alldeaths in children). Despite the considerable progressmade over the past decades, millions of children are stillaffected by acute and chronic malnutrition and manymore are suffering from some degree of sub-optimalhealth and/or development due to micronutrientdeficiencies. A number of efficacious and proveninterventions to improve dietary intake and reduce therisk of infection exist (Bhutta et al, 2013). Infant feeding,specifically exclusive breastfeeding through 6 months of age and continued breastfeeding through 2 years ofage, with nutritionally adequate complementary foodsintroduced from 6 months of age (WHO, 2003), remains at the core of these interventions.

For a host of economic and social reasons, accessinglocally available and culturally acceptable foods makessense as the basis of the complementary diet for olderinfants and young children. Evidence suggests, however,that substantial constraints to ensuring a nutrient-adequate diet exist due to ingredient availability andcost constraints. Even where economic barriers can beovercome, the adequacy of some nutrients may bedifficult to achieve using only local ingredients(Osendarp et al, 2015). High-quality commerciallyproduced fortified complementary foods or multi-nutrientsupplements could help low-income families overcomesome of these barriers if they are made available at low cost. A number of potential commercial and partlysubsidized solutions to improve the quality ofcomplementary foods have been developed during the past few years reaching middle-income targetpopulations and low-income groups (that constitute part of the so-called Base of the Pyramid (BoP).

Executive SummaryFunded by an initial grant of $38.8 million from the Bill &Melinda Gates Foundation, with other donors joining overtime (including CIFF, DFID, DGIS, Irish Aid, KBZF, and USAID),the Global Alliance for Improved Nutrition’s (GAIN) infantand young child nutrition (IYCN) program combinedproven child infant interventions – such as protection and promotion of breastfeeding – with a novel focusexploring the potential role of the private sector,targeting low-income families with fortifiedcomplementary foods or micronutrient powders (MNPs).

Recognizing the complexity of malnutrition, the GAINIYCN program sought opportunities to link with existingprograms, and included critical interventions such as protection and promotion of breastfeeding andimproved dietary diversity. The novel focus of the set of GAIN IYCN projects however, is the emphasis on expanding and securing regular consumption ofnutrient-dense complementary foods in children 6 to 24months of age alongside breastfeeding. To do this, GAINfostered multi-stakeholder partnerships across multiplesectors – specifically among government, non-governmental organizations (NGOs), the private sector,and academics, as well as policy makers and globalstakeholders.

Funding allocation for these projects depended on a number of contextual factors that related to thecompany, the government, and the market. WhereasGAIN’s projects strengthened specifically the productioncapacity of the partner company and supportedgovernment to strengthen its regulatory framework, fewerinvestments were made in other areas of the marketenvironment, such as commercial or public distributionchannels.

GAIN was working in a new and developing area forwhich no benchmarks yet existed. The projects wereresource-intense and proved challenging becauseproducts and market-based approaches were notmainstream or widely accepted in the nutrition sector.Some of the initial assumptions related to the size of themarket were overly ambitious, and in other instancesexternal risks or shocks which could not be anticipatedaffected progress, as was the case of the civil war inCôte d’Ivoire and general strikes in Bangladesh.

This paper describes what was learned regarding publicand private sector business models for nutritious foodstargeting families in low-income settings. GAIN hassought to understand and overcome barriers to

1. EXECUTIVE SUMMARY

availability, accessibility, affordability, and use of high-quality complementary foods, exploring the potentialrole of the private sector to help improve infant andyoung child nutrition. The headline findings aresummarised in six key lessons that should be consideredby anyone seeking to generate a successful socialbusiness model that catalyses the market to supportimproved infant feeding (Panel A). The lessons are basedon the experience and analysis of all GAIN projects inthe IYCN portfolio.

The portfolio generated valuable insights and earlylessons for GAIN, but also raised unanswered questionsand presented numerous challenges. Progress onavailability and accessibility of nutritious products orsupplements, through commercial and hybrid deliverychannels has now been made. Market penetration andregular consumption of the products is as yet, however,insufficient to adequately assess the level of impact thathas been made in terms of the nutritional status of thetarget population.

The United Nations’ Sustainable Development Goals(SDGs), which will be adopted in September 2015consider nutrition as a development driver and tacklingpoor nutrition is now a key goal, placing considerableimportance on the need for multi-stakeholderpartnerships to accelerate delivery at a national level.Failure to address the huge deficit in the availability ofsafe, affordable, and nutritious complementary foods forthe hundreds of millions of poor children who lack this, willimpede the Sustainable Development Goals. This taskcan only be accomplished via collaborative effort led bygovernments with communities, businesses and the widerhealth system.

GAIN Working Paper


6/38

Panel A: Six key lessons learned

1. Translating global evidence into a robustnormative and regulatory framework iscrucial to creating a favorable enablingenvironment for the introduction ofproducts as part of the solution; workingwith strategic multi-stakeholder alliancesprovides the necessary base of credibility,trust and transparency.

2. Market analysis of new productcategories for low-income consumersshows more conservative (slower) return-on-investment than industry benchmarksutilized for more mature markets.

3. Reducing barriers to market sustainabilityand success for private sector producerscan be stimulated via financial andtechnical input at different points along thevalue chain.

4. Product innovation requires deepconsumer understanding, and is paramountin responding to consumers’ needs anddrive appropriate use of IYCN products.

5. To create access for target consumers anddrive demand for IYCN products, a mix oftraditional and alternative public andprivate sector delivery channels must beused.

6. Sufficient investment and innovation indemand creation and aligned behaviourchange interventions are a prerequisite toguarantee trial, uptake, and adequate use.

GAIN Working Paper


7/38

Project selection and design In order to ensure a transparent due diligence processfor the allocation of the sub-grants, GAIN initiated arobust selection process. In December 2007 an open callfor Expressions of Interest was launched, leading to anunexpectedly high number of responses (72 proposals),which were assessed by an independent review panel.The assessment criteria consistently focused on: potentialimpact; the product; the composition and experience ofthe proposed partnership; and the business and deliverymodels. The shortlisted candidate projects were thenasked for a detailed business plan, site visits were madeby GAIN staff, and an independent appraisal of businessplans took place. Finally, the proposals were submitted forapproval to the GAIN Board. The full selection processwas rigorous and proved to be lengthy and resource-intense, taking between 12 and 24 months before sub-grant agreements were signed and projects could start.

In subsequent rounds of project design, rather thanissuing an open call for proposals, GAIN pro-activelyidentified ‘high potential’ strong local partners ‘alreadyin the market’ and invited them to come forward withproposals in order to reduce complexity and transactioncosts for all parties, and shorten design time. The strictdue diligence process for approval, with internal andexternal assessments of the proposals, was maintained.

Currently, GAIN’s IYCN portfolio includes 23 projects in 17countries (Figure 1).

2. INFANT AND YOUNG CHILD NUTRITION PROGRAM DESIGN

dy

Haiti RUTF

Côte d’Ivoire,Ghana: fortifiedinfant porridge

NigeriaMNP

NamibiaMNP

South AfricaMNP, LNS�& fortified

maize meals

Mozambique MNP

Kenya MNP & fortified infant porridge

Ethiopia, MNP& fortified infant

porridge

Indonesia:Integrated nutrition

India, fortifiedsupplementary food – 4 projects

Afghanistan LNSBangladesh MNP

China MNP

Vietnam MNP�& maternal LNS

Philippines, MNP & fortified porridge*

Ecuador�fortified yogurt

Supplements, (multi-nutrient powders (MNP), lipid-based nutrient supplement (LNS) including ready-to-use therapeutic food (RUTF)

Fortified infant foods

Integrated nutrition program

GAIN closed the Philippines project in 2012 due to lack of progress, but was recently informed about the launch of the MNP for institutional use

*

Figure 1: Geographical scope of the GAIN Infant Young Child Nutrition portfolio

FUNCTIONAL OUTCOMES

Evidence base on gaps and e�cacy

Technical consensus

Regulatory environment

Quality control mechanisms

Private sector capacity

Commercial distribution channels

Public delivery systems

A�ordability

Advocacy

Formative research & consumer insights

Consumer awareness and demand

IYCF Public health behavior change interventions

Branded product promotion

Breastfeeding practices

Complementary feeding practices

Care practices (including health and hygiene)

Target coverage

Adequate utilization

DIRECT DETERMINANTS

ENABLING ENVIRONMENT

AVAILABILITY AND ACCESS

BEHAVIOR AND DEMAND

Linear growth

Nutritional status, including micronutrients

Motor and cognitive development

Reduced Morbidity

Reduced Mortality

GAIN Working Paper


8/38

Pathway to ImpactBecause GAIN lacked any benchmark when developing its IYCN portfolio projects, we devised apathway-to-impact plan that guided the activities aspart of this portfolio of work (Figure 2). The ultimate goalwas to contribute to the improvement of functionaloutcomes such as growth and development in children,but efforts and activities were focused much further upthe pathway.

GAIN addressed specific gaps within the enablingenvironment, including barriers regarding availability and access, and initiated behavior-change anddemand-creation interventions. GAIN and its partnerssought to make substantial progress in identifying andtesting strategies across these three areas, seeking todocument progress across the pathway plan.

Intermediate outcomes, which are important in the pathway to impact on nutritional status, such ascoverage (sales and uptake) have been monitored forall projects, whereas adequate utilisation (depending onfrequency and quantity of consumption) and coverageof the target (low-income) group, has been estimated inonly some of the projects.

Measuring impact in this area is not easy. Given thehighly complex and multifaceted environment thatdetermines nutritional and health status in poorcommunities, the cost and complexity of assessingimpact is extremely challenging and expensive. It has notyet been possible to measure the impact of GAIN’s IYCNportfolio on growth and development goals, thoughimpact evaluation studies are currently being set up in projects in Bangladesh and Indonesia.

The projects that have been analysed, and from whichlessons have been learned and synthesized, includeprojects in Bangladesh, Côte d'Ivoire, Ecuador, Ghana,Mozambique, South Africa, Vietnam, Afghanistan, Chinaand Haiti. More detailed project briefs and case studiescan be found athttp://www.gainhealth.org/programs/maternal-infant-and-young-child-nutrition/#achievements .

Figure 2: Simplified pathway to impact plan

http://www.gainhealth.org/programs/maternal-infant-and-young-child-nutrition/#achievements

http://www.gainhealth.org/programs/maternal-infant-and-young-child-nutrition/#achievements

GAIN Working Paper


9/38

Disaggregating the Market andthe GAIN Portfolio: Commercial,Social Business, and PublicService Models

Across the 23 projects in the GAIN IYCN portfolio, eachproject has unique characteristics derived from factorssuch as country context, dietary practices, and degreesof involvement of government and NGO partners. Theportfolio includes three types of delivery models: fullycommercial, social business, and public service delivery(Figure 3). These models are segmented principallyaccording to the level of subsidy required to sustain them at scale.

GAIN concentrated on models reaching target D and Econsumers. The vast majority of complementary foodscurrently on the market are produced under the fullycommercial model by global multinational foodcompanies, and are unaffordable to D and E consumers.Although GAIN did support a few national partners todevelop a fully commercial model (Panel A), and workedwith others to set up a public delivery model (Panel B),most of the projects fall into the social business modelscategory.

Social business models have an explicit social objectiveand are willing to accept lower return-on-investmentthan fully commercial models. Some of these models aimto reach full cost recovery and become commerciallysustainable in the long-term, while others may continueto require subsidies in order to reach low-incomeconsumers.

Figure 3: Typology of Models (GAIN and non-GAIN projects)

Fully commercial models Social business models Public Delivery models

Reason forinvesting

Investment for profit or for scale to leverage existing brand equity orportfolio

Profit objective leads to targeting themost profitable segments

Social & political objectives

Type ofinvestment

Typically private capital, commercialloans

Typically private capital, commercialloans. Possibly grants, social impact investments & price subsidies

Donor and government funding,providing safety net for most vulnerableincome groups

Production Privately manufactured Privately manufactured ormanufactured by governmentinstitutions

Privately or publicly manufactured

Productdistribution/marketing

Distribution and marketing viacorporate retail channels

Distribution and marketing via corporate retail channels; communitylevel distribution often supported byNGOs and /or in partnership with government

Distributed for free and promotedthrough public sector institutions

Revenue model

Customer covers costs and margin viaselling price / profit margin

Selling price covers costs via margins,but social objective justifies subsidy inform of social investments, grants,Technical Assistance, etc.

