“If you want to support concrete positive change - you need to be where the change will happen”
Lawrence Haddad, executive director of the Global Alliance for Improved Nutrition (GAIN) on working with the private sector to improve nutrition. This interview was first published in Connect Magazine 2017. The complete publication is available for download.
GAIN mobilises public-private partnerships on improved nutrition. But evidence and robust examples are scant. How can the market angle be developed?
The private sector is involved at every step in the food value chain; from shaping demand to shaping what is produced, and every step in between. So, it is kind of ridiculous to say we don’t want to engage the private sector in food and nutrition, because consumers have already made that decision. The question is how can we support the good things businesses do and stop the bad things. Let me break the answer down into a few buckets:
Fifteen years ago, GAIN was set up to work with businesses to get more nutrition into the food system without really changing consumer habits. Fortification is a big part of that, adding vitamins and minerals to food staples, such as rice, wheat, flour, edible oil and milk which consumers already eat. Additionally, in the last five years GAIN has developed a set of additional programmes that are trying to change the food system in two ways. The first way is via policy, data and evaluation work, influencing the way we think about delivering nutrition in food systems. For example, we work with the European Commission on mapping food fortification, with the Committee on World Food Security on what healthy food systems look like, and we are exploring developing an indicator of healthy food systems with The Economist Intelligence Unit.
Next to that, we are directly supporting African and Asian businesses that are doing good things for nutrition, by helping them build a larger market share for healthy foods at lower prices. Here we want to show what actions are possible and will have an impact. Think of small, medium and large companies working in fruits, vegetables, pulses, nuts or dairy for example. We are supporting them through small grants and technical assistance. We link them up to larger funding sources, so that they can get more nutritious food to the market at lower price points. External evaluations (if not external, why would anyone believe us?) are showing some success. Unfortunately, some companies do things that are very bad for nutrition, like violating the code of conduct for the marketing of breastmilk substitutes. We don’t accept money from them and we don’t partner with them. When we see outright bad behaviour from companies or other types of organisations we call it out. For example, GAIN was the incubator of the Dutch based Access to Nutrition index (ATNI) that ranks big food companies on a number of indicators. ATNI is an independent organisation now.
SNV works with in-country companies in developing countries. The dilemma is that it requires a lot of on the ground effort. If you want to get the ball rolling, you encounter system dynamics with the risk that efforts remain a drop in the ocean.
If you want to support concrete positive change you need to be where the change will happen. GAIN has programmes in nine countries. Half of our staff is in Africa and Asia. This proportion will grow in the coming years. Why? To develop effective and enduring programmes you need to understand the needs of the country, the priorities of the government, the politics of possibility and the capacities and bottlenecks that exist. We work in countries to build demand for healthy foods, support businesses to meet and shape that demand and support governments to create an environment that makes it easy for businesses to do good things for nutrition and harder to do bad things.
For example, together with the World Food Programme we co-convene the SUN Business Network that helps governments understand what businesses can and cannot offer, helps businesses understand what government priorities are and helps both to understand how to make the policy and fiscal environment more supportive of nutrition. If, for example, one of our Marketplace for Nutritious Foods programmes supports a company to make long life milk more affordable and available for lower income consumers, if the government then decides to tax that milk (as opposed to fresh milk), then this will diminish incentives consumers have to actually purchase it. We have been running these Marketplace programmes for several years now in Kenya, Tanzania, Mozambique and Rwanda, and are learning how to improve them.
The key is to think about scalability right from the beginning. We do that in two ways. First, for a smaller set of companies in African and Asian countries we try to link the small and medium businesses to more formal financing, preventing dependency on Official Development Assistance (ODA) funds. Second, we support a community of practice for a bigger set of companies in those countries. We provide in depth technical assistance to the first set of companies and a less intense level of technical assistance to the larger set of companies. We try to create spill overs for the second set of companies by learning from the first. So, it is a threefold approach; intense work with a few companies, the community of practice to share the examples with other companies, and the government to make it easier for those companies trying to do the right thing and harder for those trying to do things that are not good for nutrition. It is challenging, but if we can’t make these approaches work to help transform markets to be more pro-nutrition we risk our programmes (and those of others) being just a drop in the ocean.
With the aim of accelerating towards SDG 2 (end hunger), I would expect you to involve multinationals, next to in-country companies.
Multinationals are powerful and that makes them important. We try to link the ones who behave responsibly to national companies. For example, we have a programme called the ‘Postharvest Loss Alliance for Nutrition’ (PLAN), which is very much a business-to-business or B2B activity. We will provide funds to support the smaller companies to help them engage with the bigger companies. A number of public funders run mechanisms that offer to match business resources that are brought to the B2B collaboration. For example, we bring multinationals to work with companies in Nigeria to reduce post-harvest tomato loss in Nigerian value chains. These tomatoes are nutritious, consumed in country, but are highly perishable. Working with the Rockefeller Foundation we are supporting the companies to replace grass tomato crates with reusable plastic ones, reducing food loss by 25%.
Do we have evidence of results?
