Global Alliance for Improved Nutrition annual report 2004 – 2005
Global Alliance for Improved Nutrition annual report 2004 – 2005
GAIN Annual Report 2004–2005 Copyright © The Global Alliance for Improved Nutrition, 2006. All rights reserved. Any use of information contained in this Annual Report is subject to a permission request to be addressed to GAIN, the Global Alliance for Improved Nutrition, to the attention of the Manager, Communications, P.O. Box 55, 1211 Geneva 20, Switzerland, by e-mail at: info@gaingeneva.org or by fax at + 41 22 749 18 51. Visual concept, design and editing by: Inís, www.inis.ie Printed by: Imprimerie Genevoise SA, Switzerland
Contents
GAIN – who we are and what we do
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Foreword by Jay Naidoo, Chair, GAIN Board of Directors
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Foreword by Marc Van Ameringen, GAIN Interim Executive Director
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Meeting the Millennium Development Goals
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Vitamins and minerals for good health and development
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Fortified foods and a new business alliance in China
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Baking better bread in Uzbekistan
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Fortifying oil in Mali
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Measuring our progress towards better health
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Joining forces in the fight against vitamin and mineral deficiencies
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Speaking out about vitamin and mineral deficiencies
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The Business Alliance for Food Fortification (BAFF)
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Summary of Projects
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Financial Statements
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Auditor’s Report
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GAIN – the Global Alliance for Improved Nutrition GAIN’s vision is for all people, everywhere, to have the nutrition they need to live healthy and productive lives. Who we are
GAIN is an alliance of public and private organizations. As an alliance, GAIN mobilizes multiple stakeholders to promote nutrition-based strategies to reduce vitamin and mineral deficiencies among those populations most at risk. The primary focus is on food fortification. GAIN brings together partners at both global and national levels. The alliance has no formal structure or fixed membership: rather, partners come together to carry out projects aimed at achieving specific objectives. At the global level, the list of publicly-funded members of the GAIN alliance is growing – it includes Helen Keller International, the Micronutrient Initiative, USAID’s A2Z Micronutrient Program, US Centers for Disease Control and Prevention, UNICEF, the World Bank, World Food Programme, and the World Health Organization. Private sector members at global level include BASF, Cargill, Coca Cola, Danone, DSM, Heinz, Tetra Pak and Unilever, amongst others. At the national level all GAIN-funded projects are coordinated by “national fortification alliances” of government, food manufacturers and producers, and consumer groups. These alliances are currently active in 14 countries. GAIN and the World Bank Institute have established a global Business Alliance for Food Fortification (BAFF) of more than 20 companies and are developing a national BAFF in China. GAIN’s Board of Directors represents key stakeholders in nutrition and food fortification. GAIN is also a grant-giving body. GAIN provides money and technical advice to support the delivery of fortified staple foods and condiments to populations at risk of vitamin and mineral deficiencies. These programs are both national and subnational, and they are targeted to achieve maximum benefit for public health. Food fortification programs are selected through both competitive and noncompetitive processes. GAIN’s philosophy is to establish programs that are both self-sustaining and market-driven. Where feasible, GAIN relies on its alliance partners to assist in the delivery of its programs. Priority is given to developing countries – especially in Africa and Asia where there are the greatest numbers of people suffering from vitamin and mineral deficiencies. GAIN raises its own funds to support this process. It has a small group of professionals in its Geneva secretariat, field staff in Africa and Asia, and professionals who provide liaison with the World Bank and UNICEF.
What we do
At present, GAIN primarily supports food fortification. It does so in order to reduce vitamin and mineral deficiencies and thus achieve its goal of saving lives and improving health, productivity and cognitive function.
GAIN’s focus is on vitamin A, iron, iodine, folic acid and zinc. Collectively these vitamins and minerals are known as micronutrients because they are needed by the body in only tiny amounts. Lack of these nutrients in the body can cause a range of problems, including increased child mortality, birth defects, poor cognitive development and reduced productivity. Yet it is both easy and cheap to correct micronutrient deficiencies by adding vitamins and minerals to the foods that most people eat everyday. Which food should be fortified depends on the country and the culture – flour and bread in some parts of the world, corn meal in another, soy sauce or fish sauce somewhere else. The mix of vitamins and minerals to be added depends on the needs of the population.
Our targets
More than 2 billion people worldwide lack the vitamins and minerals they need to live healthy and productive lives. GAIN has set clear targets to address this problem. These include: p to reduce the prevalence of vitamin and mineral deficiencies by 30% in the areas where GAIN supports projects; p to reach 1 billion people with food that has been fortified with vitamins and minerals; p to ensure that 500 million of the people most in need, such as children and pregnant women, regularly consume fortified foods; p to achieve these results at a cost of less than 25 US cents per person, per year.
Our plans
GAIN was established in 2002. For the first two years, GAIN concentrated on developing its grantgiving capacity for funding projects at national level. GAIN will continue this process, calling for grant applications in a competitive system. In addition, GAIN will initiate contacts with certain countries, companies and institutions. We aim to achieve significant global impact by focusing especially on countries with large populations in order to reach the many people in these countries suffering from vitamin and mineral deficiencies. In addition, strategies to reach the poor and those at highest risk of vitamin and mineral deficiencies will be actively pursued. GAIN plans to strengthen its work as an alliance. During 2006, GAIN will coordinate the development of a 10-year strategy to eliminate vitamin and mineral deficiencies. This work is being undertaken on behalf of a range of alliance members and will provide a framework for action by the many groups working in the area. GAIN is also expanding its work with the private sector through the establishment of the global BAFF, through plans for more national BAFF groups, and through partnerships with individual companies.