Distributed for free and promotedthrough public sector institutions

Target group Profit objective leads to targeting themost profitable segments

Segments A to E: Social objective allows to target lower income segments without profit

Segments D & E: Focus of government typically onpoorest income segments, mostvulnerable

A, B, C, D = A way of defining income groups, often used by private companies operating in developing markets. The A income groups corresponds to“high income”, B to “middle income”, C to “low income”, D to “subsistence” whereas E segment is considered the “extreme poverty” segment or thevery “Bottom of the Pyramid”

LEVEL OF SUBSIDY

GAIN Working Paper


10/38

However, these models require both financial andtechnical assistance to overcome the high barriers tomarket entry and market success. “Investors” in socialbusiness models can be generally classified into twogroups:

1. Donor grant funded programs that support theventure and help eradicate barriers to entry andsustainability. This can be done through subsidizingproduct development, financing of equipment,technical assistance, behavior changeinterventions, and through helping with a moreenabling regulatory environment or anycombination of the above.

2. Social impact investment programs. Social impactinvestors are willing to lend despite the higher riskprofile of the business and are willing to accept a lower return-on-investment than commercialinvestors. This form of investment can be structuredas a lower-interest loan for manufacturingequipment, longer repayment period, equity that expects less or no dividend, or even as cross-subsidization from a separate, more profitablebusiness line. Backbone organisations such asGAIN can team up with social impact investors,enabling and supporting investors who wish toenter this unfamiliar territory.

Most of GAIN’s IYCN projects are driven by grants thatare provided to small local companies and NGOs. AllGAIN grants have been provided against detailedbusiness plans and leveraged between 48% and 98% ofcounterpart investment. GAIN also has solid experiencein leveraging funds from social impact investors. Thisapproach provides the additional benefit of betterfinancial discipline from the company, and allows formore input on maintaining the financial stability of theentire business rather than a narrow focus on a singleproduct line (Panel C).

The strength of the business model is influenced by a number of contextual factors that relate to thecompany, the government, and the market (Figure 4).Project funding allocation was mostly targeting atstrengthening the company’s capacity as well assupporting the public sector partner to strengthen theregulatory environment and distribution of productsthrough public delivery systems.

In general, GAIN’s intervention model in the portfolioconcentrated on support to individual companies, withfewer investments made in improving the overall marketenvironment such as strengthening commercialdistribution channels or marketing capacity, ordeveloping greater effective demand for thecomplementary foods category as a whole.

Figure 4: Factors influencing the business model

• Type of finance the company has

• Capitalization of company

• Management capacity and understanding of market dynamics

• Maturity of market for complementary foods

• Structure of commercial � distribution system

• Regulatory environment for complementary feeding

• Political will to get project implemented

• Institutional demand from government or multilateral organizations

• Capacity and reach of the public distribution system

COMPANY

GOVERNMENT MARKET

Low–incomeconsumers

GAIN Working Paper


11/38

PANEL A: Fully commercial modelsDuring the course of IYCN project portfoliodevelopment, GAIN encountered many companiesinterested in pursuing opportunities to develop andsell good quality complementary foods that wouldbenefit low-income families, as long as it could bejustified commercially. Fully commercial companiesrequire a financial return to justify and sustaininvestment with margins of profit equivalent to otherproducts in the company’s portfolio.

Achieving adequate levels of profitability, combinedwith the high reputational risk in entering a verytightly regulated IYCN market, has been the mostimportant barrier to develop a fully commercialbusiness model for fortified complementary foods or MNPs for customers at the so-called Base of thePyramid (BoP). BoP consumers are defined asincome groups living on 0 to 5 USD per day. Furthersegmentation into three groups include: “lowincome” (3-5 USD per day), “subsistence” (1-3 USDper day) and “extreme poverty” (below 1 USD perday). Typically, only the “low income” segment ofthe BoP already participates in commercial marketson a daily basis.

People in the “subsistence” segment oftenparticipate more sporadically in markets, as theirincome is not stable and often based on harvestsales or daily wages. People in the “extremepoverty” segment are typically excluded frommarkets and can only be reached throughgovernments and NGO programs (Rangan, 2011).Another way of defining income groups, often used by private companies operating in developingmarkets, has been the A,B,C,D,E income classsegmentation. The C income groups wouldcorrespond to “low income”, D would be equivalentto “subsistence” whereas E segment is consideredthe “extreme poverty” segment or the very “Bottomof the Pyramid”.

There are three key reasons why it is challenging forcompanies to find risk-adjusted returns in the lowestsegment of the market and decide to invest. First,most businesses in dynamic economic settings, suchas those common in developing countries, naturallyaim to secure the highest returns possible over theshortest time frame. This often leads to either moreprofitable products being favoured for investmentand launch or products target higher incomeconsumers as they are more likely to make apurchase in a new product category.

For affordable fortified complementary foods orsupplements targeting lower-income groups, asignificant volume of demand needs to begenerated in a very short time frame tocompensate for the very low margins associatedwith BoP products. In effect, governance andincentive systems of purely commercial companiesmake it challenging to invest in lower-profit productsas part of their core business (Simanis, 2014) unlessthey can guarantee demand at scale, for exampleby supplying institutional markets. Second, amongthe few big players that face little competition in thepremium space for complementary foods, there is a reluctance to risk profit dilution, product or branddowngrading by launching a product targetingconsumers at the BoP. Third, most large fast-movingconsumer good companies are wary of the possiblereputational risks associated with marketing foodstargeting infants and young children – largely due to the highly regulated environment of IYCN.

GAIN Working Paper


12/38

Panel B: Public service modelsPublic service models are often the most viablesolution to reach the most vulnerable. The distributionof nutritious food for the home fortification ofcomplementary foods targeting the lowest incomegroups can be done for free, as through theIntegrated Child Development Services (ICDS) inIndia, or subsidised at cost to the consumer.

The most prominent examples of public servicemodels that GAIN has supported during the pastyear are two programs servicing the ICDS in India,namely the AP Foods program in Andhra Pradesh(AP), following a centralized production modelleveraging the AP Foods factory, and the womenSelf-Help Group program in Rajasthan, following adecentralized model that relies on self-help groupsto produce supplementary foods with localingredients. Though fully subsidised, these modelshave similar lessons regarding efficiency and qualityof production, distribution, and the need to invest in demand creation and behaviour change tomaximise impact.

Supply of fortified supplementary foods through the ICDSIn India, food rations for over 90 million children,pregnant women, and lactating mothers areprovided free of cost through the ICDS. This publicdelivery program, sponsored by federal and stategovernments, includes a highly decentralizednetwork of 1.3 million Anganwadi Centres andcommunity education and aid centres that provideeducation, healthcare, and nutrition servicesprimarily to women and children.

In 2010 GAIN in India started up three projects(Andhra Pradesh, Gujarat, and Rajasthan) toincrease the local production capacity and improvethe quality of fortified foods that were supplied tothe ICDS. Though the projects had the sameobjectives, they represent very distinct models.

Centralised production model in Andhra PradeshIn partnership with the government-ownedcompany AP Foods in Hyderabad, Andhra Pradesh,GAIN worked to increase the capacity and improvethe quality of production of their fortifiedsupplementary foods, such as ready-to-cook mixesfor common meals. The collaboration between GAINand AP Foods has led to significant improvements inthe nutritional quality and packaging of the foodthat AP Foods produces. Additionally, GAIN’s

investment and expertise acted as a catalyst for a substantial financial commitment from the Stategovernment to build a new, world class productionfacility, which allowed AP Foods to go from supplying60% of the community centres, to all 100% of the 385centres in the State, reaching over 3 millionconsumers.

The GAIN - AP Foods’ partnership demonstrates howto use business-centred practices to improve theproduct quality and efficiency of a public productionand delivery system. The AP Foods managementprioritized impacting efficiency, scale, and qualityincrementally while remaining cost effective. Thisallowed them to evaluate expert recommendationswith an eye towards sustainability of the organization,as well as impact on women and children.

The decentralised production model in RajasthanThis model centred around developing small-scaleproduction facilities run by 10-12 semi-literate womenentrepreneurs who would be both owners andworkers in the factories. The production facilities inRajasthan produce a product called Raj Nutrimix: a mix of flours and sugar, fortified with necessarymicronutrients and palatable to children andpregnant women. The State Government of Rajasthan,through their social welfare program, acts both as a buyer and distributor of the product to pregnantand lactating women and to children younger than3 years in the Anganwadi community centers.

The female self-help groups who benefit from aspecial legal status to access government subsidiesand microfinance, are being trained to run a smallproduction unit that produces up to 1 Mt per day of produce, reaching about 6,000 children youngerthan 3 years and nearly 3,000 pregnant or lactatingwomen. The government of the State of Rajasthanprovides the wheat at a subsidized price andguarantees the buy-back of the products throughthe ICDS. The village authorities provide the factory’spremises and GAIN provided funding for the productionequipment, 2 months’ worth of working capital, aswell as capacity building of the self-help groups.

GAIN Working Paper


13/38

Comparing the models, the centralized approach ofAP Foods has many advantages over decentralizedself-help group models, including increasedeconomies of scale, a consolidated organizationalstructure that allows for easier management, andstandardization and easier quality control. With thiscentralization, however, come high start-up capitalrequirements, a long ramp-up period, and aconcentration of risk for the committed capital. With strong political support, raw material subsidiesand regular orders from the ICDS, the decentralisedself-help group model also proved to be a viable,scalable business able to achieve production costson a par with the centralized model. It is, however,much more time and resource-intensive to build thecapacity of the women groups

At the same time, working with self-help groups hasa number of highly positive externalities with regardsto the economic and social empowerment of thewomen participating in the program as well as thehigher awareness of the fortified products in thecommunities, given the high local involvement in

production. It is important to point out that theAnganwadi Centres play a key role in the program,as their huge coverage allows for the products to be distributed widely, also in areas where traditionalretail channels would not reach consumers. Theproject focus was on the efficient supply of aproduct of high nutritional quality by producers tothe ICDS system.

Most governments will not be able to follow India’sexample to afford large free public delivery ofnutritious foods or supplements and are thereforelooking for alternative ways to ensure access andavailability of these products, including socialbusiness models. In Vietnam, for instance, GAINdeveloped a model, where, in partnership with theNational Institute of Nutrition (NIN), GAIN supportedthe formulation, production, and distribution of anMNP called ‘Bibomix’ for infants and young childrenage 6-59 months. In this pilot, the product isintegrated in IYCF counselling efforts, delivereddirectly and exclusively by the health staff atcommune, district and province level.

The health staff is responsible for the delivery of the counselling on optimal feeding practices, andgenerate a small margin to recover their costs,based on the sales of the MNPs to caregivers for an affordable price. The revenue stream helps thehealth system recover the costs of distribution,training and counselling, and allows for a sustainablemodel that will be expanded to more provinces andto more products.

http://www.gainhealth.org/knowledge-centre/10-women-rural-rajasthan-improving-nutrition-thousands/




GAIN Working Paper


14/38

PANEL C: Innovative finance as a tool to improve nutritionGAIN’s Innovative Finance Program has pilotedvarious models for partnering with investors whofocus on generating both a social impact and afinancial sustainability return from their investments.GAIN grant money has been used to attractinvestment capital in order to support sustainablelocal production of foods.

In Haiti, for example, Meds and Food for Kids (MFK), a non-profit organization, saw an opportunity toproduce high quality peanut-based therapeuticfoods at scale, but they did not manage togenerate the financial support to build a modernfactory. LGT Venture Philanthropy (LGT VP), a Swiss-based impact investor was asked by GAIN toconduct a detailed financial analysis, on the basis of which they decided, with GAIN, to pool theirfunds in order to extend a loan to MFK to constructits factory. Within 9 months of receiving the loan, thefactory was complete and MFK’s production oftherapeutic foods had commenced, enabling it tosave the lives of more than 30,000 children in its firstyear of operations. Between 2010 and 2013 MFK’srevenue increased by 33%, following the upgrade in production.

MFK’s financing needs are not unusual. Manybusinesses looking to achieve social impact in low-income economies have difficulty accessing thecapital needed to start and scale-up. At the sametime, many development actors are usually relianton grants to support interventions. By partneringwith investors, including those who seek a socialimpact in addition to (or instead of) a financialreturn, development actors can use their grantmoney to reduce the risk of investing in a way that

attracts, rather than substitutes for, private capital,and thereby generate a wider range of financingsolutions.

