Business Innovation to Combat Malnutrition
Two Wheels Turning: Partnership in China’s Soy Sauce Fortification Program This case was prepared by David Lane and Carin Isabel-Knoop with support from Michael Jarvis (World Bank Institute) and Bérangère Magarinos (Global Alliance for Improved Nutrition). We would like to express our gratitude to the staff of Shijiazhuang Zhenji Brew Group Company, Ltd, the Center for Disease Control and Prevention (CDC) in China and their partner organizations for their invaluable contributions to the case’s development. This case was commissioned by the World Bank Institute with the support of the Global Alliance for Improved Nutrition.
Case Study Series
Case B
NOVEMBER 2003 WAS supposed to be a celebratory period for Chen Junshi and his China CDC colleagues working to ameliorate the problems of iron deficiency and iron deficiency anemia (IDA). After two years of testing and preparation, China CDC had received funding from Geneva-based Global Alliance for Improved Nutrition (GAIN) to launch its soy sauce iron fortification program in seven provinces and the municipality of Beijing, and had already held several provincial launch conferences to kick off the campaign. But in a recent conversation, Zhang Lin, CEO of Shijiazhuang Zhenji Brew Group Company (Zhenji), had relayed the resistance of his own managers to continued participation in the program. As one of the CDC’s strongest industry supporters, Chen worried that the resistance articulated by Zhenji managers meant that there was much more hesitation among the CDC’s business community participants in the program than the CDC had bargained for.
Four years later, not only had Zhenji been a lead participant in the soy fortification project, but the program had made a tangible impact on the incidence of IDA among Hebei’s 67 million inhabitants. While iron fortified soy sauce was unavailable to Hebei consumers in 2001, by mid 2007, fortified soy sauce was displayed if not sold in 90% of Hebei supermarkets. Iron deficiency anemia had fallen to 8.4% from a high of 20.1% in 2002, the date of the earliest available survey. See Exhibit 1 for data on iron deficiency anemia in Hebei province before and after the project. The program had also been expanded to six other provinces with promising results (see Exhibit Appendix for a map).
China CDC experts convened to discuss possible approaches to strengthening the soy fortification program’s appeal to the private sector without compromising its public health goals of counteracting IDA. China CDC was in no position to order any manufacturer’s participation in the program. Indeed, one of the program’s advantages was its explicit voluntarism on the part of both consumers and soy sauce makers. But after two years of
Chen credited this outcome to China CDC’s new role in emphasizing social marketing. He and his colleagues had discovered that only China CDC, working with local CDC teams, could persuade both consumers and soy sauce makers of the benefits of participating in the campaign against IDA. Having listened to the grumbling from Zhenji’s management, in early 2004 they had set out to do just that, using a broad array of channels and approaches to
groundwork, including certification of and free technical assistance to industry participants, it was disappointing for CDC staff to hear the objections voiced by soy sauce makers, just as funds had materialized to publicize the program in seven provinces.
Copyright © 2008, WBI - World Bank Institute, Washington, DC, United States, and GAIN - Global Alliance for Improved Nutrition, Geneva, Switzerland. The views expressed in this paper are those of the authors only.
build as broad a consensus as possible behind the merits of iron fortified soy sauce.
Laying the Groundwork: The Case of Hebei Province In late 2004 and into early 2005, project launch conferences were conducted at provincial and municipal levels and training programs were conducted for the core project staff at the county and district levels in seven provinces. Hebei Province occupied 190,000 square kilometers of the North China plain, surrounding the Beijing and Tianjin municipalities. Hebei was divided into 12 prefectural level cities, 172 counties and districts, and 1,971 townships. Launch of the iron fortification program in Hebei was held in October 2004 at the provincial capital, Shijiazhuang. Over 110 participants attended, including leaders from the national Ministry of Health’s Department of Disease Control, the Hebei Provincial Health Department, the Shijiazhuang Municipal Health Bureau, and the national and provincial CDCs. Representatives of the Bill Gates Foundation and of GAIN also attended, along with senior Zhenji managers, state and provincial experts, and the media. Similar project launches at the municipal level were sponsored by the health bureaus of each city and organized by each city’s CDC.