Foreword Vitamin and mineral deficiencies affect 2 billion people around the world, resulting in increased child mortality, birth defects, poor cognitive development and reduced productivity. Yet proven and cost-effective solutions exist. In particular, food fortification – adding small amounts of vitamins and minerals to the foods people eat on a regular basis – has been shown to yield real results at costs of less than 25 US cents per person per year. With these facts in hand, we are in a rare and privileged position: we have the potential to make a global contribution to development, and to do so in a very short space of time. Wide scale implementation of nutrition strategies, including food fortification, could result in the elimination of vitamin and mineral deficiencies within the next ten years. The challenge is that no one group has it in their complete power to make this happen. Public and private sectors each have a role to play, as do civil society and the consumers of fortified goods. GAIN is mobilizing these various sectors, particularly businesses, to make fortified food available and affordable to populations around the world. We are complementing national fortification strategies with targeted approaches aimed particularly at reaching populations most at risk of vitamin and mineral deficiencies. Our aim is to stimulate programs that become self-sustaining. In the initial stages of a project we might give funding to catalyze the development of a national fortification alliance, to train food producers in fortification techniques, to help finance the first round of equipment or supplies, or to undertake a marketing campaign. However, our aim is that these programs soon become viable in the market, and will thus continue long after GAIN’s initial involvement. The next ten years are critical. We can solve the problem of vitamin and mineral deficiencies in this time, and then we’ll be free to move on to solving other development challenges. GAIN, with its alliance partners, will continue to provide leadership and seek to galvanize international support to reach the achievable goal of the virtual elimination of vitamin and mineral deficiencies by 2015.
Jay Naidoo, Chair, GAIN Board of Directors
Foreword GAIN was established in 2002 with the very specific task of eliminating vitamin and mineral deficiencies. It was set up as an alliance in recognition that various stakeholders, particularly private industry, had a role to play in achieving this goal and it was also provided with funding to directly support and stimulate the development of food fortification programs around the world. Since its inception, GAIN has awarded funding to 15 programs in 14 countries through a competitive selection process. When at scale, these programs are expected to reach nearly 500 million people with fortified foods and condiments. A feature of each GAIN-funded project is that it involves a National Fortification Alliance, with representation from government, nongovernmental organizations and industry. GAIN will continue to support such alliances and projects, and has a number of applications ready for review in early 2006. It is also developing more targeted projects to reach populations at highest risk of vitamin and mineral deficiencies, and approaches to countries with large populations, a strategy that is essential if we are to reach our global targets for coverage and reach. In addition to the multi-sector alliances at the national level, GAIN has established a number of processes to help interested parties come together around specific projects. In its work with the private sector, a particularly promising initiative is the Business Alliance for Food Fortification (BAFF). A global BAFF was established in October 2005, and the first national grouping, the China BAFF, held its inaugural meeting in Beijing in December 2005. Plans for alliances in other countries will be developed in the coming months. More broadly, GAIN is playing a key role in facilitating the development of a ten year strategy to eliminate vitamin and mineral deficiencies on behalf of the global micronutrient sector. GAIN is committed to achieving real outcomes in terms of improved health and productivity. To evaluate our success in doing so, we have developed a Performance Measurement Framework. Designed originally for use with GAIN-funded programs, this framework has generated great interest among our colleagues, and other groups working to improve nutrition have expressed interest in adopting the approach. GAIN, with and through its partners, continues to improve and expand its work. As an organization, GAIN has recently undergone a process of restructuring aimed at accelerating the delivery of our program which is already yielding positive results. We look forward to building on past efforts and expanding on our new program delivery systems to scale up our contribution to the elimination of vitamin and mineral deficiencies in 2006.
Marc Van Ameringen, GAIN Interim Executive Director
Meeting the Millennium Development Goals The United Nations has set eight Millennium Development Goals which have been adopted by the international community. The goals provide benchmarks to countries, private companies, and development and health agencies.
“Programs to eliminate micronutrient deficiencies are one of the most cost-effective development interventions available.” Copenhagen Consensus 2004
GAIN’s work is contributing to the achievement of the Millennium Development Goals. Five of the eight goals depend on better nutrition – which is our focus. Another of the goals calls for the establishment of global partnerships for sustainable development – which is precisely how GAIN works. With the following contributions to the Millennium Development Goals, GAIN is striving for a world where people are better nourished and in better health, and where there is gender equality and less poverty. goal 1 to eradicate extreme poverty and hunger. GAIN contributes to the achievement of this goal by helping to ensure that the food people eat includes essential vitamins and minerals. This in turn improves individual productivity and helps to reduce poverty. goal 2 to achieve universal primary education. School attendance and learning capacity are higher in children who are better nourished. GAIN contributes to the achievement of this goal by funding fortification programs that reach the very young with essential vitamins and minerals that will improve their cognitive function and intellectual capacity. goal 3 to promote gender equality and to empower women. GAIN’s projects promote fortification of staple foods consumed by girls and young women. This results in better nutrition, which in turn yields health benefits by reducing iron deficiency and anemia in female adolescents. By improving women’s physical and mental capacities in this way, these projects enhance women’s ability to participate as equal citizens in society. goal 4 to reduce child mortality. GAIN addresses this goal through programs that improve young child feeding practices and bolster the nutritional status of infants and children. GAIN enhances the nutritional profile of staple foods by investing in food fortification programs – particularly those with vitamin A – which aim to reduce child deaths substantially. goal 5 to improve maternal health. If women are under-nourished, and especially if they are anemic, they are at severe risk of death and illness when they have children. They are also more likely to have babies with low birth weight. GAIN’s work contributes to healthy motherhood and better prospects for babies by improving the micronutrient status of girls, adolescents and women. goal 6 to combat hiv/aids, malaria and other diseases. goal 7 to ensure environmental sustainability. goal 8 to develop a global partnership for development. As an international alliance, GAIN facilitates active partnerships that provide resources and technical assistance to international and national alliances of governments, the private sector and civil society. These national alliances will work together for a world with better nutritional status and health conditions, gender equality and less poverty.