In GAIN’s experience, working with social investorsoffers the following advantages:

Promoting sustainability and scale – social capitalleverages development actors’ support and createsincentives for a market-based intervention to besustained over time.

Addressing a range of financing needs – there isno one size fits all, but appropriate forms of financing(for example, debt and equity), can be tailored todiverse funding needs.

Amplifying the impact of scarce resources –investment partnerships allow the developmentactor to stretch its scarce resources across moreinterventions, thus broadening its impact.

Adding a complementary skill set – investors bringa set of skills and capabilities such as business andfinancial expertise, as well as networks of experts invarious businesses.

Reducing risk for innovators – purposeful use ofgrant money to support a first step towardsinnovation, within the context of an investmentpartnership helps to reduce the financial risk to thecompany.

GAIN and the International Finance Corporation(IFC) – the private sector lending arm of the WorldBank Group – worked with an Ecuadorian foodcompany that was interested in creating a fortifiedyogurt for low-income consumers. By using amatching grant to cover a portion of the cost of amarket study, GAIN and the IFC reduced the risk tothe company confirming the market potential ofsuch products. This laid the groundwork for severalsubsequent stages of support, including advice onproduct formulation, marketing and assistance withthe development of a business plan. This initial use ofgrant money ultimately led to the launch of a newproduct largely financed by the IFC and thecompany’s own capital.

Partnerships with investors are an additional strategyto support market-based interventions with positivedevelopment outcomes. When used appropriately,these partnerships can help development actorstake one more step towards achieving a sustainableimpact at a scale that could not be reachedthrough grant money alone.

GAIN Working Paper


15/38

GAIN used a mixture of methodologies to derive thelessons learned that are outlined in this paper. A mid-termreview of the portfolio was conducted by CambridgeEconomic Policy Associates (GAIN, 2012) which led toseveral changes being made to program focus. TheBoston Consulting Group (www.bcg.com) was thenengaged to review the business models once theprojects were up and running and to assess theirpotential impact, scale-up, sustainability, and replication.

Case studies conducted by the Global Business SchoolNetwork and Tuck Business School through on-siteevaluation and quantified business model analysis, havebeen published and contributed to the development ofthe lessons presented in this paper (GAIN a,b,c, 2015). Inaddition, case reports and individual experiences of ourpartners and project staff were collected and workshopswere held internally and with donors, partners, and otherstakeholders.

Based on the analysis of the different projects anddifferent business models, GAIN has extrapolated six“clusters” of lessons that should be considered topromote increased availability of nutritious foods andsupplements, affordable access, and high quality andappropriate use to improve nutrition among low-incomeconsumers.

Each of the six lessons represents one of the levels ofintervention (Figure 5) from the enabling or regulatoryenvironment, the competitive market place, as well asfactors involved in how the consumer is being reached,and the behaviour of that consumer in terms of thechoices he/she makes (Panel D).

3. KEY FINDINGS

Six key lessons learned

1. Translating global evidence into robustnormative and regulatory guidelines iscrucial to creating a favourable enablingenvironment for the introduction ofproducts as part of the solution; workingwith strategic multi-stakeholder alliancesprovides the necessary base of credibility,trust and transparency

2. Market analysis of new productcategories for low-income consumersshows more conservative (slower) return-on-investment than industry benchmarksutilized for more mature markets.

3. Reducing barriers to marketsustainability and success for privatesector producers can be stimulated byfinancial and technical input support atdifferent points along the value chain.

4. Product innovation rrequires deepconsumer understanding, and is paramountin responding to consumers’ needs anddrive appropriate use of IYCN products.

5. To create access for target consumers anddrive demand for IYCN products, a mix oftraditional and alternative public andprivate sector delivery channelsmust beused.

6. Sufficient investment and innovation indemand creation and aligned behaviourchange interventions are a prerequisite toguarantee trial, uptake, and adequate use.

Figure 5: Intervention levels of GAIN’s IYCN portfolio.

1. EN

ABLING ENVIRONMENT

2. MARKET

3. PRODUCER

4. PRODUCT

5. CONSUMER

6. BEHAVIOR

GAIN Working Paper


16/38

In order to guide companies in thedevelopment and marketing of nutritiouscomplementary foods aligned with publichealth principles, two normative guidelines arecentral: the 1991 Codex Alimentarius (FAO,1991) and the International Code on Marketingof Breast Milk Substitutes (WHO, 1981).

The first hurdle encountered by GAIN to incentivisecompanies to produce nutritious complementary foodswas the lack of appropriate guidelines for productformulation. The market rarely provides incentives toformulate products according to the latest scientificevidence, because it is driven by consumer wants andneeds, not scientific evidence. Moreover, smallercompanies are often unaware of scientific evidence orlack the expertise to translate new findings into productformulation if there is no national level legislation.

In order to share technical updates and createconsensus on key technical issues and policy concerns,GAIN has served as the secretariat for the MIYCNWorking Group under the Ten Year Strategy Initiative. This Working Group is a virtual network of more than 100global scientists and technical experts focused onnutrition programming, specifically for the first 1000 dayperiod of life. Collaboration among the MIYCN Groupmembers generated the content for a number of formal publications, of which two will be mentionedspecifically here.

The first publication of the MIYCN Working Group dealt with formulations for fortified complementary foods and supplements (MIYCN WG, 2009) This was animportant step since product formulation guidanceprovided by the 1991 Codex Alimentarius standard forcomplementary foods was outdated and did notinclude recent scientific evidence. In parallel, GAINsupported the Ghana-led Codex Alimentarius WorkingGroup to ensure inclusion of the same scientific evidenceat a global level. These two activities resulted in the 2013revision of the Codex Guidelines on FormulatedSupplementary Foods for Older Infants and YoungChildren (FAO, 1991).

A second important publication developed by theMIYCN Working Group, and supported by GAIN, aims toprovide guidance on “dos and don’ts” in the marketingof complementary foods to children age 6-23 months

(Quinn et al, 2010). The International Code on Marketingof Breast Milk Substitutes (WHO, 1981) provides strongadvice on marketing of infant formula in order to ensurecontinued breastfeeding, but it is not intended toaddress the marketing of complementary foods. In 2013,WHO mandated a scientific and technical advisorygroup to look into marketing of complementary foodsand to provide recommendations. Similarly, in the area of home fortification of complementary foods, GAINsupports the secretariat of the Home FortificationTechnical Advisory Group (HF-TAG), which bringstogether a community of stakeholders involved in homefortification comprised of members from the public,private, academic and NGO sectors. The HF-TAG offers acentralized repository of knowledge and practice to helpensure well-designed and effective home fortificationprograms across countries and within the context ofother IYCN or nutrition sensitive programs(www.hftag.org).

Equally important to shaping the global enablingenvironment was GAIN’s support to developing nationalcapacity. The policy nexus between breastfeeding andcomplementary feeding is sensitive and complex. Theapplication of the International Code on Marketing ofBreast Milk Substitutes itself faces continuous challengeresulting in less than optimal breastfeeding rates due toweak regulatory regimes, and poor compliance andinappropriate marketing by some companies. Giventhese challenges, it is critical that national policies andregulations are evidence-based, developed in atransparent manner led by government and include a range of stakeholders, and are not driven by anyvested interest.

In Kenya, Namibia, and Indonesia, GAIN’s support has ledto the establishment of national MIYCN Working Groups,uniting local and international experts to inform nationalnutrition planning processes. The working groups support,amongst others, national processes to establish productcategory standards (for example, for lipid-based nutrientsupplements) as well as building awareness andcapacity of local stakeholders around MIYCN, homefortification, dietary guidelines and behaviour change. In Côte d’Ivoire, Helen Keller International and GAINsupported the Ministry of Health in the adoption of alocal version of the International Code on Marketing of Breast Milk Substitutes, as well as the development of a product standard for fortified complementary foods,based on the revised Codex Alimentariusrecommendations (FAO, 1991; Panel D).

Lesson 1. Translating global evidence into robust normative andregulatory guidelines is crucial to creating a favorable enablingenvironment for nutritious products; working with strategic multi-stakeholder alliances provides the necessary base of credibility, trust and transparency

www.hftag.org

GAIN Working Paper


17/38

Without up-to-date product standards, GAIN’s advice on product formulation to companiesstood no ground.

The 2013 revision of the Codex Guidelines onFormulated Supplementary Foods for OlderInfants and Young Children (CAC/GL 08-1991)ensures that governments and producers areguided by recent scientific evidence

Such strategic alliances and alignment with many of theglobal nutrition actors have been successful in improvingcoordination and interaction, as well as identifyingpriorities and collectively addressing the technicalchallenges. GAIN has supported these processes,

providing secretariat support and financial support to thedevelopment of publications and other outputs. Howeverone organization alone cannot shape global andcountry agendas. The contributions in terms of time,effort, and expertise that nutrition partners continue toput into these alliances are fundamental to any progressbeing made. The credits go to a long list of organizationsthat cannot all be listed here, but notable among themare UNICEF, the World Food Programme, Helen KellerInternational, John Snow International, the University ofCalifornia Davies (UC Davies), the Micronutrient Initiative,Sight and Life, and the Hospital for Sick Children, Toronto.

More detail on GAIN’s work to create enablingenvironments at a global and country level is describedin Paper 3 of the GAIN IYCN Series (Siekmann andSchofield, 2015).

PANEL D: Ensuring Code-compliantlabelling and marketingWhile working with infant food producers, it was of major importance to GAIN to ensure that allmarketing activities of the companies werecompliant with the International Code on Breast Milk Substitute Marketing (WHO, 1981), whether itwas around labelling, packaging, or marketing. Since the Code did not intend to give guidance for marketing of complementary foods and theinterpretations vary widely, GAIN together withexperts has developed a guiding note on how tointerpret the Code and subsequent World HealthAssembly resolutions.

Some small local companies are not even aware ofthe existence of the Code or its application to foodsother than formula milk for children under 2 years. Inaddition, once companies are made aware of themarketing guidance, changing their packaging andmessages takes time and involves continuousengagement with the partner. Similar to changes intaste or pricing, companies are hesitant to changethe package design and messaging of their existingproducts – fearing this will destroy their brand equity(brand position) and lead to loss of targetconsumers. PKL in Côte d’Ivoire, for example, kept itsoriginal product, with the well-establish brand name“Farinor” and its non-Code compliant packaging inthe market for a certain time for fear of losingmarket share. However, based on consumer insightsindicating the original packaging looked ‘old’ andconstant, albeit slow growth of the new productunder the co-branding “Farinor-Nutribon”, PKLrevised the packaging of the old “Farinor” product to make it Code-compliant.

Code-compliant packaging of “Nutribon” in Côted’Ivoire

In order to comply with the Code, producers are not allowed to use health professionals to market or sell their product. In certain countries, however, an exception is made for MNPs, which do not carryany risk of breast milk displacement. In Vietnam forinstance, Bibomix MNPs are being promoted as wellas sold by government health workers,

In virtually all projects, GAIN has provided technicalassistance with regards to packaging design andimaging as well as advised on marketing strategies,to avoid promotion of products in health centresand unacceptable health and nutrition claims, and ensure alignment with the Code.

GAIN Working Paper


18/38

Bringing a new product on the market requires detailedmarket analysis, validation of the potential demand forthe product, competitor analyses, as well as formativeresearch to understand consumer habits in order todefine the viability of the business case and build abusiness plan. Many social businesses, social investors,and donors that GAIN works with had not previouslyconsidered entering the market for nutritious IYCNproducts for low-income consumers.

Market analysisGAIN supported many of its partners in conductingextensive market assessments, as well as developing a detailed business plan. GAIN’s support to theInternational Finance Corporation’s client Favorita, an Ecuadorian fruit and yoghurt company, is a goodexample of successful support for market assessment.Favorita received partial funding from GAIN to do adetailed market assessment prior to proceeding with the actual product development. Only after the marketanalysis showed a clear potential demand for theproducts, as well as consumer willingness-to-pay for the proposed product, did the project moved towardsimplementation. GAIN continued to provide technicalsupport and once the product formulation was set, GAIN supported Favorita and the International FinanceCorporation in the development of a more detailedbusiness plan.

