Urban Nutrition Program Final Report by Design Impact

Design Impact Fellowship Project overview- Urban Nutrition Project July 30, 2013 Jaskeerat Bedi, DI Fellow

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THE PROBLEM

CHILD MALNUTRITION •

Every year 45,000 children die of malnutrition in Maharashtra alone, according to ‘A report on nutritional crisis in Maharashtra’ by the Pune - based SATHI (Support for Advocacy and Training to Health Initiatives).

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More children die of mild or moderate malnutrition (33,000) than of severe malnutrition (12,000)

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One third of adults are underweight, and 15% severely underweight.

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Although the state government has introduced schemes for children meant to prevent such deaths (The mid-day meal scheme and The Integrated Child Development Scheme), only 0.8% of GDP is spent on these schemes. Poor administration and governance often leave such initiatives in the state of utter neglect.

Malnutrition, a malignant problem

MAJOR FACTORS OF

CHILD MALNUTRITION Poverty Almost one third of India’s more than 1.1 billion population continues to live below the poverty line, and a large proportion of poor people live in rural areas. Poverty remains a chronic condition for almost 30% of India’s rural population. The incidence of rural poverty has declined somewhat over the past three decades as a result of rural to urban migration1

Unhygienic Living Conditions India is facing an uneven shift of balance as people from rural India move into urban cities for better opportunities. This shift has lead to massive congestion in the cities, such that a 4 x 4 feet space may be shared amongst 16 family members.

Lack of Awareness The mother is often uneducated , relying mostly on cultural or religious beliefs and superstition. Without awareness or availability of affordable healthy food item, mothers are often left with no way to provide their children with a healthier future.

Malnutrition, a malignant problem

1http://www.ruralpovertyportal.org/countr y/home/tags/india

INTERVENTION AGAINST

CHILD MALNUTRITION DGS Pune

Design Impact Cincinnati

Co-Collaborate Deep Griha Society (DGS), a NGO based out of Pune, and Design Impact (DI) collaborated to work on the Urban Nutrition Project.

DI Fellows @ DGS DI has embedded two fellows over a span of 16 months at DGS to address to the Urban Nutrition Program.

Design Intervention

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PARTNERING ORGANIZATION

DEEP GRIHA SOCIETY

About Deep Griha Society, Pune

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Deep Griha Society is a NGO empowering Pune’s marginalized for 37 years

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Focuses on 6 different social issues

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Has centers in 3 slum areas: Tadiwala Rd, Ramtedki and Bibevadi (Pune)

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Employs 150 People

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Impacts 325 children (6 months to 5 y)

CHILD CARE ACTIVITIES AT

DEEP GRIHA SOCIETY

Children between the ages of 6 months to 5 years are looked after by the teachers at the crèche's at DGS from 9AM to 5PM in the centre from Monday to Saturday. • •

With children cared for safely during the day, both parents can work and older siblings can attend school. The children receive fully-rounded care. Emphasis is placed on working with parents and building positive relationships with the community. Parents are also invited to monthly meetings with their child's teachers, to monitor progress and address any problems.

About Deep Griha Society, Pune

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Deep Griha and Design Impact believe that the solution – better nutrition for children – can also have a positive impact on local women.

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If the 6 month nutritional snack program shows higher weights, heights, and hemoglobin counts for the 300+ children at Deep Griha’s day-care centers, it would create a new source of income for local women’s self-help groups interested in manufacturing and selling these snacks, while children in the community would have increased access to nutritious foods.

DGS Pune

Design Impact Cincinnati

Design Impact Intervention

Better Nutrition for Children

The Laddoo Project

TIMELINE

URBAN NUTRITION PROJECT

Timeline

DI FELLOW

ANISHA SHANKAR About Anisha Graduate in Communication and Energy and Environmental Policy from the University of Delaware, Anisha had spent the last 6 yrs in the U.S. She was looking for an opportunity to apply her skillset to social and environmental issues and applied for the DI Fellowship.

Timeline – Dec 2011- May 2012 As a DI fellow, Anisha spent her time observing food given at the crèches, researching & creating nutritious snack options for children, collecting feedback on health snacks from children and DGS staff, and conducting pre-nutrition analysis.

DI Fellow: Anisha Shankar

Anisha observed opportunities to make new nutritional efforts count for the DGS children.

Meals at DGS

Based on her research, Anisha created four different health snacks, two sweet and two spicy.

Engaged the DGS Community in tasting the snacks and getting feedback.

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FINALIZING THE SNACK

HEALTHY LADDOO Feedback from the community led Anisha to finalize “Laddoo” as the nutritional snack to be given to the children at DGS.

