Urban Nutrition Project: October 2012 Update

Urban Nutrition Program, Pune 1st November 2012 Jaskeerat Bedi

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Many NGO’s , crèches, balewadi’s and anaganwadi’s are dedicated to curb the problem of malnutrition. Amongst such organizations, Deep Griha Society ( DGS ) has been working since 1975 in welfare development activities, serving the impoverished communities of Tadiwala Road, Ramtekdi, and Bibvewadi.

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Run by Dr. Neela Onawale, DGS is a church funded organization that is catering to welfare development activities in – Child care, child empowerment, women empowerment, medical & healthcare, Disha ( HIV / AIDS awareness ) and rural empowerment.

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DGS believes in “Empowerment of the marginalised through capacity building and sustainable urban and rural development programmes”

Malnutrition, a malignant problem

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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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Though the state government has introduced schemes for children meant to prevent such deaths (The Mid‐day Meal Scheme and The Integrated Child Development Scheme). But the state government spends just 0.8% of its gross domestic product on these schemes. To make matters worse, poor administration and governance often leaves such initiatives in the state of utter neglect.

Malnutrition, a malignant problem

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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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What if a nutritious snack program implemented over a 6‐month period shows higher weights, heights, and haemoglobin counts for the 300+ children at Deep Griha’s day‐care centres? These positive health impacts could catalyse a new livelihood option – manufacture and sale of these snacks ‐ for local women’s self‐help groups while children in the community would have increased access to nutritious foods.

DESIGN IMPACT INTERVENTION

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The main centre of DGS is based out of Tadiwala Road, an area that houses slum community of around 35,000 people, many of whom are enrolled in DGS programmes.

Deep Griha Society, Tadiwala Road, Pune

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Child Care at DGS Child care welfare activities run across all three centers of DGS. Deep Griha crèches and balwadis provide early education for children, preparing them for starting school at the age of five.

Child Care at DGS

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

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With children cared for safely during the day, both parents can go out to work and older siblings are able to attend school. The children receive fully‐rounded care, and 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.

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DI Fellow: Anisha Shankar About Anisha: Graduate in Communication and Energy and Environmental Policy from the University of Delaware, Anisha had been spent the last six years working in the U.S. Dec 2011‐ May 2012: As a DI Fellow, Anisha spent her time observing food given at the crèches, researching and 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

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1. She observed that DGS was supplementing food as best it could within its limited budget. But plainly there were opportunities to make any new nutritional efforts count for the children.

Meals at DGS

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

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

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Pre Nutrition Analysis In order to measure the true impact of nutrition supplement given to the children, Anisha meticulously noted down their heights and weights.

Lack of proper machines and trained staff made this procedure confusing and time‐consuming, but with continuous trials and great efforts, Anisha finally succeeded in getting correct measurements of the children.

This measurement will be used in the future to further asses the impact of nutrition supplements .

Pre Nutrition Analysis

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Weight‐for‐height is a measure of current nutritional status. Low weight for height indicates moderate to severe malnutrition. The results plotted from the first round of heights and weights using WHO’s Anthro program which compares the population to the standard were‐ The red line curve shows that approximately half of the 235 children measured are more than two negative standard deviations away from the mean (moderate malnutrition, http://www.who.int/nutrition/topics/moderate_malnutrition/en/index.html ) and about one quarter are more than three negative standard deviations away from the mean (severe malnutrition, http://www.who.int/nutrition/topics/severe_malnutrition/en/index.html).

Comparing DGS children to the WHO standard.

While this is a dramatic plot, it is hard to lose sight of the many factors that confound the story: high turnover in class composition meaning that new malnourished children could skew the curve to the left; our lack of knowledge about what and how much the children eat at home; and whether the children have been unwell recently.

Comparing DGS children to the WHO standard

DI Fellow: Jaskeerat Bedi About Jaskeerat: Jaskeerat comes from a design background, with masters in strategic design management and work experience in exhibition design. She brings with her knowledge of developing business models using user centric design and brand development.

Aug 2012‐ May 2013: As a DI Fellow, Jaskeerat’s objective is to test different business models which can help in scaling the nutritious snacks such that it reaches the right audience, as well as, creates a sustainable business model for women’s self help group. She is also responsible for measuring the impact of nutrition supplement program by conducting periodic post nutrition analysis.