Because IYCN products for low-income householdsexplore a new market segment, it has provenchallenging to precisely identify the opportunities when building the business case – for example, definingaccurate estimates of the size of the target market,penetration rates, and trial and repurchase issues.Nycomed Taheda, the company launching Emvit

Sprinkles in South Africa therefore decided to target earlyadopters and high-income groups in urban pharmacies.The company decided that immediate targeting of low-income consumers was too risky when launching acompletely new product category. However thecompany’s market development model aims to exploit atrickle-down effect to lower-income groups to copy andadopt this new behavior over time.

Expectations were overly optimistic on howmany low-income consumers could be reachedin immature markets within 4 to 5 years, andhow quickly this could happen.

Industry benchmark for successful productlaunch and uptake in mature markets is evenlonger than that: around 6 to 8 years.

In hindsight, GAIN concluded that the market potentialfor fortified complementary foods for infants had tendedto be systematically over-estimated in the business plans,which were derived from the estimated number ofpotential undernourished infants and children who wouldaccess the product. This assumption requires that inaddition, supplementary investments in the marketingand distribution required to create awareness aroundthe new type of product to reach the hard-to-reachtarget populations happened. In particular, new productconcepts, such as MNPs, require a lot of start-upinvestments in awareness raising and behavior changeamong consumers.

Thus, in the development of the grant, GAIN and donorswere overly optimistic with regards to how quick andhow many low-income consumers could be reachedthrough the market within 4-5 years. Industry benchmarkfor successful business case development, productdevelopment, market testing, launch of a product, andcreating successful demand and uptake is 6-8 years in amature market. In the countries where GAIN operates inmarkets where consumers are at the Base of the Pyramidand companies are often less mature, we are working in challenging dynamic contexts with weak healthinfrastructure and in some cases civil conflict. In thesedemanding situations, GAIN aims to create a market forproducts that consumers have never used or seen before.

Lesson 2: Market analysis of new product categories for low-income consumers shows more conservative (slower) return-on-investment than industry benchmarks utilized for moremature markets

GAIN Working Paper


19/38

Smart positioning in a competitive landscape is feasibleIt is a common misconception that lower-incomeconsumers only want, and can only afford, cheapproducts. GAIN’s experience shows that poor people do not want cheap products, but are willing to pay for quality at the right price. This is an importantconsideration, because there is a constant tensionbetween nutritional quality and affordable price. Put simply, nutrition comes at a cost.

Protein Kissée-La in Côte d’Ivoire has identified theoptimal price lower income consumers are willing to payfor a high quality product, which falls between the priceof traditional foods and premium branded products(Figure 6; Kayser and Klarsfeld, 2014). Smart pricing that is based on a detailed understanding of the competitivelandscape enables companies to capture the lower-income consumer.

$0.40

$0.68

$0.80

$1.00 $1.04$1.10

$1.16 $1.20 $1.23 $1.24

$0.10

1kg–500F

Flour

300g–600F

GLP Bebe

250g–850F

Baka Ivoire

50g–200F

PKL–Nutrit

ion

240g–1200F

Baby Lac

250g–1300F

Bledine & Phosphatin

e

200g–1100F

PKL–Nutrit

ion

250g–1450F

France La

it

250g–1500F

Cerelac

250g–1535F

Lait L

ac

200g–1235F

Ninolac

Non–fortified foods Fortified foods

Figure 6: Range of available products that fall between traditional foods and premium branded products.(Price of 100g of infant food in Côte d’Ivoire, in USD) Kayser and Klarsfeld (2014)

Subsequently, in Côte d’Ivoire, the launch of the Nutribon high-quality product, in economic size packs(50g) that looked appealing caused competitors tolower their prices and copy the economic pack size.Competition resulted in more affordable prices for theconsumers, which in its turn will lead to increaseddemand for these products by the consumers. It isexpected that this competitive pressure will preventGAIN’s private sector partners from increasing their priceafter the project ends. These companies would risk losingclients to the competition were they to leave their‘niche’ price position.

Small and medium enterprises require external capitalinvestments or subsidies that help them reduce barriersto market entry and offer them an opportunity to growtheir profits in the long run. In the case of AP Foods inIndia, a GAIN grant triggered a change in companystrategy and a considerable additional investment bythe government-owned company itself in new plant and equipment. PKL in Côte d’Ivoire used the GAIN grant to obtain a commercial credit from BNP Paribas.The company’s CEO Marie Konate confirms that thestrengthened balance sheet as well as improvedcredibility through the collaboration with GAIN helpedher to secure this loan.

Reducing barriers to market success for localproducers requires not only financial support,but also substantial technical and managerialsupport

With appropriate financial and technical support atdifferent steps along the value chain, GAIN’s role as thebackbone organisation was to eliminate barriers, startingfrom the regulatory environment, translating productstandards into product development, throughout thevalue chain, all the way to product compliance (Figure7). This is where the bulk of GAIN’s support to companieshas concentrated, reaching close to 19 million customers.

GAIN Working Paper


20/38

Product development

Supplychain

Manufacturing Sales Marketing Impactevaluation

Lack of market understanding

Lack of incentive to formulate foods according to guidelines

Lack of business plan expertise

Prohibitively expensive premix sourcing

Need for adequate quality control

Capital intensive bulk purchasing

Need for new equipment

Lack of expertise to upgrade hygiene standards

Product is not affordable to some target groups

Marketing and brand building is very capital intensive Code compliant marketing is not incentivized by market

Sale requires additional education on feeding practices

Assessing program results and nutritional impact is usually not within scope of commercial enterprise

Technical Assistance for:

Market assessments & formative research

Detailed business plans

New product developmentReformulation of existing products

Offering premix sourcing services

Subsidizing quality control equipment

Subsidizing working capital in for bulk purchasing

Subsidizing equipment

Facilitating private sector financing for equipment

Upgrade quality assurance / quality control standards

Subsidizing product price in order to make it affordable to low-income consumers (mostly for MNPs)

Subsidizing market development campaigns

Subsidizing code compliant marketing and packagingInvesting in changing caring practices & health system strengthening

Financing monitoring and evaluation activities or projects

TYPICAL CHALLENGES

TYPICAL GAIN�SUBSIDIES

Figure 7: Overview of typical challenges and types of subsidies in projects that arefollowing the social business model

Lesson 3: Reducing barriers to market sustainability and success forprivate sector producers can be stimulated by financial and technicalsupport along the value chain

GAIN Working Paper


21/38

Product development and composition GAIN guidelines for fortified complementary foods are based on scientific evidence and includerecommendations regarding coverage of 50% of mostmicronutrient requirements, maximum portion size,energy density, maximum sugar levels and protein quality,amongst others (GAIN, 2011; FAO, 2013). The typicalbarriers for companies to reformulate existing foodsaccording to nutritional guidelines are – not surprisingly – related to the balance between cost and taste versusfood and nutrition quality. They can be summarised asfollows:

1. Higher level of fortification. Particularly the inclusionof more iron or a different iron compound canhave an impact on cost, taste, and colour of theproduct. It can also lead to the need for moreexpensive packaging to safeguard productstability and shelf life.

2. Lower percentage of sugar than is usuallyincluded, reducing acceptability for consumers.

3. High quality ingredients such as milk protein willdrive up costs of the product.

4. Portion size recommendations have beenreduced in the revised 2013 Codex Alimentarius toavoid risk of displacing breast feeding, potentiallyimpacting on sales volumes.

GAIN has learnt that implementing recommendedstandards can have a significant impact on the productcost structure and GAIN has therefore worked withpartners to identify cost savings along the value chain.This was evident when working with small localcompanies as well as with the more established players.For both PKL in Côte d’Ivoire and Yedent in Ghana,nutrition quality was the driver of the GAIN grant, butquality came at a cost, and for PKL this resulted in ahigher price of the end product than was foreseen in the initial business plan.

Nutrition quality comes at a cost… What is optimal in terms of nutritionalguidelines is not always feasible in terms ofmarket incentives and economics.

When working with larger producers such as Indofood in Indonesia, GAIN encountered a different set of challenges. Without the same lever of financialsupport provided by GAIN as part of the partnership, it was much more challenging to convince thecommercial partner to change their product formulation.All recommendations regarding product composition orpackaging have to be verified against their impact onthe business case and on-going product sales. A good

example is GAIN’s request to reduce the recommendedportion size from 50g to 20-25g as recommended by the2013 Codex Alimentarius. The Indonesian productstandard, however, still prescribes portion sizes of 40-50g,and the company anticipates a negative impact onvolume sold if they would be the first to move in reducingportions. While GAIN is advocating for the adoption ofthe revised 2013 Codex Alimentarius guidelines with theIndonesian Bureau of Standards, Indofood has agreed to make small but significant changes in productcomposition regarding the iron compound used. Theissue of portion size will need to be resolved for the entirecategory with a new standard and will take more time,highlighting the significant interdependencies betweenproduct standards, price, and market development.

Raw material sourcing: creating efficiencies in the supply chainFor small manufacturers, supply-chain support can makea big difference to profitability. The price of raw materialsis one of the main drivers of a product cost, whereas atthe same time, the quality of the raw materials is animportant determinant of the quality of the end product.Small producers are often not able to benefit fromefficiencies and economies of scale when procuring rawmaterials for low production quantities.

Importantly, price fluctuations of commodity inputs caneasily reach up to 20% of the commodity value and canmake or break profitability of a product. Though thesefluctuations are partially predictable, such as the harvestand lean season in the local market, small players do nothave the necessary funds to purchase ingredients in bulkat the right time. For this reason, Yedent in Ghanadecided to use part of the GAIN grant as working capitalto buy its raw material at the lowest price in the market,prior to being ready for production. Similarly, in Rajasthan,the government’s rice subsidy allowed female self-helpgroups to avoid market price fluctuations of rawmaterials and produce the fortified supplementary food at the price set by the government.

For small players, supply chain support canmake a big difference, allowing for economiesof scale and protecting against pricefluctuations.

Another typical supply-chain issue that the smallerprivate sector partners encounter in particular is thatsourcing of imported ingredients such as milk powder orpremix can be prohibitively expensive in many Africancountries, because very few factories operate in thisarena on the African continent and relatively highimportation and Value Added Taxes (VAT) apply.Through a centralised tendering process, the GAINPremix Facility (GPF) makes premix available to GAINpartners at the lowest possible costs. GAIN partners were

GAIN Working Paper


22/38

USD/kilo USD/kg

$25

$20

$15

$10

$5Sep–11 Sep–12 Sep–13

$15

$13

$11

$9

$7

$5Mar–11 Sep–11 Mar–12 Sep–12 Mar–13 Sep–13 Mar–14

able to lower their premix costs up to 40% during the past 3 years as the examples below show (Figure 8).Particularly for micronutrient supplementation projects,sourcing premix at the right price is a key factor for theviability of the overall business case. An additionalimportant factor is that in some countries the GPFmanages to negotiate a tax exemption on importedpremix, for example in South Africa, which has benefitedGAIN’s partner Nycomed.

Beside the services of the GPF in managing thetendering, procurement, and tax exemption there is nofinancial subsidy of premix prices for any of the companies.

Figure 8: Premix price development for partners of the GFP

Wherever possible, local sourcing of raw ingredients andthus supporting smallholder producers is a priority. PKL, forexample, sources its grains from women farmers aroundAbidjan, Côte d’Ivoire whereas Yedent procures its maizefrom farmer cooperatives in the Sunyani district inGhana. However, given the widespread aflatoxin issues –particularly for maize grains and legumes – qualitycontrol is a key prerequisite to making the local sourcingstrategy possible. GAIN gives sustained support for qualitycontrol, amongst others through spot-checks equipmentfor aflatoxin, to strengthen the procurement quality oflocal partners.

Improving manufacturing capacity, qualityassurance, and controla. Upgrading manufacturing equipmentAs outlined previously, most of GAIN’s private sectorpartners who enter the fortified complementary foodspace are small local enterprises. As a result they do nothave the necessary production equipment or theirequipment is out-of-date, with limited capacity, and theyare unable to produce a high quality product that could

serve the local low-income consumer. Securingcommercial loans or attracting equity investment for this kind of equipment is not an option, because thesepartners are often not capitalized sufficiently to providethe required guarantees to local financial institutions.

