OBAASIMA seal, have led to additional investment for two OBAASIMA-affiliated small and medium-sized enterprises, enabling them to increase production capacity, resulting in additional local employment as well as an increase in the availability and affordability of nutritious and safe foods.
Lessons learned
As much as fortified foods have been proven to help alleviate micronutrient deficiencies, they are not a panacea.
In light of the double burden of malnutrition emerging in LMICs, innovative business models, such as OBAASIMA, and the development of a trademark seal, in particular, are encouraging examples of how two challenges can be addressed at once (micronutrient deficiencies and the risk of overweight and obesity). Perhaps most importantly, they are the result of thought being given to an essential nutrition intervention and redesigning it in a way that it is tailored to tackling the double burden of malnutrition.
WHAT CAN WE LEARN FROM THE CASE STUDIES ON PRIVATE-SECTOR
ENGAGEMENT IN LAST-MILE NUTRITION?
Sight and Life carefully chose this set of case studies to showcase innovative models that address and strengthen all of those elements of the food environment that are required to holistically nourish the last-mile consumer.
Sizanani Mzanzi is a social enterprise that bolsters the food environment by making locally desirable, nutritious and affordable products available through traditional retail channels, while MANDI is a purely commercial undertaking that is innovating in methods of delivering and marketing affordable nutritious foods to last-mile consumers. The Malawi Egg Hub highlights the catalytic role the private sector can play in supporting smallholder farmers that have the potential to address the nutrition gap with a highly nutritious product, such as eggs, while OBAASIMA is a positive model for PPPs to improve food environments through a demand-driven approach.
The four case studies underscore that aligning the private sector with better nutrition outcomes can allow us to draw on their nutritional expertise, research and development capacities and deep consumer insights to strengthen vendor and product properties, leading to greater convenience.
They also show that building demand for nutritious foods by making products easily identifiable and recognizable (for example, through quality seals) can help to reshape the marketing and regulatory component of the food environment and can serve as a model for engaging the private sector in LMICs to address the double burden of malnutrition and improve food environments for the last-mile consumer. Lastly, the private sector’s role in ensuring availability and accessibility is undeniable; it has the networks and supply chains not only to bring its own affordable nutritious foods to consumers, but also to empower smallholder farmers with access to markets for essential nutritious foods.
LIMITATIONS
While these initiatives show an encouraging trend, many hurdles remain to reaching the last mile, including linking agricultural policy to better nutrition and developing better metrics and incentives. Public-private engagement can remain difficult due to a lack of trust between the public sector, civil society and the private sector, conflicts of interest, different goals, objectives, working cultures, timelines and expectations. There is an urgent need to improve dialogue between all stakeholders and for learnings to be captured along the partnering process, to inform jurisdictions and encourage them to undertake an evidence-based approach to assessing partnerships.
Lastly, there is a huge gap that needs to be addressed in measuring the impact of PPPs on nutrition outcomes.
CONCLUSION
There are enough statistics to highlight how the burdens of malnutrition, brought on by poor food environments, are robbing millions of people of opportunities to reach their full potential and limiting economic growth in their countries.
‘Business as usual’ is not an option; there is an urgent need for disruptive solutions and innovative new collaborations to facilitate cutting-edge research and development, sustainable investments and improved networks, leading to partnerships that meet the nutritional needs of marginalized communities at the last mile. The four case studies presented in this paper are neither exhaustive nor prescriptive, but they attempt to shine a light on private-sector initiatives to help guide key influencers and stakeholders towards principles of better engagement to deliver healthier diets for all.
FAO/SUE PRICE
References
Access to Nutrition Foundation (ATNI). 2018. ATNI [online]. Utrecht, Netherlands. [Cited 14 May 2019]. www.accesstonutrition.org/
Bajoria, M. 2018. Last Mile Nutrition in India. In: Sight and Life [online]. India.
[Cited 14 May 2019]. https://sightandlife.org/blog/last-mile-nutrition/
Beesabathuni, K., Lingala, S. & Kraemer, K. 2018. Increasing egg availability through smallholder business models in East Africa and India.