and county CDCs, health inspection and enterprise sales representatives, the principals in charge at the pilot counties and townships, village cadres, doctors of preventive medicine and heads of sales outlets. The intent was to build as broad a coalition as possible at all levels before the campaign went public. The health bureaus of Hebei’s four main cities – Shijiazhuang, Tangshan, Baoding, and Handan – selected the pilot counties and districts that would promote iron fortified soy sauce (see Exhibit 2). The 35.2 million inhabitants of these four cities comprised 52% of Hebei’s total population. Each county and district appointed selected 50 demonstration villages. The health authorities in turn set up teams at various levels. At the provincial level, the leadership group comprised 10 members including the relevant leaders from the provincial health department. At the municipal level, the leadership group consisted of the directors in charge of municipal health bureaus, work groups, campaign groups and a work team (143 individuals). Corresponding leadership groups and work groups were formed at the level of the pilot counties, districts, and cities (191 persons). At the village level, the local doctor served as project liaison officer.
Getting the Word Out Making it Official
At the next level, 12 project launch and training conferences for core project staff were held at 12 pilot counties and districts within Hebei. Each pilot county in turn held a training and a mobilization conference for core project staff. These activities reached 2,500 persons, including principals from provincial and municipal CDCs and experts in charge of nutrition and health education, county and district government officials, leaders from district and county health bureaus, staff from district
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In May 2005, the Hebei Province Health Department issued a “Notice to promote the project on iron-fortified soy sauce to prevent IDA,” and put the provincial CDC in charge of implementing promotional programs for iron fortified soy sauce in Hebei. The Hebei Health Department instructed the health bureaus of the province’s major cities to lead the change in a firm yet cooperative way. The document also required the provincial CDC and all the pilot
cities and counties to use media outlets to promote, educate, and increase public awareness of the risks of IDA and to encourage consumption of iron fortified soy sauce.
Using the Media Building upon the initial social marketing with which China CDC experimented in its 2002-2004 pilot scheme, a new, wide ranging TV campaign was launched to get the message out. Provincial, municipal, and county TV stations broadcast dozens of news reports on the iron fortified soy sauce project. Unlike TV advertisements, which were by far the most expensive element of CDC’s promotional campaign, news reports cost the CDC nothing. In fact, CDC staff recounted, reporters and other media people were typically so sensitive to the value of the CDC’s educational mission that they ran advertisements longer than contractually required and worked in other ways to give greater prominence to CDC goals. TV stations also broadcast ads related to the iron fortified soy sauce during the workshops run by the experts, focusing on the harms of IDA and the role of iron fortified soy sauce in reducing it. Coverage in the print media was also extensive in 2005 with 83 articles focused on IDA. The headlines ranged from “Films to be shown in rural areas on knowledge about preventing anemia” in the August 18, 2007 Shijiazhuang Daily to the August 5, Hebei Daily’s article titled, “Why has iron fortified soy sauce been snubbed?” CDC staff remarked that newspaper coverage, while less prominent than ads or news reports on television, was cheaper and typically offered the opportunity for a discussion of greater depth. It was also clear from that last headline that the press coverage could not be entirely controlled when first efforts to roll out the fortified soy sauce were slower than expected.