Vitamins and minerals for good health and development Our bodies need macronutrients – like protein and carbohydrate – but we also need small amounts of vitamins and minerals commonly known as micronutrients. Two billion people worldwide lack the vitamins and minerals they need to live healthy and productive lives. GAIN focuses on the five vitamins and minerals that are most commonly lacking in people’s diets and which contribute to a range of health and development problems. p
Vitamin A
Vitamin A helps children stay healthy and fight infections – such as respiratory infections, measles and diarrhoea. It also protects women before, during, and after pregnancy. Foods that are rich in vitamin A keep eyes healthy and prevent blindness. Of the 11 million children who die each year due to common childhood illnesses, it is estimated that up to 23% could be saved through improved vitamin A status. Pregnancy depletes the stores of vitamin A in a woman’s body. If she does not have adequate vitamin A in her body during pregnancy she may be at higher risk of dying from causes related to child bearing. After birth, the mother’s breast milk will contain less vitamin A than it should, so her infant may also suffer. Pregnant women with vitamin A deficiency may also have problems seeing in the dark or at dusk (“night blindness”). Breast milk is a good source of vitamin A for infants and young children, but only when their mothers consume adequate amounts of vitamin A during and after pregnancy. Fruits and vegetables provide carotenes, which the body converts to vitamin A. Good animal sources of vitamin A include liver, fish, eggs and cheese. Many commonly eaten foods can be fortified with Vitamin A including edible oil, margarine and sugar. p
Iron
Iron is an essential compound of hemoglobin in our blood carrying oxygen throughout our body. Iron is critical to our health and wellbeing and is normally stored in our bodies in several places. But when we bleed or suffer from repeated infections and parasitic infestations we lose iron. Women and teenage girls need more iron than men because they lose iron monthly, every time they menstruate. During pregnancy, the growing fetus takes iron from the mother’s stores. Thus, women must eat enough iron-rich foods before and during pregnancy so that both they and their babies will be healthy. Up to 20% of maternal deaths in developing countries are thought to be due to iron deficiency anemia.
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Small babies, and especially those born prematurely, have low iron stores from the time they are born. Iron deficiency impairs cognitive and motor development in children and restricts their ability to learn. Iron deficiency reduces the ability of the blood to carry oxygen and this reduces the capacity to work. It also diminishes the ability of the body to fight infection. There are many causes of iron deficiency. The most important one is low levels of bioavailable forms of iron in the diet. A varied array of interventions exist that are designed to prevent and correct iron deficiency anemia. These include dietary diversification, food fortification with iron, supplementation and other public health measures. Food fortification is increasingly being recognised as a cost-effective and sustainable way to prevent and control iron deficiency. Many foods contain iron. Pulses, beans, fruits and vegetables, such as raisins, dates, prunes, dried apricots, spinach and kale, contain large amounts of iron, but in a less absorbable form than in animal sources. Molasses (a sugar cane product) also contains useful amounts of iron. The best food source of iron is red meat, including the organs of animals. Eggs, oysters, molluscs, chicken, turkey and fish are also high in iron. Iron-fortified foods like wheat flour or bread, maize meal, cereals and pasta, when available, are a reliable source of iron. p
Iodine
Iodine is a trace element. It is an essential micronutrient and its only confirmed role in humans is in the synthesis of thyroid hormones. Thyroid hormones regulate many important functions of the body. The most important function being its role in human brain maturation. Without adequate iodine, the body’s metabolism, growth and development cannot be regulated properly. Iodine deficiency can cause disabilities in people of all ages. When the physiologic requirements for iodine are not met in a given population it results in a wide spectrum of effects on growth and development, collectively termed iodine deficiency disorders (IDD). IDD includes goitre at all ages, endemic cretinism, impaired mental function, increased still births and perinatal and infant mortality. Iodine deficiency continues to be the leading cause of preventable mental retardation. Pregnant women who do not consume enough iodine are more likely to have complications such as miscarriage or stillbirth. Babies born to iodine-deficient mothers have
lower birth weight and are more vulnerable to disease. They may suffer permanent mental and physical retardation even before birth. Children with iodine deficiency are more likely to have learning disabilities. They perform poorly in school, and do not learn as quickly as healthy children. They score, on average, 10-15% lower in intelligence tests. Also, iodine-deficient children tend to have poorer physical coordination than healthy children. Although the food supply can deliver adequate iodine in some geographic areas, in most areas where the soil has been depleted of iodine, the most cost-effective way to prevent deficiency is to add iodine to all salt intended for human and animal consumption. p
Two billion people worldwide lack the vitamins and minerals they need to live healthy and productive lives.