DI Fellow: Jaskeerat Bedi

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As soon as I joined DGS, I immersed myself in the ladoo making process, using it as an ice‐ breaker to interact with the “mausis” as well as understand what it takes to make these nutritious yummy snacks.

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I couldn’t help but notice how the DGS kitchen, every alternate day in the afternoon, would change into a ladoo making unit, wherein 5‐6 mausi’s got together to prepare up to 100 ladoos, all in a time spam of 1.5 hours.

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This process also enabled me to gauge the levels of hierarchy existing within team leaders, DGS staff and the mausis.

DI Fellow: Jaskeerat Bedi

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Preparing the ladoo’s

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Preparing the ladoo’s

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Next, I took a walk into all the crèches, to see how the ladoos are distributed to the children.

Preparing the ladoos

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Click here to see the video: http://youtu.be/UrkdXlMWoUQ Video: Distributing ladoos at the crèches

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The entire ladoo making and distribution process was extremely organized.

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The team leader Mrs. Ranjana, had an yearly estimate of production cost of the ladoos.

Each batch of laddos prepared are counted for and noted down in a register maintained by the team leaders across all centers.

Each crèche is given ladoos based on the number of children present on that day, so as to reduce any wastage. This number is noted down, along with signature of the supervising teacher of the crèche and the distributor.

Distributing laddos at the crèches

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Meals distributed at the crèches I made a note on the type of meals being distributed at the crèches.

Monday Milk (with coconut) + Eggs Lentils + Cauliflower + Rice Tuesday Milk (with semolina) + Laddo Lentils + Fenugreek + Rice Wednesday Milk ( with vermicelli) + Eggs Lentils + Bottle Gourd + Rice Thursday Milk ( with semolina) + Laddo Lentils + Spinach + Rice Friday Milk ( with vermicelli) + Laddo Lentils + Potatoes + Rice Saturday Milk (with coconut) Lentils + Cauliflower + Rice

One‐ time meal

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Next, I observed how health measurements of children were taken.

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All the teachers at the creches are asked to maintain WHO health card, and plot the weight to age ratio of the children on it. However, due to a new template released by WHO, many teachers were confused about plotting and reading the card. I often found myself answering questions related to the new templates.

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Despite, Anisha’s organized documentation, I faced initial problems in getting up to date height‐weight measurements of the children that I could use as reference point. This was primarily because till now all height‐weight measurements were overlooked by volunteers and the same information was not transferred to the DGS staff.

Post nutrition analysis

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Post nutrition analysis

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Training Program for Teachers Each teacher takes care of up to 30 children and spends more than six hours with them. If they can be trained to take proper measurements and file it in a systemic manner, dependency on the volunteers will reduce drastically and the process might become cyclic( or perhaps embed ) in the calendar of DGS! Training Program for Teachers

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I developed forms in Marathi, for filling health indicators and distributed amongst all teachers, such that hence forth, all measurements could be taken in a homogenous fashion.

Training Program for Teachers

We also discussed the new WHO template and what the plotting indicates. This exercise helped clear a lot of doubts amongst the teachers © Design Impact 2012

Measuring Heights After handing out the forms and giving a demonstration of measuring height and weight, I asked each teacher to take the measurements of 5 other teachers. This created quite a flutter of activities as the ladies busied themselves, excited to get themselves measured!

They often forgot to write down the name of the crèche & the date of measurement. Some even tried copying the measurements of others!

While measuring weights was fairly simple, it was difficult to get the right height measurements. It took some time for the teachers to understand the reading and the metric system, while keeping in mind the protocols of getting the accurate height.

They also got confused in reading the English numerical. After many attempts, I think they have finally figured how to read the markings!

Training Program for Teachers

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The presentation was a great way to interact with all the school teachers, as well as team leaders. Optimistically, we set our dates to collect the health indicators by 15th September, however, lack of equipment and the festival period hindered our process.

Never the less, we were successful in completing our 1st round of Post Nutrition Assessment and maintaining a systematic record in homogenous data entry fashion by the end of September.

Post nutrition analysis

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The red line indicates that‐ 1/5th ( 46 of 213 ) children are severely malnourished as they fall below three median.