Bringing the Message to the Grassroots In rural areas, local CDC teams promoted the campaign by painting over 500 slogans on various walls in the communities. In addition, short clips about IDA were shown 69 times before outdoor showings of feature films in the countryside, thereby reaching over 30,000 people. Furthermore, a total of 76,200 posters went up, one at every township clinic and food retail outlet that carried iron fortified soy sauce. Campaigns were conducted in the form of special consulting program on town squares. In addition, CDC teams throughout Hebei publicized the campaign through lectures by experts on iron fortified soy sauce, itinerant road shows, distribution of campaign flyers and placards from the mobile campaign, combined with the annual health campaigns on “May 20 Student Nutrition Day” and “Support to the Rural Regions.” See Exhibit 3 for summary statistics on the various campaigns. The thrust in urban areas was slightly different. Over 220 shops were authorized to sell iron fortified soy sauce and were thereby allowed to install plaques promoting this status on their storefronts. Experts dispensed advice and free lectures. Campaign wall maps were produced and 11,200 of them were posted in neighborhoods, schools, and sales outlets. The local CDC team printed 100,000 campaign flyers and distributed them to students in Zanhuang County alone. A total of 3.5 million flyers were posted in support of iron-fortified soy sauce in Hebei’s four main cities.
Overcoming Zhenji’s Objections The CDC’s campaign to building awareness of IDA and demand for a solution would not have worked without reliable industry partners to manufacture and distribute iron fortified soy sauce. Zhenji was
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one of China’s eight largest soy sauce manufacturers, and ranked second or third among China’s vinegar producers. Zhenji revenues came from soy sauce (56%) , vinegar (40%), with the balance from other products in four categories. The company also had plants in the United States and Canada and exported 10% of its production from China to 20 countries. “A company needs profitability,” its CEO Zhang Lin was fond of saying, “but at the start, it needs vision.” And from the start, the China CDC team felt that they had a good chance to enroll him and his management team in their vision. But even after certifying Zhenji as Hebei’s sole approved manufacturer and distributor of iron fortified soy sauce in 2002, it was no easy task to get Zhenji on board for the broader launch in 2004, as early results had not been encouraging. As a participant in China CDC’s 2002–04 pilot program to test the impact of iron fortified soy sauce on anemic Chinese in Hebei, Zhenji already had data on consumer purchases of iron fortified soy sauce. The data showed that Zhenji’s sales of the iron fortified product rose and fell in direct correlation with CDC and company promotional efforts. When the pilot program for Hebei ended in 2003, and promotion of iron fortified soy sauce along with it, Zhenji’s sales of the product slumped. Zhenji managers therefore feared that government promotion of iron fortified soy sauce would be inadequate to support ongoing sales of iron fortified soy sauce. Zhenji managers also worried that the company’s participation in the program might be hurt by several additional potential problems. Some worried that rural consumers would find the price of iron fortified soy sauce too high, even if they knew that it would improve their health. It was indisputable that – even if more expensive than the poor quality bulk soy sauce available in the countryside – iron
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fortified soy sauce was much less expensive than purchasing iron tablets on doctor’s orders. But some Zhenji managers felt that rural consumers would be too slow to absorb and change their decades-old purchasing and consumption habits. Zhenji managers who favored investing in making iron fortified soy sauce argued that Zhenji had the opportunity to make a great deal of difference to the lives of existing and potential new consumers. The argument went as follows: rural customers usually ate soy sauce anyway, so they only needed to change from regular soy sauce (at a cost of about 14¢ a bottle) to fortified soy sauce (at a cost of about 15¢ a bottle). The poor could not afford medicine or vitamins, but they could afford soy sauce. This became Zhenji’s major sales argument.
Taking the Plunge On September 1, 2004, Zhenji agreed to participate in the expanded program. Zhenji worked with Hebei provincial CDC officials to coordinate its own marketing efforts with the CDC’s public health campaign promoting iron fortified soy sauce as a weapon against IDA. Zhenji’s aims were overwhelmingly commercial. Despite their concerns, Zhenji managers concluded that fortified soy sauce presented an opportunity in two respects. First, it was a new market for their products, one that no other manufacturer in the province had been given access to. Second, marketing fortified soy sauce, especially in conjunction with an ongoing public health campaign, was likely good for market penetration. It would expand the market for Zhenji soy sauce, especially among anemics, and in rural areas, where the company had only a slight marketing presence.