GAIN offered its private sector partners the opportunityto finance the necessary machinery, laboratory, andother quality assurance & quality control (QA/QC)equipment (typically extruders, mixers, dosers, andmodern packaging machinery; Figure 10. Companies inGhana, Côte d’Ivoire, and India for example, have useda large part of their GAIN grant to renew their productionlines as well as installing proper food quality and safetylaboratories. This in turn has made the productionprocess more efficient, increasing the productioncapacity and leading to a higher quality and moreconvenient (for example, instant) product. The level ofinvestment in equipment committed by GAIN to datehas varied from 4% to 37% of the total project grantbudgets.

Yedent’s purchase of Vitamin Premix through the GFP PKL’s purchase of Vitamin Premix through the GFP

GAIN Working Paper


23/38

b. Raising the bar for manufacturing practicesThe production of infant foods demands stringenthygiene standards. Most partners did not have an ISOcertification for their processes, nor did they follow apreventative HACCP (Hazard Analysis and CriticalControl Points) approach, because this was not requiredfor their existing product portfolio or by local regulation.From a public health perspective, however, no foodsafety risks are acceptable when infant and child foodsare concerned, and a stringent QA/QC is core to GAIN’s objectives.

For this reason, GAIN supported various partners withtechnical assistance either by supporting the set-up of a laboratory at the company’s premises or trainingpersonnel in HACCP Standard Operational Procedures.This caused some tension with the private partners whenGAIN requested additional tests, additional to nationalstandards and requirements.

For example, Yedent’s product was already approved by the local Food and Drugs Authorities in Ghana.However GAIN, as an international organisation requiredto comply with international recommendations,requested that a number of additional tests must beconducted. The results from these tests were not entirelyto GAIN’s satisfaction and additional QA/QC measureswere agreed to ensure the product meets both localand international standards (Panel E).

Rigorous quality controls, however, also open up newmarkets for the local companies as they may fulfil strictsupplier requirements that are applied by internationalorganisations or NGOs. Improved access to institutionalmarkets for large international humanitarian agenciescan boost a company’s volumes and reduce time takento break even. Renata in Bangladesh, for example,supplies the BRAC community distribution network withPushtikona MNPs. This represents a much larger volume of sales than through their traditional pharmacy channel.Another example is PKL in Côte d’Ivoire: in the past theyproduced a fortified complementary food calledCerealPlus (formerly Corn Soy Blend +) for the World FoodProgramme, and now there are renewed discussionsaround CerealPlus institutional supply.

Figure 10: New production lines for Kidifeed, in Ghana (left) and Raj Nutrimix, India (right)

GAIN Working Paper


24/38

PANEL E: Yedent, a local company,determined to improve nutrition in GhanaYedent Agro-processing Ventures Ltd is a localmanufacturer in Sunyani, in Center-Ghana, driven by a mission to provide nutritious and affordablefoods for Ghana and West Africa. GAIN worked with Yedent to adapt their existing maize-basedcomplementary food into a high quality, instantinfant food (KidiFeed) enriched with vitamins andminerals. The grant agreement was signed in May2010, but it took until end of 2014 for Kidifeed to belaunched into the market. The road was long andpresented many challenges, which GAIN andYedent resolved together.

Support business plan development of localcompanies to address inaccurate assumptions.The cost-structure in the original business plan wasbased on the original product which was non-instant and non-fortified. Insights from formativeresearch in the first phase of the projectrecommended producing an instant product, torespond to mother’s need for convenience andtime. This obviously had budget implications foradditional equipment, and therefore price point of the product. Close to the launch, Yedent andGAIN re-conducted a cost analysis, leading to anincreased sales price ensuring business sustainability.The new price still falls within the price range thatlow-income consumers are willing to pay and is notexpected to have an impact on sales andaffordability.

Project management and support to the partnerrequire in-country presence. GAIN did not have a Ghana country manager untilmid-2012, and managed the project from Geneva.The distance led to insufficient appreciation of thelocal situation regarding time and resource needs.For instance, the production premises lackedessential infrastructure such as gas, clean water, and ample electricity supply to power the newequipment. Resolving these issues in Central Ghanaproved unexpectedly complex and resulted insignificant delays. GAIN technical experts visited thefactory multiple times to conduct analyses, correctcourse and provide technical assistance.

Management and technical capacity of local companies requires ample investment.Through its partnership with GAIN, Yedent attracted attention from other internationalcompanies. These projects diverted time and limitedresources of Yedent’s senior management thusaffecting GAIN’s project.

GAIN supported Yedent with the review of the needs and recommendation of manufacturing and laboratory equipment. Upon reception andinstallation of the equipment, Yedent’ staff did notrecognise the defective status of some of theequipment, resulting in additional costs and delays. Despite the challenges, Yedent succeeded inlaunching a high-quality and affordablecomplementary food product on the market inSunyani district, with plans to quickly roll out to Accraand beyond. As a local company, using localingredients, Yedent is commended by theagricultural, health, and traditional authorities inGhana. Although the project targets have not beenachieved within the time-frame that was initially set,the vision and passion of this company will ensure a slow but steady growth in the distribution anduptake of Kidifeed.

GAIN Working Paper


25/38

All GAIN-supported projects have demonstrated thatlow-income consumers are quality conscious. They wantto avoid wasting limited disposable income on poorproducts and instead spend their resources on relevant,appropriate, appealing, aspirational, and high-qualityproducts.

High quality appealing packaging and choice of flavorsare also important drivers that inspire trust in quality ofthe product for low-income consumers. To drive uptakeof any product it is important, specifically for low-incomeconsumers, that products are perceived as aspirational,high quality, and trustworthy. Business planning based ondetailed market assessment and consumer insight musttranslate into products tailored to the needs and thewants of low-income consumers. The packaging ofNutribon in Côte d’Ivoire and Bibomix in Vietnam areexamples that compete with the packaging of anypremium product, whereas they are priced much lower.

Formative research conducted in Ghana (Pelto et al,2011) pointed to the importance of convenience for low-income consumers, who are both resource-constrained and time-constrained. Mothers did not havethe time to prepare separate porridges or meals for theirchildren. It is not surprising that this consumer behaviorholds for developing markets as well as for developedeconomies - taste, price, and convenience are the maindrivers for consumer behavior in food. Based on the

insights of this research, Yedent, GAIN’s partner in Ghana,decided to change its plans and launch an instantproduct requiring minimal preparation.

Mothers want to give their children the bestfood they can afford and which is mostconvenient – not necessarily the cheapestproduct on the market

In Vietnam, one study (Alive & Thrive, July 2013) identifiedthe key components of the packaging and product mixthat helps increase adherence and appeal towardsmothers. The locally manufactured product, with localbrand of MNPs, Bibomix (meaning “the mix for babies”), is sold in packs of 10 sachets, which equals a monthlydosage, with 60 sachets in a box for a semi-annual dose.In this case, consumer-tested colorful packaging, locallyrelevant branding, and right sizing/pricing combinationwith government endorsement, positions the productalongside established brands, thus inspiring quality andtrust (Panel G), and ultimately higher uptake.

Lesson 4: Product innovation, requires deep consumer understanding,and is paramount in responding to consumers’ needs and driveappropriate use of IYCN products

GAIN’s experience has confirmed that it is challenging toreach lower-income consumers through the commercialretail market alone. This is not just because low-incomeconsumers often do not buy in retail, but also becauseretail channels are not equally well developedeverywhere, and sometimes even non-existent in ruralareas. Moreover, it is sometimes difficult for smallcompanies to access these channels via wholesalers or distributors because of monopoly situations that arecommon in food distribution in developing economies.

In addition, distributors and shop owners take a margin of the final product price, which is much higher for smallcompanies than for established consumer-goodscompanies. Interviews with established players such asUnilever and Nestle reveal that they spend less than 10%of the final product price as margin to the distributor, andless than 10% as margin to the shop owners. For smallcompanies without established brands, these marginsare much higher, totalling in the range of 40%-50%. Thereason why large companies benefit from low margins islargely due to high sales volumes and driven by intensemarketing efforts. For products marketed by smallcompanies, the distributor takes a risk that these productsmight not sell fast and that they take up shelf space. Ascompensation, therefore, the seller will be setting a higherprofit margin on the final product price.

Improving access through multiple delivery channelsTo overcome the aforementioned challenges, socialbusinesses need to use all available delivery channels in order to accelerate demand creation and optimizeaccess for the targeted low-income population. In almost all of the GAIN-supported programs, non-traditionaldelivery channels have been adapted for nutritiousproducts, including leveraging community or health systemsplatforms, and working with social marketing organizations.

To increase reach to low-income consumers, GAIN’sproject in Mozambique is piloting voucher distributionthrough health centers and the community, as well as direct sales through retailers, in partnership withPopulation Services International and Save the Children.

Renata Ltd in Bangladesh experienced a relatively lowdemand for Pushtikona MNP through pharmacies, whichis their traditional distribution channel. GAIN thenengaged with BRAC to increase distribution of the MNPsleveraging BRAC’s network of trained female communityworkers (called Shastya Shebikas) who sell the productdoor-to-door. Large numbers of children in low-incomehouseholds are being reached through the communitysales force, which has delivered the largest part of theMNP market growth in 2013 and 2014.

In Vietnam, GAIN works with the National Institute ofNutrition to develop and produce MNPs, called Bibomix,and distribution is secured through government healthworkers who are acting as the sales force. The MNPs arebeing promoted via social marketing materials as well asradio and TV advertising, and as part of a campaign ledby the Government on “Micronutrient Day”.

It is challenging to reach lower-incomeconsumers through retail alone.

Using a mix of delivery channels canaccelerate demand creation and optimizeaccess to nutritious products for theseconsumers

Subsidizing the final price?Lower-income groups are less likely to be able to afford a full priced, high-quality nutritious product. To ensurethat the most vulnerable groups also have access toMNPs or fortified complementary food products, subsidieson the final product price are often made bygovernments and NGOs.

GAIN Working Paper


26/38

Lesson 5: To create access for target consumers and drive demand forIYCN products, a mix of traditional and alternative public and privatesector delivery channels must be used

GAIN Working Paper


27/38

In Mozambique, for example, a voucher is given tomothers after the completion of home fortificationcounselling by Save the Children and the local healthworkers, or “activists”, who already had an existingprogram for infants and mothers at the local healthcenters. Another type of subsidy is being provided inBangladesh, where GAIN pay for the Value Added Tax(VAT) of the product in the first phase of the project,which effectively incentivised initial demand creation by making it more affordable to consumers.

Besides direct product subsidization, any type of socialimpact investment – whether it is in the form of moreaffordable capital or in the form of programmaticsupport – is a subsidy that eventually lowers the cost ofthe product to the consumer. Furthermore, many privatesector partners have been indirectly subsidizing fortifiedcomplementary food production through profitsgenerated by other product lines such as maize grit foranimal feed in the case of Yedent, a portfolio of over

300 pharmaceutical products for Renata, and grain forbreweries in the case of PKL.

The risks with this approach, besides lack of sustainabilityand high costs, are that products associated withsubsidized price programs will suffer in terms of brandperception and positioning in the market, or that a priceincrease later on will cause a substantial fall in demand.The risk of negative brand perception can be mitigatedby creating unique packaging and targeted marketingcampaigns for the retail and social-marketing channel,which reinforce generic behavioral change interventionmessaging. The risk of losing market share as a result ofprice increases is much harder to mitigate, and subsidiesmay need to be phased out gradually over time. Theimpact will depend on how sensitive consumers are toprice increases in individual markets. Nonetheless,subsidies need to be strategic and consider thesustainability of the intervention over time.

Panel F: Female entrepreneur in Côted’Ivoire addresses nutrition –the case of Protein-Kissée-LaAlthough infant cereal porridge has been aroundand consumed for more than 100 years in Côted’Ivoire, Marie Konate, a dynamic femaleentrepreneur in Abidjan, envisaged a convenientnutritious cereal product that would be sold at a lowenough price to make it accessible to all familieswith young children.

20 years ago, Marie Konate sat in her kitchen inAbidjan contemplating how families could feedtheir young children nutritious meals quickly, easily,and – most importantly – inexpensively. Her businessplan began with a black-and-white sketch of asmall sachet of infant cereal. Konate started herbusiness in the early 1990s with only USD 750, onemachine, and a rented stand in her local market.Under her fervent leadership, Protein Kissée-La, alsoknown as PKL, grew into an established localcompetitor to the international food giants.