Folic acid
Folic acid is a B vitamin that the body needs to make healthy new cells. Optimum folate levels in early pregnancy are essential for prevention of Neural Tube Defects (NTDs). NTDs are birth defects in a baby that affect the brain or the spinal cord. The two most common NTDs are spina bifida and anencephaly. Worldwide, 250,000 babies are born each year with spina bifida or anencephaly. To prevent these disorders associated with folate deficiency, women must consume 400 micrograms of folic acid daily for one month before becoming pregnant, as well as during the first three months of pregnancy. Since many pregnancies are unplanned, all women of reproductive age should consume this amount of folic acid daily by means of a dietary supplement, or a fortified food. Folic acid may also protect the heart. The American Heart Association has noted 48,000 fewer deaths from stroke and other heart disease since the mandatory fortification of grain products with folic acid in the United States. For potential benefits to the heart, everyone should try to eat diets rich in folate. Foods that are rich in folate include leafy green vegetables such as spinach and broccoli, legumes and dried beans, nuts and citrus fruits. p
Zinc
The human body relies on zinc to perform many functions, such as healing of wounds, growth and repair of tissue, blood clotting, thyroid functions (especially metabolism of proteins,
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carbohydrates, fats and alcohol), fetal development, and sperm production. Studies of people receiving zinc supplements show lower rates of infection – especially acute lower respiratory infections. Children receiving zinc supplements show less incidence and shorter duration of diarrhoea. Signs and symptoms of zinc deficiency include poor appetite (which leads to lack of other nutrients), low immunity, slow healing of wounds, anemia, poor growth, skeletal abnormalities, spontaneous abortion, impaired sexual maturation, and sterility. Zinc deficiency is often associated with other health conditions. For instance, high rates of iron-deficiency anemia in a particular region indicate a risk of zinc deficiency. And high rates of stunting (very low height for age) among children indicate widespread zinc deficiency. The effects of zinc deficiency vary according to a person’s age. For women of reproductive age, zinc deficiency is associated with pregnancy-induced hypertension, pre-eclampsia, placental abruption, pre-term delivery and haemorrhaging. For the baby the effects can be severe – poor fetal growth, low birth weight, birth defects, poor development and higher rates of infant death. Infants with low birth weight may be especially vulnerable to zinc deficiency. Studies of low-birth-weight babies who received zinc supplements show increased weight gain and improved developmental scores. Male adolescents with zinc deficiency have shown delayed sexual development, decreased sperm count and lower levels of testosterone, as well as skeletal abnormalities, short stature and anemia. Among the elderly, common symptoms of zinc deficiency include chronic non-healing leg ulcers and recurring infections. Breast milk is the best source of zinc for babies. It is better absorbed than the zinc contained in infant formula. The best and most easily absorbed sources of zinc come from animals, including the organs and flesh of beef, pork, poultry, fish and shellfish. Good plant sources include nuts, seeds, legumes and whole-grain cereals. And of course, foods may be fortified with zinc.
Fortified foods and a new business alliance in China Shortly after GAIN was founded in 2002, the Government of China asked GAIN to help implement a micronutrient fortification project in the west of the country to address vitamin and mineral deficiencies there. The Public Nutrition and Development Center (PNDC) of China was designated to carry out a project to fortify wheat flour and to work towards a mandatory national wheat flour fortification program. Another project to fortify soy sauce with iron was implemented and supported by the Chinese Center for Disease Control (CDC). Soy sauce was chosen as an ideal food vehicle for iron fortification among the Chinese population because it is consumed throughout the year by all family members. The goal of the project is to make domestically-produced iron-fortified soy sauce available at an affordable price to all Chinese people who are at risk of iron deficiency anemia. The agreements for these two projects – GAIN’s first two grant agreements – were signed in October 2003. Soon after the start of the GAIN-funded wheat flour project, some changes occurred that meant that project plans had to be revised. In particular, there were changes to Government policy on a reforestation project, to which this project had been aligned. Consequently, a new strategy is currently being designed to reach the target population and to develop a Government policy to promote mandatory flour fortification. Despite this setback, the project has made progress in improving the prospects for flour fortification throughout China. Collaborative partnerships at national and provincial levels have been formed. Many groups are involved, notably, CDC, China Grain and Oils Association, the Flour Fortification Initiative, PNDC, the State Grain Administration (SGA), and UNICEF. Private mills and pre-mix companies are also important contributors to these efforts.
“Increasing the availability of micronutrients, particularly reducing iron deficiency anemia through dietary supplements, has an exceptionally high ratio of benefits to costs.” Copenhagen Consensus
GAIN served as a catalyst for the creation of a global Business Alliance for Food Fortification (BAFF) in Beijing in October 2005. A group of Chinese food companies, as well as international pre-mix producers, then held its first meeting in December 2005, hosted by UNICEF, to set up an action plan for the creation of the China BAFF. These strategic partnership networks aim to further private sector initiatives in food fortification for the poor in developing countries. They are an innovative way of promoting sustainable, market-driven nutrition programs that can contribute to eliminating vitamin and mineral deficiencies within the foreseeable future.
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Baking better bread in Uzbekistan Some 8 million people in Uzbekistan are expected to benefit from the national flour fortification project that was launched in Tashkent in March 2005. The project specifically addresses the issue of iron-deficiency anemia among women and children and is supported by a US$ 2.8 million grant from GAIN. The grant agreement between the Uzbekistan government and the World Bank, who are administering the project in Uzbekistan on behalf of GAIN, was signed in November 2004. Iron-deficiency anemia affects over 60% of women of childbearing age and one-third of children under five years old in Uzbekistan, according to the most recent damage assessment reports by UNICEF and the Micronutrient Initiative. This causes health risks to mothers during childbirth and increases the number of underweight babies and children with learning difficulties. The GAIN project will increase the number of mills that fortify wheat flour with vitamins and minerals from 14 to 48. This is expected to reduce iron-deficiency anemia by 20% among women of childbearing age. The project builds on a pilot project undertaken in Uzbekistan with the support of the Asian Development Bank. The pilot project introduced fortification to 14 large urban mills, while the new project extends fortification efforts to mills that use locally produced flour which is consumed by poorer households. This is a good example of the “scaling up� of fortification efforts which GAIN seeks to support. In order to ensure that the supplies of fortified flour will be sufficient to address the needs of those most at risk of vitamin and mineral deficiencies, there must be both appropriate production facilities and legislation in place. This project seeks to work with all flour mills, and with the distribution and retail industry. At the same time, it will work with the government to formulate new laws on flour fortification, and will carry out an extensive social marketing campaign to help ensure that consumers are aware of the benefits of fortified flour and choose to buy it and eat it in their homes.
Fortifying oil in Mali The project to fortify edible cottonseed oil with vitamin A in Mali was awarded a grant by GAIN of just over US$ 1 million in August 2004. Before this, much work was done by committed health and nutrition workers in Mali, and by partners in the GAIN alliance such as Helen Keller International and the Micronutrient Initiative, to pave the way for the project. Because vitamin A deficiency among pregnant women and those of childbearing age is a problem, commercially produced cottonseed oil was chosen as the ideal staple food for fortification. One of the first jobs was to install a large tank where the vitamin A could be mixed with the oil. The tank was built just down the road from the offices of Helen Keller International, the organization coordinating the project. It became a local landmark – with dimensions of 3 x 3 x 3 metres and a capacity of 27 tonnes. At the same time, the project team moved ahead with the advocacy and communications aspects of the project. Team members made a presentation to parliament and gave talks to women’s groups. The team also developed a series of public announcements for broadcast by 60 radio stations. Mali’s National Fortification Alliance, which brings together public and private sector groups, is the key strength of the project. Working with food producers is essential, but it brings its own problems – when the oil production company changed ownership and workers were laid off, the project suffered too. Nevertheless, the project is laying the foundation for fortification of other foods with vitamins and minerals, and already there is talk of adding iron to wheat flour.