Maternal Child Nutrition, 14(S3): e12667. (also available at https://onlinelibrary.
wiley.com/doi/full/10.1111/mcn.12667).
Brar, J., Gupta, S., Madgavkar, A., Maitra, B.C., Rohra, S. & Sundar, M.
2014. India’s economic geography in 2025: states, clusters and cities. Identifying the high potential markets of tomorrow. Insights India report. Mumbai, India, McKinsey & Co. (also available at http://www.governancenow.com/files/
Indias%20economic%20geography%20in%202025%20States%20clusters%20 and%20cities.pdf).
Caspi, C.E., Lenk, K., Pelletier, J.E., Barnes, T.L., Harnack, L., Erickson, D.J. & Laska, M.N. 2017. Association between store food environment and customer purchases in small grocery stores, gas-marts, pharmacies and dollar stores. International Journal Behavioral Nutrition and Physical Activity, 14: 76.
(also available at https://link.springer.com/content/pdf/10.1186%2Fs12966-017-0531-x.pdf).
Development Initiatives. 2018. 2018 Global Nutrition Report: Shining a light to spur action on nutrition. Bristol, UK. (also available at https://globalnutritionreport.
org/documents/352/2018_Global_Nutrition_Report.pdf).
Hall, K.D. 2018. Did the Food Environment Cause the Obesity Epidemic? Obesity, 26(1): 11–13. (also available at https://doi.org/10.1002/oby.22073).
Hawkes, C. & Buse, K. 2011. Public-private engagement for diet and health:
addressing the governance gap. In United Nations System Standing Committee on Nutrition (UNSCN), ed. SCN News No. 39: Nutrition and business: how to engage? pp. 6‒10. Geneva, Switzerland. (also available at https://www.unscn.
org/files/Publications/SCN_News/SCNNEWS39_10.01_low_def.pdf).
High Level Panel of Experts on Nutrition and Food Systems (HLPE). 2017.
Nutrition and food systems. A report by the High Level Panel of Experts on Food Security and Nutrition of the Committee on World Food Security. HLPE Report No.
12. Rome. (also available at http://www.fao.org/3/a-i7846e.pdf).
Iannotti, L.L., Lutter, C.K., Bunn, D.A. & Stewart, C.P. 2014. Eggs: The uncracked potential for improving maternal and young child nutrition among the world’s poor. Nutrition Reviews, 72(6): 355–68.
Iannotti, L.L., Lutter, C.K., Stewart, C.P., Riofrío, C.A.G., Malo, C., Reinhart G., Palacios A., et al. 2017. Eggs in Early Complementary Feeding and Child Growth: A Randomized Controlled Trial. Pediatrics, 140(1): e20163459. (also available at https://pediatrics.aappublications.org/content/pediatrics/140/1/
e20163459.full.pdf).
International Institute for Population Sciences (IIPS). 2017. National Family Health Survey 2015–16 (NFHS-4): India fact sheet. Mumbai, India. (also available at http://www.indiaenvironmentportal.org.in/files/file/national%20family%20 health%20survey%20-%20India%20fact%20sheet.pdf).
Milani, P. 2018. A new framework for public-private partnership for nutrition.
Sight and Life, 32(2): 130‒139. (also available at https://sightandlife.org/wp-content/uploads/2018/12/26_SALMZ_0218_Perspectives_13.pdf).
Strengthening Partnerships Results and Innovations in Nutrition Globally (SPRING). 2017. Malawi National Anaemia Profile. Arlington, VA. (also available at https://www.spring-nutrition.org/sites/default/files/publications/anemia-profiles/spring_nap_malawi.pdf).
Sustainable Development Goals Knowledge Platform. 2018. Sustainable Development Goal 17: Strengthen the means of implementation and revitalize the global partnership for sustainable development. In: Sustainable Development Goals Knowledge Platform [online]. Washington, DC. [Cited May 2019]. https://
sustainabledevelopment.un.org/sdg17.