GAIN invested in a tri-partite project in Côte d’Ivoire,‘Projet de Promotion de l’Alimentation deComplètement Enrichie du Jeune Enfant’, alsocalled PACE, with PKL and the NGO Helen KellerInternational. The aim of PACE was to develop asocial business model, functioning with little to nogovernment involvement. GAIN did not have anyfield teams in-country but relied on PKL for all value

chain activities and Helen Keller International forsocial marketing, as well as a contribution to thecreation of an adequate regulatory environment.

PKL was an established player in the market and theFarinor brand had developed positive brand equityin the Abidjan region. The collaboration intended tobuild on the success of an existing brand andproduct, and through improvements in the productand efficiencies in the supply chain thecollaboration led to increase effective coverage of low-income consumers with a high quality,adequate complementary food. This product lineextension was branded Farinor-Nutribon (Nutribon).

Important achievements of the project include:

• Launch in 2011 of a reformulated infant porridgeaccording to international recommendationsregarding energy density, vitamin and mineralfortification, protein quality and reduced sugarcontent.

• Introduction of affordable and attractive 50gsachets (2 portions) to reach low-incomeconsumers

• Packaging and labelling that is compliant withthe International Code of Marketing of BreastMilk Substitutes (WHO, 1981).

• Reaching 250,000 children to date, which is lessthan originally planned, but a very good result inthe light of the 2011 civil war and subsequenteconomic crisis.

• Acceptable price positioning, albeit higher thanplanned due to unexpected cost increases.

GAIN Working Paper


28/38

Nutritional quality and food safety come at a cost GAIN’s primary focus was on the quality of theNutribon product. With GAIN’s help PKL was able tofulfill international Codex requirements (FAO, 2013).Higher quality, redesigned packaging was alsoimplemented to improve overall quality. At the sametime, affordability to rural and lower incomeconsumers was also a key priority, with the original50g sachet price set at $0.25 per unit for twoservings. However, this prioritization of quality, whichcalled for higher priced input, decreased Nutribon’s

profit margins. In addition the capital expenditureshave been significantly underestimated due tohigher than expected cost in operating in post-civilwar Côte d’Ivoire, including import, equipment,electricity and construction costs. It provedchallenging to bring a high-quality product to the market that is affordable to the neediest ofconsumers. Nutritional quality and food safetycome at a cost with pressure on margins. PKL had toincrease the price of the product in order to ensuresustainability, while still remaining the cheapestfortified product on the market.

Cost-effective delivery to a hard-to-reachconsumer basePKL, being cash-constrained, does not have thelarge marketing budget of its competitors, butbenefits from the awareness they build around the product category. By being the cheapest, high-quality product on the shelf in pharmacies, moderntrade, and road-side kiosks, Nutribon rapidlyincreased sales volumes in urban Abidjan, especiallyfor the 50g sachets. This, however, did not work inareas where product category awareness is low, as among the rural populations. PKL employed a mobile sales force on motorbikes and heldroadshows with a branded van. However this type of push marketing is less effective and much slowerin creating product demand than mass-mediamarketing.

Reaching out into rural areas incurs high distribution costs, high marketing and sales costs that PKL cannot afford without incurring losses.Moreover, in 2011 and 2012, the security situation inCôte d’Ivoire was poor. Through a grant to HelenKeller International, GAIN aimed to increase theawareness around fortified infant porridges, as anadequate alternative choice for complementaryfood, through health staff training and cooking

demonstrations. These demonstrations wereunbranded, in order to be aligned with theInternational Code on Breast Milk SubstituteMarketing (WHO, 1981), and did not seem to haveany impact on product awareness or uptake.Though Nutribon shows some sales growth, uptake is slow and requires more important investment in abranded product promotion campaign in order topenetrate into rural areas. In retrospect, a non-branded campaign should have been aligned with a product promotion campaign to reinforcethe public health messages while driving sales of Nutribon.

Cost Structure (per 50g sachet) 2013 Price (West African CFA franc)/50g

2008 business plan 2011

Finance

Marketing

Distribution

Packaging

Raw Material

$0.025

$0.020

$0.020

$0.090

$0.011

$0.063

$0.028

$0.074

$0.086

Traditional Foods

Farinor Nutribon

Ninolac

Baby Lac

Lait Lac

France Lac

Cerelac

Bledina

110

240

250

255

275

305

335

395

GAIN Working Paper


29/38

Business sustainability The high costs of producing a high, quality, nutritiousproduct in a developing country context mean thatfor a product to be affordable, profit margins haveto be very low. For instance, the profit marginbenchmark of the food and beverage industry is 2-3times higher than PKL’s current profit margin. In orderto reach a breakeven point (the point at which costand income are equal and there is neither profit norloss) by 2018, PKL will need to increase its marketshare from around 30% today to over 40% by 2018, or grow the total market (i.e. increase the totalnumber of children that are consuming fortifiedcomplementary foods). GAIN and PKL have

worked hard to develop additional avenues toincrease sales volumes, such as identifying andaccessing institutional markets and other publicdelivery systems, as well as developing innovativelow-cost marketing approaches. Continuous effortsare needed to ensure Nutribon’s sustainability in thelong-term.

Sustainability of the business will depend on whetherthe overall profit made by this product line, to coverall costs, and generate sufficient cash to invest in thebusiness growth, through more intensive marketingand distribution efforts.

2001 2012 2013 2014e 2015e 2016e 2017e 2018e 2019e 2020e

12

44

93

24

41

98

3836

97

49

51

100

62

58

114

77

66

129

94

73

144

111

81

160

127

90

176

142

98

192

Nutribon (50g sachets)

Nutribon (200–250g)

Farinor

2013 2014e 2015e 2016e 2017e 2018e 2019e 2020e

97-$233 -$189-$141

-$89 -$33

$23 $80$135

End of GAIN–PKLPartnership

BreakEven

Sales Volume by Product Type (data are in millions of tonnes/MT; e=expected)

PKL-Nutribon is expected to break even in 2018 (Data are in thousands of USD, e=expected)

GAIN, 2015 bhttp://www.gainhealth.org/wp-content/uploads/2015/02/Entrepreneur-to-Ensure-Childrens-First-Foods-are-Fortified.pdf

GAIN Working Paper


30/38

GAIN initially counted on private sector marketingexpertise to drive purchasing, and did not directly investin branded marketing. Most small local companies are,however, quite cash constrained, and will only makelimited investments in marketing and promotion. Ananalysis of the initial business plans of GAIN’s partnersindicate around 9-25% of investment in this activity.Moreover, these companies do not have access to thebest creative or marketing talent. The project experienceshowed that more investments, as well as moreinnovation, in demand creation would have beenbeneficial for the success of GAIN’s projects. A new and unknown product requires a change in habit andbehavior: demand creation should therefore be alignedwith sufficient investments in behavior changeinterventions.

Demand creation and marketingIn the case of an unknown product category, for whichno or few other examples exist in the market, or a newbrand, strong marketing support is needed to successfullylaunch a product. Private sector companies typicallycreate demand for their products through integratedapproaches, surrounding the target audience with amixture of above-the-line (targeting the mass consumeraudience) and below-the-line (targeting specifically toindividual consumers) branded messages. In establishedcategories with high market leadership brands, large fastmoving consumer goods players sell through shopsrelying on consumer pull – for example, consumersdemand the products in shops, and in turn shop ownersdemand the products from distributors. This pull isestablished through large-scale multi-media campaigns(often TV, radio, bill boards, as well as market activationsin the communities and markets) that help the companyestablish credibility and trust in the brand or the newproduct. Without strong brand building and continuouscommunications support, a product will struggle to gettaken up by the shop owners, who do not want to riskstocking up on low turnover products for which there isno consumer demand and which will end up being asunk cost for them.

Pull marketing on a regular basis, however, is extremelyexpensive, and unaffordable for most small localcompanies. Instead, they often choose to follow more of a “push model”, which pushes the product to shopowners by targeting them with intensive sales efforts andoffering them higher margins rather than having theproduct “pulled” through the consumers. This modelrequires less initial investment, because the companydoes not invest in a mass-media marketing campaign.On the other hand, the model is much slower in creatingdemand and establishing the brand with consumers, and therefore the manufacturer often struggles to getthe product taken into the small portfolio that shopowners have.

PKL in Côte d’Ivoire is mainly making use of pushmarketing, with its mobile sales force directly selling toshop-owners in the larger Abidjan region and a roadshow with a branded van targeting consumers onmarket days in densely populated neighbourhoods. To overcome hesitation of shop owners to stock Farinor-Nutribon, PKL in Côte d’Ivoire has decided to air a TV advertisement once or twice a year in order todemonstrate that Farinor-Nutribon is recognised as acredible and well-known brand.

Small players can grow their market by being morecreative and flexible than larger companies. Their smallsize has the advantage that they are closer to theconsumers, and can offer more convenience or betterservices to attract customers. Researchers have cited theexample of Nutrizaza in Madagascar, which highlightedthat mothers are willing to pay a little more for a hot-cooked porridge for their children if offered the choice of a home-delivery service (KaYser and Klarsfeld 2014).Convenience and taste were the main driving factors.

Aspirational and credible on-pack marketing Packaging is the most direct form of marketing toconsumers. Product composition, benefits and claims are being made on the pack in an effort to convince the consumer about the product’s attributes. In mostcountries, regulatory authorities determine what ispermitted regarding health and nutrition claims to ensure that no false statements are being made. The International Code on Marketing of Breast MilkSubstitutes provides very good guidelines on marketingand labelling of breastmilk substitutes but less so formarketing of complementary foods. GAIN has workedclosely with producers to ensure appropriateinterpretation of the Code (Panel D).

Lesson 6: Sufficient investment and innovation in demand creation andaligned behavior change interventions are a prerequisite to guaranteetrial, uptake, and adequate use.

GAIN Working Paper


31/38

Consumers can also be “pulled” in and trust can becreated in a product through the endorsement of acredible authority. There are many examples of logos thatcertify the nutritious quality of products and make thenutrition benefits more visible to the consumer. In SouthAfrica, GAIN collaborated with nutrition stakeholders tocreate a nutrition logo, called “Nutrimark”. GAIN workedwith the South African Millers Association in order to fortifyinfant maize meal and develop the logo for maize mealsthat satisfy certain conditions with regards to productformulation and Code compliance. Ultimately the idea isthat all types of fortified complementary foods and multi-nutrient supplements (such as fortified peanut butterspreads and infant cereals porridges) will carry this logo,providing an incentive for millers and producers toadhere to a higher quality standard.

Behavior change communicationCompared with other typical fast moving consumergoods such as health and hygiene products, sellingnutritious foods such as fortified complementary foods or MNPs is much more complex because the benefits ofgood nutrition are difficult to demonstrate in the short-term. This is something that is very difficult to achievepurely through pull marketing in media campaigns and is much more effective and credible if delivered orendorsed by a neutral individual or organisation. In the case of Renata, a pharmaceutical company inBangladesh, their Pushtikona MNPs are being sold viapharmacies and direct to consumers through communityhealth workers that work for BRAC. In both cases thepersonnel (pharmacists and community health workers)are being educated about the health benefits of theproduct so they can recommend them to their clients.Health workers (doctors, nurses, midwives) are crediblesources of information for the population, and thereforeperceived as an effective channel for push marketing bypharmaceutical companies for selling medicaltreatments.

This insight has led GAIN to support unbrandedawareness raising or behavior change campaigns, that focus on the delivery of nutrition behavior changemessages through NGO partners (for example, HelenKeller International, Program for Appropriate Technologyin Health [PATH], Population Services International).Rather than delivering the nutrition messages with anexplicit link to branded products, the messages aregeneric and include for instance the option of usingfortified complementary foods or MNPs in addition todietary diversity messages promoting the use of localnutritious complementary foods. GAIN found, however,that this approach is less effective from a demandcreation point of view, because it does not make anexplicit link with the branded products in the market, and the product-related message gets diluted in themultitude of messages. Also, GAIN found in Bangladeshand Indonesia that the complexity of the messages oftenconfuses the recipient (mother) – leading to inadequateunderstanding of dosage and/or use. Despite this,however, these campaigns can still potentially beeffective in changing overall infant feeding behavior, butso far no evidence has been collected to determine therelationship between the behavior change campaignsand the uptake of nutritious foods through the markets.