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Measuring our progress towards better health GAIN is committed to applying the latest knowledge in project design, implementation and evaluation. In 2005, a comprehensive performance framework, the first for GAIN, was developed and presented to the GAIN Board of Directors and partner organizations. The performance framework was designed following a review of performance tools used by other international organizations. It encompasses GAIN’s two central functions – to provide funding and technical assistance to food fortification programs, and to build alliances at national and international levels. Results are specified over the short, medium and long term, and a set of 17 indicators is used to measure annual progress. The indicators are standardized to the greatest degree possible, thus allowing GAIN and its partners to compare performance across all of the foundation’s investments. Under the performance framework, eight targets have been set – including reach of GAIN’s programs, expected reductions in prevalence of vitamin and mineral deficiencies, and public as well as private sector commitment to food fortification. The targets also emphasize efficient program delivery by setting benchmarks for cost-effectiveness and maximum overheads. Measuring annual performance against these targets will guide GAIN in redirecting resources where appropriate to maximize impact. In 2006, GAIN will start to roll out the performance framework across all its programs. To this end, indicators will be further refined and baseline surveys will be set up in a number of GAIN project areas. In addition, to ensure rigour, an independent expert panel will be convened to advise the performance measurement program and to review methods, data and reports. GAIN will deliver its first annual report against the 17 indicators and targets to its board and other stakeholders in October 2006. GAIN’s performance targets indicator
target
Cost-per-DALY* gained
Less than US $15
Reduction in deficiency prevalence
30% minimum
Coverage of target groups
500 million people
Cost-per-target individual reached
Less than 25 US cents annually
Reach
1 billion people
Additional private sector investment
US $700 million
Additional donor investment in GAIN
US $50 million
Total overhead costs as % of programs
15% maximum
* Disability-adjusted life year
Joining forces in the fight against vitamin and mineral deficiencies As with all new organizations, GAIN’s start-up phase was not without challenges. We have learned from our experiences, and the difficulties of the first few years have been addressed or are being addressed. One of GAIN’s most important concerns has been how to fulfil its role as an alliance. The stakeholders who played a role in establishing the organization, and who invested resources in its development, felt strongly that the added value of GAIN was that it would not merely deliver its own program of work, but that it would perform an alliance function of convening and mobilizing the different actors in the sector around common objectives and programs. To date, GAIN has performed this function mainly through its Board of Directors which includes representatives of the major constituencies with an interest in nutrition. The GAIN Board of Directors has performed this role well, yet it is clear that additional consultative mechanisms need to be developed if GAIN is to engage effectively with its alliance partners. In order to start building consultative processes GAIN invited its alliance partners to a one-day workshop in Short Hills, New York, USA, in 2005. The objectives of the meeting were: p to introduce the new GAIN strategy to the alliance partners; p to discuss feedback from the partners on the new strategy and workplan for the GAIN secretariat; p to identify the partners’ expectations of the alliance, and the added value of a more active alliance role for GAIN. The main conclusions of the consultation suggested that the purpose of the GAIN alliance needed to be reinforced by a broader vision, including a statement of willingness to take risks and foster innovation. An example of a project which fulfils these criteria is the development of a global plan to end vitamin and mineral deficiencies by 2015. The group suggested that the GAIN secretariat’s delivery mechanisms should be flexible and simplified, that decisionmaking processes on grants should be speeded up, and that technical assistance to projects should be delivered in partnership with alliance members. It was suggested that the GAIN strategy towards countries should be more proactive. Communication was identified as a key instrument in the alliance building process, especially through knowledge management. The public advocacy role of GAIN was underlined in the context of the need for an effective communication strategy around the 10-year plan, as well as reinforced communication to consumer groups and civil society in general.
“Probably no other technology available today offers as large an opportunity to improve lives and accelerate development at such low cost and in such a short time.” World Bank
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Speaking out about vitamin and mineral deficiencies GAIN advocates for food fortification worldwide. GAIN’s aim is to create an environment where people in decision-making positions are aware of the problem of “hidden hunger”, realize that food fortification is an effective and low-cost solution to the problem, and know what they need to do to make it happen. GAIN aims to equip decision-makers with the information and skills they need to play an active role in food fortification, and motivate them to act now. This might mean urging a Minister of Health to take the lead role in establishing a National Fortification Alliance. It might mean highlighting to a Minister of Consumer Affairs the need to introduce, or enforce existing, regulations to ensure that food fortification standards are being met by all producers. It might mean advocacy in the private sector by talking with business leaders in the food industry, including packaging and retail, to explain the business case for fortification and to show how positive action can help the company fulfil its corporate social responsibility as well as its bottom-line obligations. Some of this advocacy happens through the mass media, often in collaboration with partners. Since its establishment, GAIN has achieved media coverage of signing ceremonies for the launch of projects in Côte d’Ivoire, Morocco and Uzbekistan, and for the Business Alliance for Food Fortification. GAIN’s presence at key international and regional meetings is also a way for the alliance to get its message out. GAIN staff and board members gave presentations to the International Grains Council, and to the regional workshop of the East, Central and Southern Africa Health Community (ECSA) in Kampala, Uganda. GAIN set up information booths at the Middle East and Africa District Conference of the International Association of Operative Millers (IAOM) in Morocco, the International Nutrition Congress of the International Union of Nutritional Sciences (IUNS) in Durban, South Africa, the Institute of Food Technologists (IFT) meeting in New Orleans, USA, the International Grains Council in London, UK, and at the Global Grain Conference in Geneva, Switzerland. GAIN has produced communication resources to support these activities: a series of six posters highlighting the fact that each person has a role to play in food fortification, and a large fabric display for use at conferences and meetings. More quietly, but just as importantly, GAIN staff and board members are constantly meeting with leaders in the public, private and nongovernmental sectors to argue the case for – and to seek commitment to – the cause of food fortification.