Turner, C., Kadiyala, S., Aggarwal, A., Coates, J., Drewnowski, A., Hawkes, C., Herforth, A., Kalamatianou, S. & Walls, H. 2017. Concepts and methods for food environment research in low- and middle-income countries. London, UK, Agriculture, Nutrition and Health Academy Food Environments Working Group (ANH-FEWG), and Innovative Methods and Metrics for Agriculture and Nutrition Actions (IMMANA) programme. (also available at http://anh-academy.org/sites/
default/files/FEWG_TechnicalBrief_low.pdf).
United Nations Children’s Fund (UNICEF). 2015. Saving Children and Mothers.
Pretoria. (also available at https://www.unicef.org/southafrica/SAF_overview_
survival.pdf).
UNICEF. 2017. The last mile – Addressing the unfinished agenda in health and nutrition. Pretoria. (also available at https://www.unicef.org/southafrica/SAF_
resources_brieflastmile.pdf).
UNICEF. 2018. Nutrition Statistics in Malawi. Malawi Statistics. Lilongwe. (also available at https://www.unicef.org/malawi/sites/unicef.org.malawi/files/2018-09/UNICEF_Nutrition_Factsheet_2018.pdf).
UNICEF, World Health Organization (WHO) & World Bank. 2018. Level and trends in child malnutrition: Key findings of the 2018 Edition of the Joint Child Malnutrition Estimates. New York, Geneva, Switzerland, and Washington, DC.
(also available at https://www.who.int/nutgrowthdb/estimates2017/en/).
University of Ghana, GroundWork, University of Wisconsin-Madison, KEMRI-Wellcome Trust & UNICEF. 2017. Ghana Micronutrient Survey 2017. Accra.
(also available at https://scalingupnutrition.org/wp-content/uploads/2019/04/
Ghana-Micronutrient-Survey-2017-Summary-of-Final-Report.pdf).
United States Department of Agriculture (USDA). 2018. USDA Food Composition Databases. Agricultural Research Service. In: USDA [online].
Washington, DC. [Cited May 2019]. https://ndb.nal.usda.gov/ndb/
Van Zutphen, K.G. & Bajoria, M. 2018. Sizanani Mzanzi Marketing Mix – Product & Price. Sight and Life, 32(1). (also available at https://sightandlife.org/
wp-content/uploads/2018/08/SightandLifeMagazine_ProductInnovation_2018_
SizananiMzanziMarketingMix.pdf).
WHO. n.d. Population nutrient intake goals for preventing diet-related chronic diseases. Geneva, Switzerland. (also available at https://www.who.int/
dietphysicalactivity/publications/trs916/en/gsfao_overall.pdf).
WHO. 2014. Global Nutrition Targets 2025: Policy Brief Series. Geneva, Switzerland.
(also available at https://apps.who.int/iris/bitstream/handle/10665/149018/
WHO_NMH_NHD_14.2_eng.pdf?ua=1).
WHO. 2016. Addressing and managing conflicts of interest in the planning and delivery of nutrition programmes at country level. Report of a technical consultation convened in Geneva, Switzerland, on 8–9 October 2015.
Geneva, Switzerland. (also available at https://apps.who.int/iris/bitstream/
handle/10665/206554/9789241510530_eng.pdf;sequence=1).
Willett, W., Rockström, J., Loken, B., Springmann, M., Lang, T., Vermeulen, S., Garnett, T., et al. 2019. Food in the Anthropocene: The EAT-Lancet Commission on Healthy Diets from Sustainable Food Systems. The Lancet, 393: 447‒92.
World Bank. 2011. South Africa – Nutrition at a glance. Washington, DC. (also available at http://documents.worldbank.org/curated/
en/413801468334804797/pdf/771960BRI0Box00th0africa0April02011.pdf).
Yunus, M. & Weber, K. 2009. Creating a World Without Poverty: Social Business and the Future of Capitalism. New York, PublicAffairs.