What is a Laddoo? • Laddoo (sweet round balls) has been an essential part of Indian sweets, synonymous with happiness, celebration and festivals. Children love them as much as adults do • We have created two flavors of healthy laddoos: PEANUT & SESAME SEED

Product Development

NUTRITION FACTS

Nutrition

HEALTHY LADDOO

Is it really healthy?

Sample A: Sesame Seed Laddoo

National Agricultural and Food Analysis and Research Institute, Pune (NABL Accredited Laboratory as per ISO/IEC: 17025: 2005) conducted nutrition analysis on the laddoos and published the nutrition facts.

How much does it cost? Making 1 laddoo costs INR 3/Which is equivalent to USD 0.05

Energy

404 kcal/100gm

Protein

8.9 g/100gm

Carbohydrate

55.9 g/100gm

Fat

16.1 g/100 gm

Sugar

10.5 g/100gm

Iron Nutrition

Sample B: Peanut Laddoo

5.80 mg/100 gm Unit

Energy

405 kcal/100gm

Protein

9.4 g/100gm

Carbohydrate

54.2 g/100gm

Fat

16.7 g/100 gm

Sugar Iron Product Development

Unit

5.8 g/100gm 3.03 mg/100 gm ÂŠ Design Impact 2012

Pre-nutrition Analysis In order to measure the impact of the Laddoo on the children, Anisha recorded down their heights and weights. Lack of proper machines and trained staff made this procedure confusing and time-consuming, but Anisha eventually succeeded in obtaining accurate measurements of the children. These measurements will be used in the future to further asses the impact of the laddoos.

Pre Nutrition Analysis

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DI FELLOW

JASKEERAT BEDI About Jaskeerat Jaskeerat comes from a design background, with a Master’s in strategic design management and experience in exhibition design and developing user centric business models.

Timeline – Aug 2012- May 2013 As a DI fellow, Jaskeerat’s objective was to test different business models to scale and distribute the laddoos and create a sustainable business model for women’s self help group. She was also responsible for measuring the impact of the nutrition supplement program by conducting periodic postnutrition analysis.

DI Fellow: Jaskeerat Bedi

BONDING AT

DEEP GRIHA SOCIETY Nothing works better than bonding over Laddoos and Chai My own ethnic background allowed me to easily blend into the culture of the organization. I was quickly able to be-friend the staff members, and gauge their interest in the project.

While making the Laddoos, we decided to rechristen the project THE LADDOO PROJECT Making it more contextual and catchy!

Immersion & Re-evaluation

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INGREDIENTS OF SUCCESS

THE LADDOO PROJECT

Of the staff, I identified Bismillah (left) and Nisha Naidu (right) as truly talented women who believed in the potential of the project and were entrepreneurial in nature.

Though in the beginning I was often aggressive and impatient with the working pace of the NGO, these women helped me realize that perseverance, patience and commitment are the key ingredients to success.

Immersion & Re-evaluation

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CHALLENGES AT

DEEP GRIHA SOCIETY DGS has direct access and influence in the community. By positioning themselves in the slums, DGS naturally becomes the preferred choice of parents for crèche services.

Extreme Working Environment • The crèches were positioned in crammed spaces within the slums for maximum access to the community. • Uneven walls, rough flooring, and stacked walls caused chaos and confusion within the crèches (not an ideal environment to conduct accurate measurements of height for children)

Immersion & Re-evaluation

A crèche manned by two women on an average looks after 20-30 children. These ladies are called as “maushies” ( mother’s sisters) and are responsible for looking after children ( feeding, personal care, etc). Food is made by the staff of DGS and then distributed to these crèches. The crèches are equipped with basic infrastructure, tin roofs and uneven flooring and walls. As a result of the bad construction, the crèches are not compatible with existing tools to conduct health measurements. Since these crèches serve children as young as 6 months, it is difficult to transport the children to a facility capable of such measurements.

CHALLENGES AT

DEEP GRIHA SOCIETY The Maushies that look after children are mostly educated till Standard 12 and are home-makers. They are attentive to the children, and ensure proper care is provided at all times. However, they are resistant to new changes and are slow at adapting to new systems and processes. I faced obstacles in translating Maushies computing data as the from Marathi script.

Immersion & Re-evaluation

Untrained Staff • Lacking in expertise and confidence, staff dependended on volunteers for measuring children.

Due to difficult working conditions, Maushies often made errors in computing data of children, risking the accuracy of the data.

• Complicated tools • Extreme working environment increased error in data tabulation

CONVERTING CHALLENGES INTO OPPORTUNITIES

DEEP GRIHA SOCIETY

Developed data organization tools Created an effective system to record and manage data collected by increasing responsibility of the parents.

Immersion & Re-evaluation

Empowering DGS Staff

Resources at DGS

• Gave training on how to use height and weight measuring tools and remove errors.

• Generated funds to bring better tools (HB Machine) that could provide accurate results in testing a child’s growth.