Taking a New Look at the Market Zhenji’s market research showed, moreover, that differences between rural and urban consumers could be overcome with appropriate marketing to each group. For example, on the question of whether farmers were willing to spend more for iron fortified soy sauce, Zhenji conducted three market research surveys and a survey of its own staff, and held trials at the village level. “We discovered that the perception that farmers couldn’t afford fortified soy sauce was wrong,” a company manager explained. According to another manager, farmers stated that, although they had a low income, they had no other way to get iron in their diet, and feared having to spend more on medicine or treatment for anemia in the future more than paying more to get iron in their diet now. “For farmers, fortified soy sauce would cost only a bit more per year. These surveys made us realize that we shouldn’t have underestimated consumers’ desire to protect themselves from health problems. Also, word of mouth support for iron fortified soy sauce developed after some consumers felt better as a result of using it. This was very helpful to us.” Government promotion of iron fortified soy sauce for IDA helped Zhenji in another way as well. Zhenji managers worried that popular mistrust of the claims advertised by the producers of other nutritional supplements would limit the credibility of Zhenji’s marketing of its iron fortified product. But in the event, Zhenji managers concluded, “Even exaggerated ads conveyed some useful health information, including on the connection between iron and health. Furthermore, we relied on government support to overcome consumer resistance because the government was considered a much more reliable source of health information than companies that were trying to sell something.” Thus, on the basis of both the relationship between CEO Zhang and
China CDC and evidence of the CDC’s commitment to the campaign, particularly once GAIN had committed its financial support for social marketing, “we concluded that the government would promote it,” a manager noted.
Investing in Marketing As a result, Zhenji decided in 2004 to invest RMB 20 million ($2.4 million) in marketing and promotion of its iron fortified soy sauce over three years. In recalling the reasoning to decide in favor of the investment and renewed participation in the CDC program, a Zhenji manager made several points. “First, we get all the benefits of being the first to penetrate the market. Remember that brand loyalty is high among soy sauce consumers. Second, being the only certified soy sauce producer in Hebei distinguishes us from other local producers. Third, iron fortified soy sauce allows us to segment our customers better. For example, our marketing targets parents by emphasizing the contribution iron consumption makes to childrens’ concentration. It targets women by emphasizing the beauty effects of iron consumption. And it promotes vitality for the general population. Finally, we think it’s fair for the government to limit certification for iron fortified soy sauce to 11 producers nationwide.” On April 8, 2005, Zhenji established its own central office to promote iron fortified soy sauce, consisting of three teams to plan, promote, and develop consumption. Meanwhile, group level sales and marketing actions for iron fortified soy sauce were approved and implemented in the urban areas of Shijiazhuang, as well as in the county areas of Shijiazhuang, Tangshan, Baoding, Handan, Cangzhou, and Hengshui. Internal training conferences to increase staff awareness about IDA and Zhenji’s new products were conducted for 580 staff in July
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and August 2005. These included 17 workshops for 3,210 rural doctors on how to popularize the science of iron nutrition. Especially in urban areas, Zhenji used a broad approach to building demand for the new product but with the retailer at its center. “We decided for our part that we needed to mobilize retailers,” a Zhenji manager underlined. “Word of mouth alone only gets so far. Back in 2004, we distributed leaflets and posters along with gifts to retailers. The leaflets stated at the bottom that if the reader finished reading the flyer Zhenji would give them ¥1 [about 12¢]. This was a big success. In addition, we held trials in retail stores, and bundled the soy sauce with little freebies. In villages, we offered a free pencil case with purchase of five bottles of iron fortified soy sauce. To boost initial sales, we paid consumers ¥0.10 [about 1¢] for every empty iron fortified soy sauce bag that they brought back to the point of purchase. Through such efforts, retailers became marketing agents for us. Further, people with severe anemia told others about the beneficial effects of Zhenji’s iron fortified soy sauce.” Sales of Zhenji’s iron fortified soy sauce doubled every year to date. Between October 2005 and October 2006, Zhenji sold 1,500 tons of iron fortified soy sauce, which was consumed by an estimated 8.4 million people. Sales no longer correlated directly with the CDC’s public health campaigning.