Behavior change communication is not only important todrive uptake or sales, but also to drive appropriate use ofthe product and to ensure optimal impact on nutritionalstatus. In Vietnam, GAIN is therefore using rewards (smallgifts such as feeding bowls and bibs) to drive repeatpurchase and use and in Bangladesh we providecalendars as reminders to encourage mothers to givethe MNPs with adequate frequency to their child.

Based on GAIN’s lessons learned in behavior change,innovations in behavior change communication arecurrently being developed and tested in Indonesia andSouth Africa using mobile phone platforms, mass media,and social media. More detail regarding this issue can befound in the GAIN IYCN Series Paper 2 (Van Liere andPoonawala, 2015).

GAIN Working Paper


32/38

The success of any intervention is ultimately measured byits impact. Social business models should assess success in3 realms:

1) in the extent to which they are available andaccessible to low-income and vulnerablehouseholds,

2) in the extent to which the targeted individualswithin those households (i.e., infants and youngchildren 6 to 24 months of age) consume theproducts according to recommendations,ultimately leading to nutrition and/or healthimpacts, and

3) the business model must be viable andsustainable, leading to a positive profit-lossbalance that includes an acceptable profitmargin, as well as sufficient market volume, in orderto keep the private-sector partner engaged in theentrepreneurial venture.

Typically, for the producers of foods and supplements theultimate measures for success lie in profit, sales volumes,and market share. For GAIN, however, our main interest inworking with the private sector is to demonstrate howsocial impact investment can be effective in improvingnutrition. The main questions that need to be answered,therefore, are: “Is the product being purchased by themore vulnerable lower-income households asexpected?”, and “Is the product being consumed orutilised in the appropriate way – both frequency andquantity – that will lead to an improved nutritionalstatus of the target individual”?

Intermediate outcomes, which are important in thepathway to impact on nutritional status, such ascoverage (sales and uptake) have been monitored forall projects, whereas adequate utilisation (dependingon frequency and quantity of consumption) andcoverage of the target (low-income) group, has beenestimated in some of GAINs projects.

Measuring change in purchase and utilization ofproducts is challenging but even more complex isattributing any change to the social impact model.Even if measurement and attribution challenges areovercome, for most projects product availability anduptake is as of yet too limited to be able to measureimpact of GAIN’s IYCN portfolio on the ultimate growthand nutrition indicators at population level. For the two

largest IYCN projects that are currently beingimplemented in Bangladesh and Indonesia, until 2018and 2017 respectively, impact evaluation studies arecurrently being designed.

Coverage and consumptionAs a measure of availability and accessibility, GAINcollects data from their partners on total sales ordistribution volume, which leads to an estimated numberof children reached, for all of its projects on an annualbasis. By the end of 2014, six years after the inception ofthe first projects in 2008, cumulative coverage of theentire IYCN portfolio was 19 million beneficiaries. By theend of 2015, cumulative coverage is expected to beclose to 25 million beneficiaries. Figure 9 highlights theglobal coverage of the IYCN portfolio. To identify whothese consumers are, and whether they are part of thelower-income target group, GAIN has carried outpopulation-based surveys in the last quarter of 2014 inCôte d’Ivoire, India, and Bangladesh. GAIN used thesurvey methodology known as the FortificationAssessment Coverage Tool (FACT) that allows for relativelyrapid measurement of coverage (defined as anypurchase/receipt of the product by the household in a defined time period, in this case 7 days) as well asenabling the measurement of product utilisation andconsumption by the targeted individuals within the

4. MEASURING THE SUCCESS OF AMARKET-BASED MODEL TO IMPROVENUTRITION

5

10

15

20

2597

2010 2011 2012 2013 2014

Complementary foods

Micronutrient supplements

Cumulative reach, Million

Figure 9: Global coverage of IYCN portfolio, mainly driven by the India projects

GAIN Working Paper


33/38

household (i.e., children 6 to 23 months of age) in orderto estimate the potential for impact on nutritional status. The tool was originally designed by GAIN to assesseffective coverage of food fortification programs andhas been adapted for use in the MIYCN portfolio. Forinstance, effective coverage of MNPs is defined as thenumber of children who consumed three or moresachets per week during the project timeline. This wasdefined to approximate adherence to the WHOguideline, when averaged over a yearly period.

Preliminary results of the Côte d’Ivoire, India, andBangladesh surveys are presented below. For Côted’Ivoire GAIN found that 70% of children 6 and 24 monthsof age in the survey in Abidjan had ever consumedfortified complementary foods. Moreover, the surveyfound that 85% of the caregivers had heard of PKL’sproducts. The message coverage of PKL’s products was a little higher among better-off households (88%) thanlow-income households (74%)1]. Among the childrenbetween ages 6 and 24 months, 38% had ever been fed with PKL’s products, 9% were fed PKL’s productsoccasionally (defined as at least once in the past month)and 5% regularly (at least once in the past week). Thechildren from low-income households were less likely tohave ever been given PKL’s products than better-offhouseholds. However there was no difference in thefrequency of usage between low-income and better-offhouseholds. These are preliminary results, final surveyresults will be published later in 2015 (GAIN preliminarydata). Awareness and trial of the fortifiedcomplementary food produced by PKL is high. Based on their sales data, PKL has been able to increase itsshare of the total market (% of target population usingthis product category) from 25% in 2010 to 30% in 2014,despite strong competition of several multinationalcompanies. More emphasis will need to be put in thefuture on driving regular and compliant utilization, whichcurrently is still too low for a public health impact.

In Andhra Pradesh, India, GAIN partnered with agovernment-owned factory (AP Foods) to improve the nutritional quality of take-home rations (Panel B).Preliminary results of a survey provide insights on thecoverage of the Integrated Child Development Services(ICDS) and the fortified take-home rations produced byAP Foods and distributed to children between 6 and 36months. All the caregivers have heard of the ICDS systembefore, nearly all (98%) have ever been to an ICDScenter, and 91% regularly go to an ICDS center (i.e. atleast once in the past month). The fortified take-homeration for the children between 6 and 36 months wasknown by almost all caregivers (94%), was already beengiven to 87% of the children in the target age range, and75% of the caregivers received the product for the childthe past month. The product was actually consumedregularly (defined as everyday) by 57% of the targetchildren (GAIN preliminary data), which is ten-fold higherthan the national average that is 5.6% (IIPS, 2007). Thefinal analysis and publication of these results is expected

for late 2015. GAIN worked exclusively on the supply sideof the product to the ICDS centres, and did not directlywork on distribution towards the end consumers. It istherefore not possible to attribute the high regularconsumption of the fortified supplementary foods to theGAIN project. Nevertheless, based on earlier results inGujarat there is be some indication that improvedproduct quality and improved consumer packagingpositively influence uptake by consumers. Moreover, APFoods has been able to expand its production capacityin order to supply from 2/3 to 100% of the ICDS centers inthe State with this high quality product, and they haveintroduced a mobile-based supply monitoring tool. Theseresults reiterate the high potential of this delivery platformto improve IYCF practices, reflected in the highpercentages of awareness and access to the products.

The Bangladesh IYCN program is in the second phase ofprogramming. During the first phase, an evaluation ledby the International Food Policy Research Institute (IFPRI)among children 6-23 months showed a prevalence ofanemia above 70% at baseline (Rawat, 2014) and endline time points (IFPRI preliminary results), with MNPcoverage less than 3%, as defined by > 2 sachets perweek. Similarly, a baseline coverage survey conductedby the International Center for Diarrheal DiseaseResearch, Bangladesh (icddr,b) in 10 districts that arepart of phase II of the program found an overallprevalence of anemia above 60% among children 6–59months (icddr,b, preliminary results), with a comparableanemia prevalence to the IFPRI survey in the subset ofyounger children. Program coverage of MNPs wascomparable across both evaluations, indicating the lowpenetration and uptake of MNPs. The phase II programactivities are geared toward increasing the awarenessand usage about MNPs, with increased investments inbehavior change interventions.

1 The low-income versus better-off household categorisation used in thissurvey has been derived from the multi-dimensional poverty index (MPI)developed by Oxford Poverty & Human Development Initiative andUNDP. This overlaps respectively with the two lowest income quintiles(D&E) versus the three highest quintiles (A, B,C).

GAIN Working Paper


34/38

Though we lack impact evaluation designs that permitattribution of the results to the program activities in Coted’Ivoire and Andhra Pradesh, the preliminary data of theFACT surveys indicate a positive trend that is not easilyexplained by non-program factors. Overall, one canconclude that successes have been obtained inincreasing availability, awareness and trial of productsamongst the target populations. Progress on regular andcompliant utilization is much slower and requires furtherinvestments and efforts by multiple partners tocoordinate and intensify their behavior changeinterventions, including products as part of the solution,and ensuring that messages are aligned, focused, do-able and compelling.

Viable and profitable business modelsAdequate use of a product by consumers is key to achieving the desired impact. However, equallyimportant is that these new products are available on shelves in the long-term. The only way this can beachieved is by ensuring that the business model issustainable. This Paper has described the differentaspects of the cost structure of nutritious products,demonstrating that profit or sustainability margins in thisproduct category are low. In traditional business models,price flexibility is critical to maintain sustainability as itallows for adjustment of the profit or sustainability marginin response to external influences. This is not an option,however, in social business models due to theimportance of affordability for low-income consumers or the set purchase prices by government and otherpublic-sector institutions.

Despite the grants and other investments made by GAIN,profit margins for most of our production partners is muchlower (up to 8 times lower) than the industry benchmark,which may be as high as 30% to 40% depending on theproduct category. To recover any investments made, andin order to break even before starting to see a positiveprofit-and-loss balance, will take much longer with such alow profit margin. Therefore, rapid growth of sales volumesis of key importance for the viability of a social businessmodel. For example, in order to break even by 2018, PKLwill need to increase its market share from around 30% in2014 to 40% by 2018. Increase in sales volumes forbusinesses means their break-even period is shorter andtheir margins start to contribute to the company’s profits(or growth) sooner, therefore solidifying the productsavailability in the long run (Panel D).

As described, retail market for low-income consumersgrows only very slowly and requires considerableinvestments in marketing and distribution strengthening,which will put the profit margin under even morepressure. One way to quickly grow volume sales is bygaining access to the institutional markets. Supplying bulkquantities of MNPs or fortified complementary foods toan institutional buyer, without additional investments inmarketing or distribution, is a very efficient way to growthe market, and will largely increase the sustainabilityand viability of the business. GAIN’s investment in MNPs inBangladesh, for example, resulted in approximately 22million sachets sold between July 2013 and June 2014 ofwhich 82% were sold through the BRAC door-to-doorcommunity sales and only 18% were sold through theRenata pharmacy network.

GAIN Working Paper


35/38

The initial focus of the GAIN IYCN program to innovativemarket-based approaches to increase access andavailability of affordable products, has allowed GAIN todo pioneering work in an area of nutrition that lackedany evidence or benchmark. This novel focus has beencombined in all projects with other essential nutritioninterventions, notably the promotion of exclusive andcontinued breastfeeding, dietary diversity, and handwashing with soap. In all projects, GAIN has worked witha myriad of partners including nutrition researchers,government officials, civil society organisations, as well as local entrepreneurs driven by a social mission toimproving nutrition. The past years have brought valuableinsights, but many questions remain unanswered. Progresson availability and accessibility of nutritious products orsupplements, through commercial and hybrid deliverychannels has been made. Market penetration andregular consumption of the products is as yet, however,insufficient to be able to establish impact on improvednutritional status of the target population.

GAIN’s experience shows that markets cannot be fixedwithin a short time-frame. It takes longer than a 5-yrproject cycle to identify partners, agree on projectproposals, develop and test products, get themregistered and launched in the market, create demand,and achieve regular uptake. GAIN also found that asocial business model – combining delivery of nutritioninterventions, including products, through multiplechannels – is more effective than distribution via acommercial channel alone. Most projects launched thedistribution of fortified complementary foods or MNPsand achieved some level of uptake, but some of themhave achieved their ambitious initial goals in terms ofscale up of product sales and reach of consumers. Muchhigher investments in demand creation and behaviorchange will be necessary to achieve this. However, whencomparing product sales with an industry-benchmark of 6-8 years of market success, virtually all projects are on target.

Beyond investments in the development and productionof high-quality nutritious foods, GAIN has learned thatinvestment in marketing and branding is key for successin scaling up the use of nutritious foods, and that localproducers have insufficient resources to do this on theirown. Public-health partners should be prepared tocollaborate with the private sector to co-createinnovative and aspirational ways to create demand.

