1 Executive Summary

An extensive qualitative study among the FFP’s target audiences and intermediaries in twenty districts across Pakistan finds that the programme is having mixed success.

In a handful of locations, the market is evolving well, with consumer awareness raised and traders growing the supply of fortified wheat flour and ghee. In a minority of districts, the FFP has failed to gain traction thus far, with low consumer awareness and no knowledge of fortification amongst retailers. In the majority of areas surveyed there are signs that the FFP’s communication effects are building but the overall uptake of fortified foods is restricted by limited awareness, little or no supply and concerns about costs for the poorest households.

The potential for DFID’s investment in food fortification is high: problems of malnutrition are widely recognised, there is latent demand for fortified foods and little negative response from target audiences provided the cost is palatable. The FFP’s messaging is understood and generates a positive response, although it sometimes requires further translation into local languages or to be accessible to less literate audiences. There is very little rejection or suspicion of food fortification.

However, barriers identified in the research indicate that the FFP’s communication plan is failing to achieve its full potential. The efforts of LHW and their LHS and IRMNCH supervisors are the dominant driver of awareness, with little or no recall of other public-facing activities; where awareness has grown, consumers and traders widely believe that fortified products are not available in their community.

Best practice in development communications encourages programmes to go where the audience is. This explains why the LHW are successful, working within their local communities and going door to door; and why some of the FFP’s broadcast promotions are not achieving cut through due to, for example, placement on Cable TV rather than the more popular news channels (itself perhaps a result of the relative cost of cable versus news channels). The community outreach itself has limitations, partly due to the many pressures on LHW and partly due to the very small volume of materials provided in each district.

As the programme looks towards its next phase, recommendations for the evolution of the communication efforts focus on using popular new channels such as GEO, ARY and Express and the greater use of community networks; stronger engagement with trade associations and retailers to improve supply and raise awareness through these channels; and better sequencing so that fortified foods are readily available in a district before LHW promote them to consumers.

The aims of DFID’s Food Fortification Programme are practical but ambitious: to promote greater knowledge of fortified wheat flour and ghee, seed positive attitudes towards such products, and catalyse the purchase and use of fortified foods. The FFP’s communication activities is a key component of this work.

This large-scale qualitative study indicates that the potential for the FFP’s work to be successful is high: there is latent demand for fortified foods, little negative response from target audiences provided the cost is palatable, and an enthusiastic network of LHW who are willing to help catalyse demand. Elements of the communication programme are working in several districts but judging by the participants’ perceptions there is still much work to be done on raising awareness and improving the availability of fortified products.

The purpose of qualitative research is to inform and guide decision-makers rather than provide direct answers and recommendations. However, drawing upon the findings of this research and Accadian’s own experience in the design and delivery of development communication programmes in Pakistan and elsewhere, we can make clear suggestions that arise from the findings. These include:

1. Ensure that products are available within each District, and that both large and small retailers are engaged in their supply. Understand the shopping patterns of all consumers, and the extreme price sensitivity of the poorest and most vulnerable beneficiaries