The Business Alliance for Food Fortification (BAFF) It is now clearly recognized that the private sector has a critical role to play in controlling and eliminating vitamin and mineral deficiencies. Only the private sector can fortify food and produce supplements. The role of the business community need not be limited to production but can include innovation and product development, distribution and marketing, and advocacy and lobbying. The development community acknowledges that partnering with business is key to scaling up current programs tackling malnutrition. However, for this partnership to take shape and deliver the expected impact for at-risk populations, a profound transformation process is needed, involving food manufacturing and distribution systems and the development community. The Business Alliance for Food Fortification facilitates the private sector’s contribution to the control of vitamin and mineral deficiencies. A global BAFF was launched in October 2005, and a national BAFF for China held its first meeting in December 2005. Other local BAFF groups are planned for India, Africa and the USA. Through dialogue, learning, and peer influence, companies are reflecting on new business models and new partnership structures capable of delivering sustainable solutions to populations at risk of vitamin and mineral deficiencies. As an informal network, BAFF generates new resources, visibility and pressure for government action.
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Countries that have been awarded funding by the GAIN Board reach – number of people in millions*
food fortified
Bolivia
Wheat flour and vegetable oil
6.9
Iron, folic acid and other B vitamins
2.6
Burkina Faso
Cottonseed oil
8.6
Vitamin A
1.2
China (soy)
Soy sauce
181.3
Iron
3.0
China (wheat)
Wheat flour
43.3
Iron, folic acid and other B vitamins, zinc
3.0
Côte d’Ivoire
Palm and cottonseed oil, wheat flour
18.6
Vitamin A, folic acid, iron
3.0
Dominican Republic
Sugar, wheat flour
8.1
Vitamin A, folic acid and other B vitamins, iron
1.9
Ghana
Vegetable oil, wheat flour
19.9
Vitamin A, folic acid and other B vitamins, iron
1.8
Mali
Cottonseed oil
Vitamin A
1.0
Morocco
Wheat flour and vegetable oil
17.4
Vitamin A, folic acid and other B vitamins, iron
2.9
Nigeria
Wheat and maize flour, malt drink, sugar, vegetable oil, cocoa based beverage
86.8
Vitamin A, folic acid and other B vitamins, iodine, iron
2.4
Pakistan
Wheat flour
30.7
Folic acid and other B vitamins, iron
3.0
South Africa
Wheat flour, maize meal
34.2
Vitamin A, folic acid and other B vitamins, iron
2.8
Uzbekistan
Wheat flour
8.0
Folic acid and other B vitamins, iron, zinc
2.8
Vietnam
Fish sauce
9.0
Iron
3.0
5.6
Vitamin A, folic acid and other B vitamins, iron, zinc
2.4
Zambia
Total
Maize meal
7.7
486
main fortificant
grant awarded us$ millions**
country
36.8
* Reach is defined as the estimated number of people consuming fortified products when the national programs are fully in place. ** Grant amounts awarded include some grants administered by the World Bank, which do not therefore appear in the GAIN financial statements.
countries targeted through a large country program
countries with projects under consideration
countries and regions that have received a small enabling grant
p Bangladesh
p Georgia
p Azerbaijan
p Malawi
p Brazil
p Malawi
p Cape Verde
p Mexico
p Egypt
p Turkey
p Chile
p Tajikistan
p India
p Uganda
p Jordan
p Turkmenistan
p Kazakhstan
p West Africa
p Indonesia
p Kyrgyzstan
23
Global Alliance For Improved Nutrition, Geneva Financial Statements for the Year ended June 30, 2005 and Auditors’ Report Balance Sheet as at June 30, 2005 (with 2004 comparative figures) ASSETS
(expressed in US dollars) NOTES
2005
2004
14,588,510
13,281,823
1,056,991
1,767,055
-
11,658
322,388
3,597
15,967,889
15,064,133
144,114
140,027
16,112,003
15,204,160
Current Assets : Cash and bank Advances to UNDP and UNOPS Other advances Prepaid expenses Total current assets fixed assets, net
3
TOTAL ASSETS LIABILITIES Current Liabilities : Bank overdraft
164,757
-
Accounts payable
362,872
34,637
Accrued expenses
440,492
628,697
Grants payable
4
1,965,643
3,108,483
Project supervision fees payable
4
479,057
530,000
3,412,821
4,301,817
4
5,747,796
3,508,167
5
36,187
36,187
Surplus
6,915,199
7,357,989
Total capital and reserves
6,951,386
7,394,176
16,112,003
15,204,160
Total current liabilities
Long Term Liabilities : Grants payable after one year
Capital And Reserves : Foundation capital
TOTAL LIABILITIES
See notes to financial statements
25
Statement of Income and Expenditure for the Year ended June 30, 2005 (with 2004 comparative figures)
(expressed in US dollars) 2005
2004 (March 26, 2003 to June 30, 2004)
9,550,000
20,989,823
98,377
–
9,648,377
20,989,823
4,452,951
9,252,716
405,248
530,000
4,858,199
9,782,716
2,173,982
1,524,816
Income : Donations received Bank interest Total income
Expenditure : Project related costs : Project grant expenditures Project supervision fees
General Administration Expenses : Staff related expenses Office rental Secretariat operational expenses Professional, technical and legal fees
170,832
176,434
662,138
441,477
1,228,349
971,731
874,208
690,692
47,608
28,941
40,813
9,674
5,197,930
3,843,765
34,991
5,244
47
109
35,038
5,353
10,091,167
13,631,834
Excess of expenditure over income / surplus of income over expenditure
(442,790)
7,357,989
SURPLUS, beginning of year
7,357,989
–
6,915,199
7,357,989
Travel and meeting expenses Depreciation Other miscellaneous
Finance Related Costs : Bank charges Exchange difference, net
Total expenditure
SURPLUS, end of the year
Notes to Financial Statements for the Year Ended June 30, 2005 (with 2004 comparative figures, expressed in US dollars)
1
GENERAL The Global Alliance for Improved Nutrition (GAIN) is an independent non-profit Foundation created under Article 80 of the Swiss Civil Code, and is registered with the Geneva Register of Commerce under statutes dated March 26, 2003. The Foundation has been established to support food fortification and other sustainable nutrition strategies in order to save and improve health, productivity and cognitive function. In pursuing this objective, the Foundation intends to improve the micronutrient status of individuals living in developing countries, contributing to the following goals : p
Reduce child and maternal morbidity and mortality ;
p
Improve productivity ;
p
Promote the ability of populations to achieve their physical and intellectual potential ;
p
Reduce healthcare costs.