Commercial distribution channels (including wholesalersand retailers) are often weak and underdeveloped inmost resource-poor countries, restricting the potentialreach of products. Closer collaboration will be needed in the future to develop effective local distributionchannels.

From our work with social impact investors such as theInternational Finance Corporation and the AcumenFund, GAIN has learned how to be more targeted indeploying grants to companies interested in beingactive in this field, and leveraging these for additionalsocial investments. To increase sustainability andscalability even further, we will strengthen ourengagement with private capital providers. These willinclude impact investors, who make investments intocompanies, organizations, and funds with the intention to generate social and environmental impact alongsidea financial return, as well as organisations using results-based financing mechanisms,2 advanced marketcommitments,3 and other investment instruments tofacilitate local producers’ access to capital. Byleveraging grant funding to attract private capital wecreate more investable opportunities for private capitalinvestors which broadens impact and the sustainability of our interventions.

5. CONCLUSIONS AND WAYS FORWARD

2 Defined as any programme whereby financial or other incentives areset in order for an agent to deliver predefined outputs or outcomes andthe agent is rewarded for the achievement of results upon verification(Musgrove, 2010)

3 An advance market commitment is a binding contract, typically offeredby a financial entity, used to guarantee a viable market if a product issuccessfully developed.

Though the established multinational food and beveragecompanies have not yet shown a lot of interest in fortifiedcomplementary foods or MNPs for households at thebase of the income pyramid, this may change when theysee smaller competitors establishing new brands andlaunching businesses. GAIN’s partnerships with largerplayers such as Indofood have made it evident thatwithout a direct grant or investment incentive,partnerships need to operate within the constraints oftheir market environment. In future projects, GAIN aims tofocus more on establishing a competitive market spaceand level-playing field, instead of collaborating with onesingle producer.

GAIN has also found that being a pioneer carries areputational risk for the organization itself when productsand market-based approaches to nutrition are neithermainstream nor commonly accepted. Over the past fewyears, GAIN has been perceived as being the advocatefor private sector, and our programs interpreted asunsupportive of breastfeeding or dietary diversity.Insufficient communication by GAIN and insufficientinformation checking by others has most likelycontributed to this perception. All GAIN IYCN projectsplace emphasis on the promotion of adequatebreastfeeding practices, with this work sometimes carriedout by one of our NGO partners. GAIN has been cautiousto embed a product and market-based approach in abroader set of nutrition interventions, recognizing thatnew products will never be the only solution andrecognizing the need to ensure that all productformulations and promotion complies with the 2013Codex Alimentarius and the International Code forMarketing of Breast Milk Substitutes.

GAIN has also been cautious to ensure that any productand market-based approach is embedded in a broaderset of nutrition interventions, recognising that fortifiedcomplementary foods or micronutrient powders can onlybe part of the solution. Where we work with privatesector partners, we aim to take a “full market” approachto improve access to an entire nutritious productcategory, simultaneously offering support to multiplecompanies, strengthening a wide range of public andprivate sector delivery channels, and strengtheningdemand creation for trial, uptake, and use. GAIN will alsoplace renewed focus on driving investments andinnovations in effective demand creation and behaviorchange for trial, uptake, compliance, and adequateutilization with the aim of ensuring maximum impact ofany intervention. Social change and advocacy to createan enabling regulatory environment will remain andimportant part of that work.

Close collaboration between governments and NGOnutrition partners remains crucial to ensuring politicalcommitment and the buy-in that is needed on theground. In the future, GAIN will continue broadening itspartnerships to include new collaborations with thefinancial sector, with distributors and retailers, socialmedia and new and traditional communicationtechnology providers, as well as community-basedwomen groups, workplace-based programs, and farmer associations.

The nutrition sector as a whole is at the start of a journey.Increasingly, bilateral donors and foundations willdevelop a greater interest in the potential sustainabilityof market-based approach. Aid and trade go hand inhand in a number of leading donor countries, but theoperationalization of this new development approach isyet to be determined. Making markets work for the poorwill take more time, require the involvement of moreactors and greater investment, before achievingmeasurable nutrition impact. In the near future, withrapid urbanisation, most consumers – including the low-income consumers – will source their food throughthe market and therefore radical change across theentire food system will be required.

Based on experience and evidence from over 23projects in 17 countries, GAIN concludes that nutritiousproducts being delivered through a social or commercialbusiness model can and should be part of a sustainablecomprehensive nutrition approach for infant and youngchild nutrition. The Sustainable Development Goals(SDGs) which will be adopted in September 2015emphasise more sustainable approaches via multi-stakeholder collaboration which can harness the effortsof governments in joining forces with communities,businesses, and the wider health systems to acceleratedelivery. GAIN encourages partners and stakeholders tojoin the effort to radically improving the accessibility andaffordability of quality complementary foods as a part ofnational level infant and young child nutrition strategies.

GAIN Working Paper


36/38

GAIN Working Paper


37/38

Alive & Thrive (2013). Engaging the private sector toreduce stunting in Bangladesh, Ethiopia, and Viet Nam:Lessons learned from Alive & Thrive. Washington, DC: Alive& Thrive, July 2013http://aliveandthrive.org/wp-content/uploads/2014/12/Private-sector-experience-and-lessons-July-2013.pdf

Bhutta ZA, Das JK, Rizvi A, Gaff MF, Walker N, Horton S,Webb P, Lartey A, Black RE, The Lancet NutritionInterventions Review Group, and the Maternal and ChildNutrition Study Group (2013). Evidence-basedinterventions for improvement of maternal and childnutrition: what can be done and at what cost? Lancet2013; 380: 452-477.

FAO. (1991) Codex Alimentarius Guidelines on FormulatedSupplementary Foods for Older Infants and YoungChildren. FAO, Rome. Adopted in 1991; Revised in 2013. https://www.google.com/url?q=http://www.codexalimentarius.org/input/download/standards/298/CXG_008e.pdf&sa=U&ei=U8DUVLCMG7fCsASvlYEo&ved=0CAUQFjAA&client=internal-uds-cse&usg=AFQjCNGd7QGColF5AtTHoP5z2S3l3BOdjw

GAIN (2011). Nutritional Guidelines for ComplementaryFoods and Complementary Food Supplements. GAIN: Geneva, 2011.

GAIN (2012). GAIN’s Infant and Young Child NutritionProgram: Mid-term review of lessons learnt, Internalreport. January 2012.

GAIN (2015) a. Case Study: Empowering WomenEntrepreneurs to Produce Fortified Food for Mothers and Children in Rajasthan, Geneva: GAIN 2015 http://www.gainhealth.org/wp-content/uploads/2015/02/Empowering-Women-Entrepreneurs-to-Produce-Fortified-Food-for-Mothers-and-Children-Rajasthan.pdf

GAIN (2015) b. Case Study: Investing in a Côte d’IvoireEntrepreneur to Ensure Children’s First Foods are Fortified,GAIN: Geneva, 2015 http://www.gainhealth.org/wp-content/uploads/2015/02/Entrepreneur-to-Ensure-Childrens-First-Foods-are-Fortified.pdf

GAIN (2015) c. Case Study: Better Business PracticesBoost Indian Government Efforts to Provide NutritiousFoods to Young Families, GAIN: Geneva, 2015http://www.gainhealth.org/wp-content/uploads/2015/02/Andhra-Pradesh-Case-Study-Better-Business-Practices-Boost-Indian-Government-Efforts-to-Provide-Nutritious-Food-to-Young-Families.pdf

International Institute for Population Sciences (IIPS) andMacro International (2007). National Family HealthSurvey (NFHS-3), 2005–06: India: Volume I.Mumbai: IIPS.

Kayser O, Klarsfeld L, Brossard S (2014). MarketingNutrition for the Base of the Pyramid. Introducingsuccessful practices for improved access to nutritiouscomplementary foods: Key lessons from case studies.Hystra Hybrid Strategy Consulting: Paris, 2014.

Maternal, Infant and Young Child Nutrition WorkingGroup (MIYCN WG) (2009). Formulation Subgroup.Formulations for fortified complementary foods andsupplements: review of successful products forimproving the nutritional status of infants and youngchildren. Food Nutr Bull 2009; 30(2 Suppl):S239-55.

Musgrove, P (2010): Rewards for good performance orresults: a short glossary; online:http://www.rbfhealth.org, Washington, DC: World Bank.

Osendarp SJM, Bahirathan L, Klassen E, Van Liere MJ,Neufeld MN (2015), Using local foods to meet nutrientrequirements of 6-23 month old infants in developingcountries: a review of the evidence. 2015 (submitted).

Pelto G, Armar-Klemesu M (2011). Balancing nurturance,cost and time: Complementary feeding in Accra,Ghana. Blackwell Publishing Ltd, maternal and ChildNutrition (2011), 7 (Suppl. 3), page 66-81.

Quinn V, Zehner E, Schofield D, Guyon A, Huffmann S(2010). Using the Code of Marketing of Breast-MilkSubstitutes to Guide the Marketing of ComplementaryFoods to Protect Optimal Infant Feeding Practices. GAINWorking Paper Series No. 3. GAIN: Geneva, 2010.(Published as part of the GAIN Working Papers Series,2010 and available on HKI and GAIN websites).

Rangan K, Chu M, Djordjija P (2011). Segmenting theBase of the Pyramid. Harvard Business Review 89, no. 6,June 2011.

Siekmann J, Schofield D (2015). The EnablingEnvironment, Geneva, Global Alliance for ImprovementNutrition, 2015 (in press).

Simanis E, Duke D. (2014). Profits at the Bottom of thePyramid. Harvard Business Review, October 2014; 86-93.

Van Liere MJ, Poonawala A (2015). Behaviour Changeand Demand Creation. Geneva; Global Alliance forImprovement Nutrition; Geneva, 2015.

World Health Organisation (1981). International Code forMarketing of Breast Milk Substitutes. Geneva: WHO, 1981.http://www.who.int/nutrition/publications/code_english.pdf

World Health Organization (2003). Global Strategy forInfant and Young Child Feeding. Geneva; WHO, 2003.

REFERENCES

http://www.who.int/nutrition/publications/code_english.pdf

http://www.rbfhealth.org

http://www.gainhealth.org/wp-content/uploads/2015/02/









https://www.google.com/url?q=http://www.codexaliment





http://aliveandthrive.org/wp-content/uploads/2014/12/

http://aliveandthrive.org/wp-content/uploads/2014/12/

GAIN Working Paper


38/38

GLOSSARYAP Andhra Pradesh

BCG Boston Consulting Group

BoP Base of the Pyramid

CIFF Children’s Investment Fund Foundation

DFID UK Department for International Development

DGIS Netherland’s Directorate-General for International Cooperation

FACT Fortification Assessment Coverage Tool

FAO Food and Agriculture Organization

GAIN Global Alliance for Improved Nutrition

GPF GAIN Premix Facility

HACCP Hazard Analysis and Critical Control Points

HF-TAG Home Fortification Technical Advisory Group

ICDS Integrated Child Development Services

ICDDR,B International Center for Diarrheal Disease Research, Bangladesh

IFC International Finance Corporation

IFPRI International Food Policy Research Institute

Irish Aid Ireland’s Department for Foreign Aid and Trade

IYCN Infant and Young Child Nutrition

KBZF Khalifa Bin Zayed Al Nahyan Foundation

LGT VP LGT Venture Philanthropy

MFK Meds and Food for Kids

MIYCN Maternal, Infant and Young Child Nutrition

MIYCN WG Maternal, Infant and Young Child Nutrition Working Group

MNP Micronutrient Powder

MPI Multi-dimensional Poverty Index

NGO Non-Governmental Organization

NIN National Institute of Nutrition, Vietnam

PACE Promotion de l’Alimentation de Complèment Enrichie du Jeune Enfant

PATH Program for Appropriate Technology in Health

PKL Protein Kissée-La

QA/QC Quality Assurance & Quality Control

SDG Sustainable Development Goals

UC Davies University of California Davies

UNICEF United Nations Children's Fund

USAID United States Agency for International Development

VAT Value Added Taxes

WHO World Health Organization

Documents

GAIN Working Paper INFANT AND YOUNG CHILD ... Working Paper INFANT AND YOUNG CHILD NUTRITION: PAPER 1 IMPROVING COMPLEMENTARY FEEDING: ASSESSING PUBLIC AND PRIVATE SECTOR BUSINESS