Taking Stock CDC: Expanding, Experimenting, and Learning In 2006, the Hebei provincial CDC promulgated another document: “Letter regarding the further improvement of the work on iron fortified soy sauce project to prevent anemia.” In addition to specifying
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the requirements and specific details for implementing the project in the existing demonstration cities, the letter helped buttress official support for and attention to increasing public awareness of iron fortified soy sauce. Locally influential publications published the letter and a series of signing events followed. As in 2005, volunteers were mobilized to distribute the letter to citizens and retailers. TV ads were run and media coverage of events encouraged. In addition, 35-second public service announcements (PSAs) were broadcast by mainstream media two to four times each day from mid June 2006. The announcements aimed to educate, but importantly for the success of the CDC’s collaboration with industry, each PSA was followed by a companyspecific advertisement, focusing in Hebei’s case on Zhenji brands and products. Zhenji managers noted that booking advertisements for its iron fortified soy sauce immediately following these PSAs exemplified the type of collaboration fostered by their relationship with China CDC. On the basis of the success in Hebei and seven additional provinces (plus Beijing), in 2007 the CDC hoped to begin to extend the iron fortification campaign to the seven additional provinces of Heilongjiang, Liaoning, Shandong, Shanxi, Sichuan, Xinjiang, and Zhejiang. “Now we need to scale the program up,” explained Chen Chunming, a former China CDC leader. “We estimate that there are 130 million people at high risk for iron deficiency anemia. Our hope is to reach 360 million with our campaign. To get there we need to go beyond than Beijing and the seven provinces covered now.” A key thrust for 2007 was greater emphasis on rural areas, both expanding the area of coverage and expanding the number of people covered. Other ideas included the provision of student lunches and the encouragement of group purchases as ways to further disseminate the product and build word of mouth. As the CDC experimented,
however, it became clear that ideas were not lacking. Instead, some CDC managers said, it was the efficient transfer of best practices across geographies that needed improvement. With so many experiments underway, the CDC and its partners had to systematize their learning so as to become even more efficient in every new province in which they invested. China CDC had already learned that it need not limit itself to its historical role of research and prevention, but had the ability to influence public health by taking an active role in developing and implementing policy. According to China CDC FFO vice-director Sun Jing, “CDC staff changed from being purely scientists to operating more as social advocates.” CDC collaboration with social actors and the media was the key proselytizing tool, but without building relationships with industry producers to supply and distribute a product that the CDC could not, all its media and face-to-face work would have had no impact.
25% and 35% of its total soy sauce sales for the year. Zhenji had yet to market fortified soy sauce to its existing industry or restaurant clients, but this was a promising new market. Because Zhenji’s expansion of fortified soy sauce sales beyond the Hebei market depended on both CDC’s recommendations as to its desired area of influence (since each province would have its own local producers working with CDC), CEO Zhang Lin expected to focus sales and marketing on Zhenji’s own backyard, Hebei Province. Zhenji managers expected to make a profit on fortified soy sauce in 2007 due to increased volume. As they looked back on progress to date, Zhenji managers had become convinced of the power of the CDC to build demand. “Urban consumers do not trust the claims of company advertisements,” explained Chen Chumning, “so they suspected that this could not be right either. This is where the trust enjoyed by CDC made the difference: unlike the private sector, the CDC had a high level of credibility.” In addition, CDC promotion built the demand that Zhenji had worried might not materialize.