• Gave training on how to identify health indicators of children plotted on WHO Cards.

• Working with a product design intern to make a better height measuring device.

NUTRITION ANALYSIS OF

GIVING HEALTHY LADDOOS We conducted Nutrition analysis every 3 months and plotted the data on WHO AnthroPlus. Survey goal To assess whether the DGS Laddoos tended to increase the health of the children. Data 68 children from the 3 DGS centers: Bibvewadi:16 ; Ramtekadi:15 ; Tadiwala :37 37 boys ; 31 girls

Post Nutrition Analysis

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RESULT OF

GIVING HEALTHY LADDOOS The collected data was then shared with Jehangir Clinical Development Centre, to validate the results… “What your results show is that ht and wt have increased significantly (as the Z scores have been calculated, data is adjusted for age, the increase is not merely because they have grown older). The BMI has however not changed, but since it is a ratio, I think it is ok, your kids are doing well." - Dr. Anuradha Khandilkar, Jehangir Hospital

Post Nutrition Analysis

TALKING TO PARENTS

DEEP GRIHA SOCIETY

Interviewing Parents

Created Health Report + Awareness Brochure

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Spoke to parents to identify the parameters of choosing DGS as a crèche service provider.

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Inquired whether they were aware of the child health program run at DGS.

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Inquired about eating habits/lifestyle.

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Do they see any positive change in their child?

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Collect fresh data of the parents, their occupation, where they live, their

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Inform the parents about their child’s health status (Ht, Wt and Z-score). In case the child is moderately/ severely malnourished, it will be brought to the parents notice.

Find out how much the parents know about what food available to them through DGS. Do the parents know about the laddoos. Would they be interested in knowing how to make them?

involvement in their child’s development, etc.

Scaling via Parents

TALKING TO PARENTS

DEEP GRIHA ACADEMY

Convincing through Live Measurements

Scaling via Parents

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We had an opportunity to reach out the parents of a school. We used this opportunity to measure the children’s height & weight, which we plotted on the WHO Anthro S/W, and shared the results.

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Most of the parents were shocked to know that even though their child “looked” fine, he/she was moderately malnourished

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Through live demonstration and laddoo tasting, we were able to convert 50% parents into potential customers of a weekly Laddoo pack in an effort to ensure their child’s good health.

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From talking to parents, we realized that they were interested in either purchasing the laddoos off the shelf or subscribing to a weekly pack. However, since DGS is an NGO, they cannot directly enter into commercial business.

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Putting the laddoos on the shelf would require FDA regulations, which in turn would require an established production unit, quality control, and distribution network. This is a serious investment, that DGS cannot undertake.

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DGS can out-source their laddoos to self help groups run by women, but would first need to garner more demand. To gain traction, DGS needs to invest in raising awareness about laddoos by conducting camps in government schools and approaching parents directly.

Learning & Insights

TALKING TO CONSUMERS

SELLING LADDOOS Then we engaged the Pune based design studio “Elephant Design,” to design packaging ideas for Healthy laddoo’s, catering to women and children.

packaging In our first attempt we tried selling the laddoo’s in air tight plastic bags with little information about the project

The laddoo’s often broke, did not attract children, and had a shelf life limited to 4 days.

Graphic designer from Elephant Design conducts user research and collects feedback of community women.

Product Development

LEVERAGING PRICE BY

DESIGNING IDENTITY

Current cost of selling promotional pack is Rs. 50 per pack, with 5 laddoos in each Making cost: Rs 20 Packaging Cost: Rs 2 Profit: Rs 28 After Elephant’s work was incorporated the new cost with packaging can be Rs. 60 per pack, with 4 laddoos in each Packaging cost (printing, plastic tray & foil): Rs 5-6 Cost of 4 laddoos: Rs 16 Making cost: Rs 22 Profit: Rs 38

Product Development

Developed brochures in English for awareness towards the laddoo project.

Product Development

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Created home-made Video Tutorials in Hindi and Marathi, that teach how to make healthy laddoos. The idea behind this is to sell them as awareness material. These videos were shown to different stakeholders, iterations were made based on the evaluation of their understanding of the videos.

Communication Material

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At the moment, laddoo’s are being sold as merchandise produced by DGS, which cannot be sold for profit making, since DGS is an NGO.

RETAIL

“Sales of promotional packs can help sustain the project in the organization internally” However, DGS can sell the recipe to an interested partner, who will take the responsibility of producing and distributing the laddoo’s.

Learning & Insights

TALKING TO NGOs AT

DEEP GRIHA SOCIETY

Learning from the Workshop • 3 NGOs turned up for the workshop conducted by DGS. • Workshop representatives were social workers and showed keen interest in the recipe.

Laddoo Making Demonstration

• Some saw personal commercial potential and hinted that with the packaging, the laddoos could be produce a profit.