We want to get impact evaluations done on all programmes where there is some doubt that they are effective, whether because they are a new type of programme, a new geography, or with a new partner. In Indonesia, we have a large-scale programme in four districts, involving hundred thousands of people. Ahead of time, we were unsure about the impact on diets of the programme because it only focused on dietary behaviour change, not on supply. We did consumer insight analysis with Indonesian partners and used the learnings for a mass and social media campaign including TV. The evaluation done by an Australian university showed it had a significant impact on diet diversity. We will now expand from four to nine districts and if the results hold up we hope the government will scale it nationally. But in general, we would like more impact studies to be available and we have been strongly investing in them for the past three years. Soon a stream of high quality studies will be published that others and ourselves can and must learn from.
Behaviour campaigns in rural areas can be effective because there is an alternative supply as people can grow crops. But the urban poor pay for their food in cash. Awareness campaigns could create an appetite for certain diets they cannot afford. How should we adapt our methods from rural to urban?
Urban environment is more challenging, but in most countries the differences are not binary. For example, the Indonesian project I was telling you about was both urban and rural. It surprised me that we could use social media awareness in rural areas as well, since rural penetration of mobile phones was only slightly lower than urban. In urban areas, where population density is high and people are more likely to buy their food, there are indeed fewer ways of accessing food other than the market. But more and more welfare programmes are being cashed out, where they used to hand out food, giving people a bit more income to buy food. That’s when businesses should get more interested, and where governments should create strong incentives for consumers to reward businesses that provide affordable healthy foods. Another interesting area is food standards. In India, the food safety and standards authorities are moving into the healthy foods’ area quite strongly, even experimenting with healthy food standards and labels.
The poor generally don’t buy in supermarkets, not in Africa. The middle class does. What is the link with poverty reduction?
I would agree with you up to a point, but you have to be realistic about market-based approaches. You will reach the $3 to $5 per day population, but not those on $1 a day. For the latter group the public sector is vital and we work with public sector providers to make that food as nutritious as possible. But if you can create momentum for three to five dollar a day group (realising that this population is still very poor), you help businesses inch towards the one dollar a day ultra-poor. For example, we work with the garment industry in Bangladesh to provide better quality food in factory cafeterias. We were trying to convince factory managers that it was good to reduce absenteeism rates, productivity and certainly beneficial for their image. But cafeteria based solutions turned out to be not that effective because workers don’t want to stay in the factory at lunchtime, instead they go out to nearby vendors in the streets. So we will start to work with these vendors, trying to support them to raise the quality of their food. It might be about the kind of cooking oil they use, or the amount of salt, helping them to reduce the use of these products. Creating a healthy competitive edge for them. It is in an early stage.
Market based approaches need to be opportunity driven. That might not be the ideal way, but we need to be pragmatic. We are at early stages in knowing how to make markets work better for nutrition. But if we can figure it out it will be transformational. We feel we are at the forefront of developing methods. And we try to be accountable in our aims by basing our work on evidence we generate and that is generated by others. And we are committed to making this evidence available to everybody. Our funders know that the private sector is important but they are, by and large, cautious and tentative about what to do. They are dipping their toes into the water and we want to de-risk the space for them.
You describe market based action to promote the availability of healthy food. What about mitigating price volatility in cities?
More households in urban areas buy from markets. But in most countries, most households buy a significant portion of their food from markets. So volatility in prices is a rural as well as an urban issue. Food price volatility kills infants so we need to reduce it, fast. If our post-harvest loss work is effective, it will improve storage and transport facilities and reduce price volatility. Most focus on post-harvest loss has been on cereals. This is important of course, but price volatility in more nutrient dense food is also important but efforts to address it have been hampered because governments are focused almost exclusively on cereals and food security. They need to focus on nourishment too. For example, more public research and development spending should go to fruits, vegetables, pulses, nuts and some animal source foods in areas where it is very expensive.
SNV focuses on behavioural change for improved nutrition and hygiene and triggering parental concern. Results are sustainable but resource heavy. What is your advice for scaling up without compromising the approach?
We use a behavioural approach called ‘Emo Demo’, using emotional demonstrations to mothers and fathers to make nutrition messages stick. The Indonesia programme did this via short TV dramas embedding nutrition messaging. But triggering emotional response also works with policymakers and business leaders. We need them to change their behaviour as well, it is not just about mothers, father, babies and adolescents. We are all swayed by emotions. I have spent a lot of time talking to policy makers. They sometimes come around to nutrition because something has happened in their personal lives. I have known people who were resistant to working with nutrition, even when I showed them benefit-cost ratios, malnourished brains and the likes for years. And then, all of a sudden, their daughter has a baby and then nutrition gets their interest.
Recently, I spoke to a CEO who was quite ‘gung ho’ about nutrition and I asked him why he was really so into it. It turned out he had felt it ever since he had been doing field work in Malawi as a young man. In a sense, the emotional response transformed him. We need to do a better job with policy makers and business leaders to change behaviour because they can unlock a lot of possibilities.
And for consumers?
At nutrition meetings, I always hear about making nutritious foods more available, affordable and accessible, but I never hear about making them more desirable and delicious for consumers. Those of us in the public sector need to work with responsible private sector experts to create hybrid approaches to behaviour change to build demand for bona fide healthy foods and diminish the demand for foods that are unhealthy. Without this demand, supply side efforts will never realise their potential.