Zhenji: Thinking Through Next Steps Meanwhile, by 2007 Zhenji had begun the first phase of a project to boost annual output of iron fortified soy sauce to 100,000 tons (the company had total annual integrated output capacity of 200,000 tons). Zhenji’s fortified soy sauce production reached 13,000 tons in 2006, well below its existing capacity of 24,000 tons. Production in the first five months of 2007 was 8,000 tons, with a total of 20,000 tons of sales expected for the year. The goal for 2008 was 48,000 tons. Zhenji felt that 50,000 tons was a mature market, but the firm’s plans to build a 100,000 ton capacity clearly signaled that Zhenji managers believed they could take the product national. Zhenji sold US$3.6 million worth of fortified soy sauce in 2006, amounting to between
Taking Pride in the Outcome and Going National As the various players looked back and planned ahead, they had pride in the outcome of their collaboration to date. Indeed, by 2007, iron fortified sauce was widely known, available, and consumed in the pilot areas. See Exhibits 4, 5, and 6 for awareness, distribution, and sales data. In the pilot areas, Chen Chunming noted, “child malnutrition is way down. The program has been a big success. In addition, the program is sustainable: affordable, safe, and profitable with our help in social marketing to generate awareness of the problem and acceptance of fortified soy sauce.”
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On the basis of this success, China CDC in May 2007 signed a distribution agreement with French hypermarket Carrefour, which operated 49 stores in eight Chinese cities. The agreement stipulated that Carrefour would give shelf space to iron fortified soy sauce at no charge, and allow the manufacturers of the products that local Carrefour managers chose to feature on those shelves to conduct periodic instore promotion of the product. For soy sauce producers, the agreement created one way to get their products into a high-end retail environment that they might not otherwise have access to. For the CDC, the agreement created yet another venue to advance its public health agenda. For Carrefour, the agreement created a way to associate itself in China with health and nutrition at little cost, while also guaranteeing that, in a marketplace full of adulterated and counterfeit goods, its soy sauce at least would come from nationallycertified producers.
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Exhibit 1. Initial Results from Hebei Province, 2004–05
Baseline results for women and children in Hebei’s main cities
Test date
Location
Number of women over 20 tested
Anemia rate (percent)
Number of children aged 3–7 tested
Anemia rate (percent)
Oct 2004
Shijiazhuang
801
42.32
198
17.17
May 2005
Tangshan
933
28.40
190
5.26
June 2005
Baoding
931
27.18
220
11.36
July 2005
Handan
749
40.45
160
17.50
Total: 3,414
Average: 34.59
Total: 768
Average: 12.82
Baseline results for Shijiazhuang youth
Test date
Location
Age level
Students tested
Students found anemic
Anemia rate (percent)
Urban/rural
Oct 2005
Zanhuang High School
High school sophomores
495
167
33.74
Rural
Oct 2005
Shijiazhuang High School #2
High school sophomores
530
107
20.19
Urban
Oct 2005
Shijiazhuang University
19–22
511
137
26.81
Urban
1,536
411
26.76
Total
Improvement of anemia conditions in pilot counties and districts: Hemoglobin levels among Shijiazhuang women and children Number anemic
Anemia rate (percent)
Location
Year
Number of women
Zanhuang county
2004
401
192
47.88
2005
332
120
36.14
2004
400
147
36.75
2005
384
105
27.34
2004
801
339
42.32
2005
716
225
31.42
Chang-an district Shijiazhuang city
Improvement (percent)
24.52
25.61
25.76
Number of children 3–7
Number anemic
Anemia rate (percent)
100
22
22.00
100
14
14.00
98
12
12.24
100
10
10.00
198
34
17.17
200
24
12.00
Improvement (percent)
36.36
18.30