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• Participants offered new variations to the recipe, since making laddoos is a common practice in many households.

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Workshops were conducted, in which live demonstration of making the two types of laddoo was shown.

Recipe and ingredients were shared with participating NGOs.

Scaling via NGOs

• Measuring nutritional value of the laddoos and administrating them as healthy food was seen as an innovative idea. • They promised to share the recipe with their respective organizations for further collaboration.

TALKING TO NGOs

SNEHA, Mumbai

TWO z

Paid training at SNEHA on June 4, 2013 • • •

Trainers from DGS Hand out brochure (English, Hindi) Hand out Ingredients

TRAINERS

Rs 2000

Objective of training • • • •

Brief description about Laddoo Project Show positive results of laddoos ( success stories, statistical result ) How to make laddoos training Discuss benefits of laddoos

Scaling via NGOs

Together we planned two models DGS could use for NGOs and SHGs interested in ladoo training.

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Laddoo Workshop at DGS (Free) DGS Trainers conducts workshop at NGOs (Paid)

In addition to pursuing the workshops, we also began to look into retail options.

Learning & Insights

RESEARCHING

EXISTING MARKETS

What type of food attracted children? What was their nutrition content? Did parents care about what their children were eating? What would imprint a child’s consumption pattern?

Strategic Partnerships

A short walk in the community made me aware about... Huge presence of small scale/ local producers:

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Children want things that their “friends” eat!

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Animated cartoon characters largely influenced their purchasing power

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Brighter the color, happier the child

No FDA guidelines No Nutrition analysis No quality check

Strategic Partnerships

Success of the project depended on continuous supply of the laddoos to the childrenâ&#x20AC;Ś The decision makers of these nutrition snacks are the benefactors of the children, not the children themselves. We need to reach out to parents through a distribution system that is continuous in nature. I began contacting organizations that provided mid-day meal schemes in India. This narrowed my search to two major organizations- AkshayPatra and Naandi. Both organizations work with the government to provide mid-day meals to children across India.

Strategic Partnerships

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IN PURSUIT OF

STRATEGIC PARTNERS About Naandi Naandi is an NGO working out of Hyderabad. They provide Mid-Day Meal Schemes (MDMs) and Anganwaadi's Welfare Service ( AWC's). In the state of Hyderabad, they cater MDMs for 98,000 children (6yrs to 10 yrs ) and AWCs for 19,000 children (6 months to 5 yrs). Naandi also provides meals to other states, such as Orrissa, Andhra Pradesh, Madhya Pradesh, Rajasthan and Chhattisgarh. Partially funded by the government, Naandi functions on a very strict budget. However if another organization is interested in funding the Laddoo Project, Naandi can accommodate the project. They have identified a village in Oddisha that expressed interest in the project.

Strategic Partnerships

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IN PURSUIT OF

STRATEGIC PARTNERS Now that Naandi was interested in partnering in the Laddoo Project, I had to pursue a funder. My search led me to contacting the creators of a popular Indian animated cartoon character, Chotha Bheem who gets his super human energy by eating Laddoos. The collaboration of all four organizations seemed like the perfect marriage to take the project further.

Strategic Partnerships

Recipe + R&D

DESIGN IMPACT DEEP GRIHA SOCEITY

Production + Distribution network

Brand + Marketing Platform

NAANDI.ORG

GREEN GOLD

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Although I had positive interactions with both organizations, their business limitations did not allow for collaboration on the Laddoo Project. However, I feel the Indian market is ready for a product that is healthy and affordable to those below poverty line. Currently the biscuit industry is the only dominant industry catering to the BPL and are adding nutrition supplements. The low cost, high volume market strategy caters to a Market Opportunity Of Rs. 2000- 5000 crore (annual turnover).

Learning & Insight

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FUND RAISING OPPORTUNITY

STRATEGIC PARTNERS

Reaching New Heights, Literally! The Laddoo Project has collaborated with a Bangalore based adventure firm, Unventured and is getting funding for Rs.2.4 lacs. This money is being raised by 11 cyclists who recently went to the Himalayas on a cycling expedition . In addition to the fundraising, they also increased awareness about healthy food and distributed laddoos to the local community!

Funding

ÂŠ Design Impact 2012

The power of a simple idea has taken the Laddoo Project so far. As a part of this journey I have had the pleasure of experiencing and cherishing every moment of happiness and sorrow. During my 10 months, every day was a new challenge that together we have over come. The reward of which is the smile of a waving child, as she says to me: “ See you again, Didi ”

Thank You

THANK YOU! DESIGN IMPACT DEEP GRIHA SOCIETY

Thank you Contact: Jaskeerat Bedi jaskeeratbedi@gmail.com Jaskeerat.bedi@d-impact.org www.d-impact.org

ÂŠ Design Impact 2012