In order to attain these goals, the Foundation shall support developing countries in food fortification efforts, undertaken in the context of broader micronutrient strategies that will reduce micronutrient malnutrition in developing countries, particularly through increased consumption of micronutrient-rich foods. The Bill and Melinda Gates Foundation and certain governments and other contributors have made available initial resources to support the projects and programs to be supported by GAIN. These resources are managed by the International Bank for Reconstruction and Development (World Bank) via a Trust Fund to be administered by the World Bank as trustee on behalf of GAIN. Donations may also be received directly by GAIN. The initial projects satisfactorily appraised by the World Bank and approved by the GAIN Board of Directors shall be administered and supervised directly by the World Bank in accordance with the written agreement between the World Bank and GAIN. With respect to each such project, the World Bank shall, as administrator on behalf of GAIN, enter into a grant agreement with the recipient of such grant. The World Bank shall solely be responsible for the supervision of the project activities under the Grant Agreement. Any other projects approved by the GAIN Board of Directors shall be administered and supervised by GAIN. The World Bank shall provide to GAIN an amount equal to the budgeted annual operating costs of the GAIN Secretariat as approved by the GAIN Board of directors. At June 30, 2005, GAIN has no direct employees. The majority of personnel and related costs, including current and post employment benefits are provided and managed by the UNDP and WHO (World Health Organization) and charged in full to GAIN, covered by written agreements. Following agreement with UNDP and WHO, GAIN will employ its own employees directly and will no longer rely on the services of UNDP and WHO.
27
Notes to Financial Statements for the Year Ended June 30, 2005 (with 2004 comparative figures, expressed in US dollars)
Certain personnel and related costs are provided and managed by the World Bank, and are paid directly from the Trust Fund and are not charged to GAIN. 2 SIGNIFICANT ACCOUNTING POLICIES Basis of accounting – The accounting policies comply with the Swiss Code of Obligations. Donations received – The donations received are recorded on a cash basis. Foreign currency – Accounting records are maintained is US dollars. Income and expenditures in other currencies are recorded at the rates ruling at the date of the transactions. Period-end balances for assets and liabilities in other currencies are translated into US dollars at rates of exchange prevailing at balance sheet date. Exchange gains and losses are included in the determination of the net income. Fixed assets – Fixed assets are stated at cost less accumulated depreciation. The Foundation applies the straight-line method for the depreciation of these assets using rate of 20% per year for office equipment and 50% per year for computer equipment. Grants committed for projects – All grants are governed by a written grant agreement. All expenses are accounted for at the moment of the signature of the agreement. Grants or portions of grants that have not been disbursed at the balance sheet date are recorded as short and long-term liabilities. Certain agreements provide that the payments of part of the grants occur when defined milestones have been met. 3 FIXED ASSETS, net Fixed assets held at June 30, 2005, are as follows : Office equipment
Computer equipment
Total
Gross book value
56,206
164,458
220,664
Accumulated depreciation
(22,958)
(53,592)
(76,550)
Net book value
33,248
110,866
144,114
The fire insurance cover amounts to USD 158,128 (CHF 200,000) (2004 – USD 159,859 – CHF 200,000).
Notes to Financial Statements for the Year Ended June 30, 2005 (with 2004 comparative figures, expressed in US dollars)
4 GRANTS AND PROJECT SUPERVISION FEES PAYABLE Cumulative total Grant expenditure
Short term
Long term (after one year)
Total undisbursed
China Soy Sauce Project
3,000,000
405,790
1,376,500
1,782,290
China Wheat Project
3,000,000
127,850
1,331,667
1,459,517
Wheat Flour and Maize Meal Project
2,800,000
–
800,000
800,000
Côte d’Ivoire Project
2,999,694
1,081,535
1,918,159
2,999,694
Mali cooking oil Project
1,010,000
218,195
321,470
539,665
257,690
57,690
–
57,690
Other small grants
347,998
74,583
–
74,583
Other fully disbursed projects
290,398
–
–
–
13,705,780
1,965,643
5,747,796
7,713,439
935,248
479,057
–
479,057
Morocco Project
Total grants Project Supervision Fees
5 FOUNDATION CAPITAL The Foundation capital amounts to CHF 50,000 (equivalent at USD 36,187 at the March 26, 2003 exchange rate). 6 RENT AND LEASING COMMITMENTS At June 30, 2005, the Foundation had future minimum office rental commitments amounting to USD 126,832 (2004 – USD 258,370), corresponding to expected rental fees until the end of the lease (April 30, 2006). The Foundation has also entered into a leasing contract for computer equipment for which the remaining commitments as at June 30, 2005 amount to USD 55,457 (2004 – USD 89,704). 7
OTHER COMMITMENTS The Foundation had signed a long term agreement with UNDP regarding staff and other expenses. This contract has been cancelled and will terminate in December 2005.