30.11
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Exhibit 2. Pilot Counties and Districts Promoting Iron Fortified Soy Sauce, Hebei Province
City Shijiazhuang
Baoding
County and district
Handan
Total
10
Total area (km2)
Number of township/ district committees
Number of village/ neighborhood committees
Chang-an district
40.0
110.2
3/8
35/85
Luquan city
36.0
603.0
13
208
Zanhuang county
23.0
1,210.0
11
212
New urban district
40.6
143.7
6/6
74/85
113.6
1,274.0
22/3
486/31
Li county
48.0
652.0
13
232
Libei district
51.2
120.0
2/9
38/109
Zunhua city
69.3
1,521.0
25/2
648/22
Qian-an city
71.8
1,208.0
19/1
534/10
Fengfeng mining district
50.2
353.0
9
148/68
Quzhou county
40.2
667.0
10
342
Jize county
24.7
339.6
10
165
172
3,534
Dingzhou city Tangshan
Population (in 10,000)
608.44
8,201.5
Exhibit 3. Overview of CDC Marketing Efforts, Hebei Province Forms
Frequency
Location distribution
Theme
Population coverage
Films projected in rural areas
69 times
Baoding, Luquan, Dinzhou, Li County
Scientific popularization
30,000
Street performances
11 times
Handan and Shijiazhuang supermarkets and communities
Knowledge about iron-fortified soy sauce
15,000
Expert consultations
9 times
Handan TV coverage of programs at parks and urban squares in Luquan, Dingzhou, Li County, and Baoding
Q&A on ironfortified soy sauce, consulting service, and promotion
250,000
Wall signs, posters, banners, window displays, leaflets, desk calendars
602 times
Communities and supermarkets in Shijiazhuang, Tangshan, and Handan
Knowledge about iron-fortified soy sauce
Close to 1 million
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Exhibit 3 (continued). Including campaign columns, wall signs, ceramic tiles, banners, window bulletins, exhibition boards, leaflets, flyers, and desk calendars. Number of publications
Date
Distribution
Location
Coverage
Wall maps
55,000 pieces
2005
55,000
12 demonstration counties and districts in Sjijiazhuang, Baoding, Tangshan, and Handan
1 million people
Leaflets
16,000 copies
2005
16,000
12 demonstration counties and districts in Sjijiazhuang, Baoding, Tangshan, and Handan
1 million people
Placards
4 sets
2005
4 sets
Plaques for shops
222 pieces
May–Oct 2005
222
Window displays
5 pieces
—
5 pieces
Forms
—
Urban areas of Shijiazhuang, Handan, and Tangshan
—
Supermarket in Shijiazhuang
—
Flyers
580,000 copies May–Oct 580,000 copies Urban and rural 2005 areas of Shijiazhuang, urban areas of Handan, urban areas of Tangshan
580,000 people
Health manuals for iron-fortifies soy sauce
100,000 copies
—
100,000 people
6,000
—
6,000
—
10,000 people
1,860 pieces
May–Oct 2005
1,860
Communities in Shijizhuang, Baoding, Handan, and Tangshan
650,000 people
Point-of-purchase posters
31,200
May–Oct 2005
31,200
Supermarkets in Tangshan, Handan, and Baoding
100,000 people
Advertisements on bus exteriors
60
—
60
Tangshan
600,000 people
375 pieces
Jun–Dec 2005
375 pieces
County and urban districts in Baoding and Shijiazhuang
700,000 people
40,000
Jul 2005
40,000
80
Aug 2005
80
460
Aug–Nov 2005
460
Wall calendars Scrolls
Display boards
Aprons Wall advertisements Advertisements on ceramic tiles
100,000 copies All the large hospitals in Shijiazhuang
Source: Chinese Center for Disease Control and Prevention.
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4 demonstration cities
Urban districts and counties in Tangshan Luquan city Demonstration counties of Shijiazhuang, Baoding, Tangshan, and Handan
40,000 150,000 500,000 people
Exhibit 4. Consumer Awareness of IDA Baseline survey results on the knowledge about iron nutrition
Survey location
Survey cases
% known of iron deficiency lead to anemia
2005
Shijiazhuang
400
46.12
16.24
0.20
2005
Tangshan
400
33.08
18.69
0.20
2005
Baoding
400
29.51
6.56
0.05
Survey date
% perception of being iron deficient
Cognitive level
Source: Chinese Center for Disease Control and Prevention.