1/3rd ( 66 of 213) children are moderately malnourished as they fall between ‐2 & ‐3 median

Post nutrition analysis

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After having completed our 1st Post Nutrition Analysis, we decided to conduct our 2nd Analysis in the 1st week of December.

Meanwhile, I decided to sketch some probable business models as to circulate ladoo’s to a wider audience.

Sketching business models

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Sketching Business Models

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MULTIPLE ENTRY LEVELS: Government + DGS

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integrated child development services municipal corporations government schools anganwadi’s

Sketching Business Models

APPROACH STRATEGY: 1.INDIVIDUAL APPROACH DGS has networks with different Anganwadi’s & nearby government schools that can be explored.

2. VIA ICDS ICDS is a government run body that controls all nutrition related activity for children. Approach via ICDS will have maximum impact over a large number of schools & crèches.

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MULTIPLE ENTRY LEVELS: NGO’S + DGS

1. Connect with NGO’s that focus on child care, health, nutrition based initiatives

APPROACH STRATEGY: 1. DGS AS SERVICE PROVIDER DGS will provide healthy ladoo’s to the children at these NGO’s and as well as measure nutrition assessment.

2. DGS AS TRAINER DGS will provide training service to NGO’s on how to make ladoo’s as well as measure health indicators 3. DGS AS CONSULTANT Provides training & supervision services for certain time period till the NGO has developed its own resources to manage the project.

Sketching Business Models

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MULTIPLE ENTRY LEVELS: SELF HELP GROUPS + DGS

1. Connect with self help group’s for new start‐up initiative 2. Connect with existing groups for launching a new food product

Sketching Business Models

APPROACH STRATEGY: 1. DEEP GRIHA INITIATIVE PRODUCT DGS will provide employment opportunities to run its own SHG, under which women will make, package & sell healthy products as Deep Griha Initiative.

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MULTIPLE ENTRY LEVELS: RETAIL + DGS

1. Connect with corporate that cater to children ( food, entertainment, education, etc )

Sketching Business Models

APPROACH STRATEGY: 1. CSR INITIATIVE OF CORPORATE DGS can approach a corporate to fund The Ladoo Project on a large scale using existing resources of the Corporate

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Keeping the business models in mind, I thought of hitting the ground zero,!

I began going for events and exhibitions, where different NGO’s would get together and started talking about‐ THE LADOO PROJECT

Laddo talks

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Participating in Yellow Ribbon NGO Fair Due to oncoming Diwali season, we got the opportunity to participate in another NGO Fair at Ishanaya Mall, Pune.

This time we decided to take a step further than just talking about the project. We decided to make people taste our healthy ladoos and get some market feedback!

Yellow Ribbon NGO Fair

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Some quick sketches and rough prototypes later, we created our 1st set of Samples of ladoo’s ( peanut & millet ) ready for sale.

Yellow Ribbon NGO Fair

Rs 50 per packet Each Ladoo package contained 5 ladoo’s each and was priced at Rs 50/ packet.

We prepared 60 such packets to be sold in a span of 4 days event, starting from 26th October to 29th October.

Yellow Ribbon NGO Fair

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Key Learning's +People were inquisitive about our project and came forward to support the cause. +We had some children too, whose facial expressions gave us an honest feedback on the rather unattractive colours of our ladoos +We also gathered a lot of feedback on how to make the branding of the project more visual and empathetic. +Met some organizations that showed interest in learning the recipes of these ladoos, while others were interested in offering retail space for them. +Some people also suggested to reduce the size of the ladoos as they seemed really heavy to consume +Some enquired if the ladoos could benefit cancer, diabetic patients, or old people.

Yellow Ribbon NGO Fair

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PROFIT EARNED: Of the 60 packets made, we were able to sell 30 packets in a span of four days. We realized that in order to sell these ladoos, we needed to persuade people to taste the ladoos first, talk about the cause and then they would buy the packets. So, we were constantly on our feet, and adopted aggressive marketing to get our laados going.

We were able to make 100 % profit, even though we sold only half the number of packets.

Of all the products displayed at the Deep Griha Stall, the laados were the hottest selling products.

This experience gave confidence to the DGS Staff on how effective story telling about the product via design thinking can earn good returns.

Training Program for Teachers

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Thanks for your time. Would love to hear your feedback.

Contact: Jaskeerat Bedi Jaskeerat.bedi@d‐impact.org www.d‐impact.org

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