29
Auditor’s Report
31
cover © 2003 Georgina Cranston, Courtesy of Photoshare Nineteen-year old Yasmina recovers in the Nutrition Rehabilitation centre at the Child In Need Institute (CINI) in Kolkata, India with her two children who are two years old and two months old. With lack of emotional support from her husband, she struggled to cope with the loss of a child and the needs of her two children. The eldest still wasn’t walking, and the youngest was malnourished on arrival at the centre (Yasmina was unable to breastfeed). After 11 days, with emotional and nutritional support, all this has changed. page 6 UNICEF/HQ98/0521/Giacomo Pirozzi page 8 Françoise Chomé, GAIN page 9 © 2000 Mohsen Allam, Courtesy of Photoshare Women work in the field with their children in Egypt. page 11 CDC/ Chris Zahniser, B.S.N., R.N., M.P.H. Women and children in Gorakhpur, India, 2000.
Photo Credits
page 12 © 2003 L. Goodsmith, Courtesy of Photoshare A young girl feeds her baby sister at a community feeding center (centre d’alimentation communitaire) in Daghveg, Mauritania. This feeding center is one of several operated by the aid organization World Vision International with supplies provided through the World Food Programme. At the centers, malnourished children receive two meals daily of porridge made from high-nutrition corn/soya blend. At the time of this photograph, Mauritania was in its third year of severe drought, with crisis concentrated in the southcentral (Assaba) region. page 14 © 2003 Melissa May, Courtesy of Photoshare Girls in Ghana learn how to make bread as part of a livelihood training, aimed at reducing adoption of Female Genital Cutting. page 15 Claudia Parvanta page 16 Tim Higham page 16/17 UNICEF/HQ01/0516/Shehzad Noorani page 17 Françoise Chomé, GAIN page 18 © CCP, Courtesy of Photoshare A woman in Bangladesh attends a community meeting with her infant. page 19 © 2001 Njamburi/Cabak ELS, Courtesy of Photoshare Children sift powdered cassava in Nyegina Village, Tanzania. page 20 © 2004 Amber Beckham, Courtesy of Photoshare A little girl in Rwanda feeds herself porridge at a community meeting held to promote better nutrition for children under 5 years. page 21 © 1991 Lauren Goodsmith, Courtesy of Photoshare An infant eats at a P.K. 10 clinic and feeding center outside of Nouakchott, Mauritania. page 24 UNICEF/HQ04/0211/Asad Zaidi page 31 © Maggie Murray-Lee/Lutheran World Relief, Courtesy of Photoshare Two women winnowing grain at a cereal bank. LWR partner GRAD (Groupe de Recherche-Action pour le Developpement) is a multifaceted community organization: projects include literacy programs for 150 local women and men, community health awareness, initiatives to support the local elementary school and construction of a cereal bank to ensure village food security. back cover © 1999 Anne Palmer/CCP, Courtesy of Photoshare Happy children in Jakarta, Indonesia.
BOARD MEMBERS Jay Naidoo Chair, GAIN Board Chair, Board of Directors, Development Bank of Southern Africa Chairman, J&J Group, Johannesburg, South Africa Sally Stansfield Vice Chair, GAIN Board Associate Director for Global Health Strategies, Global Health Program, The Bill & Melinda Gates Foundation, Seattle, USA Chunming Chen Senior Advisor, Chinese Center for Disease Control Director, International Life Sciences Institute, Beijing, China Anwarul Chowdhury UN Under-Secretary-General and High Representative for the Least Developed Countries, Landlocked Developing Countries and Small Island Developing States, United Nations, New York, USA Frances Davidson (from October 2005) Health Science Specialist, Office of Health and Nutrition, Bureau for Global Programs, U.S. Agency for International Development, Washington DC, USA Christopher Elias President, Program for Appropriate Technology in Health (PATH), Seattle, USA Kul Gautam (from October 2005) Deputy Executive Director, United Nations Children’s Fund (UNICEF), New York, USA Syamal Gupta Director, Tata Sons Limited, Mumbai, India Pierre Henchoz (from October 2005) Partner, Lombard Odier Darier Hentsch & Co., Lausanne, Switzerland Richard Hurrell Professor, Institute of Food Science and Nutrition, Swiss Federal Institute of Technology (ETH), Zurich, Switzerland Catherine Le Gales-Camus Assistant Director-General, Noncommunicable Diseases and Mental Health, World Health Organization (WHO), Geneva, Switzerland Ernest Loevinsohn Director General, Program Against Hunger, Malnutrition and Disease, Multilateral Programs Branch, Canadian International Development Agency (CIDA), Hull, Quebec, Canada Louise Sserunjogi Nutritionist, Child Health and Development Center, Makerere University, Kampala, Uganda Victoria Tauli Corpuz Executive Director, Tebtebba (Indigenous Peoples’ International Center for Policy Research and Education), Baguio City, Philippines Nicolas Tsikhlakis Vice President, Modern Flour Mills & Macaroni Factories Company, Amman, Jordan EX-OFFICIO MEMBERS Jacques Baudouy Director, Health, Nutrition and Population, International Bank for Reconstruction and Development, The World Bank, Washington DC, USA Elhadj Sy Director, HIV/AIDS Group, Bureau for Development Policy, United Nations Development Programme (UNDP), New York, USA Marc Van Ameringen Interim Executive Director, Global Alliance for Improved Nutrition, Geneva, Switzerland
Global Alliance for Improved Nutrition thru 1 may, 2006: Avenue Giuseppe-Motta 52 PO Box 55 1211 Geneva 20 Switzerland
from 1 may, 2006: Rue de Vermont 37-39 PO Box 55 1211 Geneva 20 Switzerland
Tel: +41 22 749 1850 Fax: +41 22 749 1851 www.gainhealth.org info@gainhealth.org