1. Awareness rate among the target population at surveillance sites: The awareness rate of the people from Changan district and Zanhuang County in Shijiazhuang increased from 20% in 2004 to 80% in 2005, and to 70% in rural areas. By 2006, the awareness rates for the pilot counties of the Shijiazhuang, Baoding, Tangshan and Handan reached 90%, and 80% in rural areas. 2. Population coverage rate in project regions for iron fortified soy sauce: reached 72% in 2006 3. The number of Hebei people who have consumed iron fortified soy sauce: about 8.4 million in 2006
4. Consumption rate for iron fortified soy sauce in the project regions: 24% of the targeted population in Hebei’s four project cities. 5. Availability of iron fortified soy sauce at the sales outlets in project regions: 40% in 2006 6. Reduction in morbidity rate for iron deficiency anemia among the target population at the surveillance points Adult women in Shijiazhuang: Adult women in Baoding: Children in Shijiazhuang: Children in Baoding:
25.77% 26.47% 30.23% 14.91%
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Exhibit 5. Availability of Iron Fortified Soy Sauce in All Sales Outlets, Hebei Province Promotion of the coverage rate for outlets Year
Urban (percent)
Rural (percent)
2002
—
—
2003
—
—
2004
35.61
26.86
2005
47.81
37.17
2006
61.47
53.69
Source: Chinese Center for Disease Control and Prevention.
Exhibit 5 (continued). Retailers of Iron Fortified Soy Sauce in Hebei Cities, by Size Large supermarkets Urban Shijiazhuang Market share Urban Tangshan Market share Urban Baoding Market share Urban Handan Market share Total Market share
Medium supermarkets
2004
2005
2006
2004
2005
2006
2004
2005
2006
32
32
32
100
100
100
400
400
400
100%
100%
100%
100%
100%
100%
30%
50%
90%
10
10
10
70
70
70
500
500
500
100%
100%
100%
100%
100%
100%
50%
60%
70%
10
10
10
12
12
12
1300
1300
1300
100%
100%
100%
100%
100%
100%
15%
30%
40%
10
10
10
20
20
20
1100
1100
1100
100%
100%
100%
100%
100%
100%
40%
50%
60%
62
62
62
202
202
202
3300
3300
3300
100%
100%
100%
100%
100%
100%
Source: Chinese Center for Disease Control and Prevention.
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Smaller retail outlets
30.45% 43.63% 57.27%
Exhibit 6. Shijiazhuang Urban Resident Consumption of Iron Fortified Soy Sauce, 2006 Survey contents
Response numbers
Percentage
Stocks available
191
40.90
No stocks for sale
276
59.10
Intend to stock
14
5.00
Currently consuming
210
44.97
Not consuming
257
55.03
Prepare to consume
237
92.22
Not prepared to consume
20
77.88
Sales outlets in urban areas/Market share of iron fortified soy sauce Percentage of residents who have consumed iron fortified soy sauce
Source: Chinese Center for Disease Control and Prevention.
Exhibit 6 (continued). Selected Statistics on Shijiazhuang Sales of Iron Fortified Soy Sauce
Sales revenue (RMB 10,000)
Tons sold (in 10,000)
Increase over same period last year (%)
Number of consumers (in 10,000)
Increase over the same period (%)
Jun 2002– Apr 2004
221
0.100
—
—
—
Apr 2004– Oct 2004
66
0.030
—
36.52
—
Oct 2004– Apr 2005
708
0.320
1073
391.80
1073
Apr 2005– Oct 2005
1372
0.620
194
759.26
194
Oct 2005– Apr 2006
1483
0.670
108
820.70
108
Apr 2006– Oct 2006
1505
0.680
101
832.86
101
Total
5355
2.420
—
Year
—
—
Source: Chinese Center for Disease Control and Prevention.
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