9% Breastfeeding children age 6-23 months receiving an adequate diet4

28%Low-birth weight rate6

53% Women of reproductive age who are anaemic5

45%Vitamin A deficiency in children 6–59 months old7

20%Men whose body mass index (BMI) is below normal9

23% Women whose body mass index (BMI) is below normal8

22%Adults overweight10

5%Adults obese11

10% Total children age 6–23 months receiving an adequate diet3

1.3bnTotal population2

Advancing Nutrition by Improving the Consumption of Nutritious and Safe Food

The Malnutrition Challenge in India

With annual GDP growth rates nearing 7 percent and population of 1.3 billion, 65 percent of whom are younger than 35, India is among the fastest economies in the world. However, it will be difficult for India to sustain inclusive and sustainable growth, unless it equitably invests in an educated, healthy, and nutritionally secure population. Malnutrition is a serious public health problem in India. Nearly 40 percent of Indian children under 5 are stunted, over 50 percent of women are anaemic, and the share of overweight adults is now about the same as the share of underweight adults1. India faces multiple burdens of malnutrition, and poor-quality diets are at the heart of all of them.

Low income consumers suffer the most from the negative consequences of both undernutrition and overweight/

obesity. They often lack access to diverse diets and nutritious foods and they tend to consume too much of certain types of food – mostly starchy foods like rice and wheat, or ultra-processed foods, which are inexpensive and filling, but lack micronutrients such as vitamin A, iron, and zinc, essential for good health.

Working with partners, the Global Alliance for Improved Nutrition (GAIN) wants to make healthier food choices more affordable, more available, and more desirable.

We believe that this transformation is essential if we are to achieve the Sustainable Development Goals (SDGs) and end malnutrition in all its forms by 2030. Ending malnutrition is a collective responsibility. This strategy describes the choices GAIN has made to contribute to this goal working together with our partners. It will guide our efforts to support the Government of India, state governments and other nutrition stakeholders from civil society, business, and development partners as they work to build a healthy society.

GAIN’s Work in INDIA

Dashboard: Key nutrition challenges faced by India

1, 3, 4, 5 Government of India, National Family Health Survey–4, 2015–16: India Fact Sheet (Mumbai: International Institute for Population Sciences) http://rchi-ips.org/nfhs/pdf/NFHS4/India.pdf

2 World Bank 2016

6 Unicef global databases, October 2014, https://data.unicef.org/topic/nutri-tion/low-birthweight/

7–11 International Food Policy Research Institute, Global Nutrition Report 2016: From Promise to Impact: Ending Malnutrition by 2030 (Washington, DC, 2016).

May 2018

GAIN’s contribution

GAIN offers high quality know-how transforming make food systems to improve the consumption of nutritious and safe food for all people, especially those most vulnerable to malnutrition.

We are unique because of our focus on food systems and diet quality, our alliance-based approach to working, and our ability to engage critically and productively with the private sector.

We aim to support and advise the Government of India and state governments, businesses, and development partners as they build and mobilise food and nutrition plans to advance nutrition outcomes.

In this context, we work with governments, businesses and civil society stakeholders to:

• design and deliver food based policies and programs that improve the consumption of safe and nutritious foods

• be knowledge leaders in our field by measuring and analysing programs and policies related to improving the consumption of safe and nutritious foods

• help scale up programs with demonstrated benefits so they can achieve widespread impact

Our work to improve the consumption of safe and nutritious food is based on three strategic objectives:

• Increase consumer demand for safe and nutritious food • Increase accessibility of safe and nutritious food • Strengthen the enabling environment for designing,

implementing, and scaling up effective programs

These objectives are linked together: For sustainable change, consumers need to demand more nutritious foods from public and market sources. That demand needs to be met and expanded by businesses, governments, and civil society working together to increase the availability and affordability of safe and nutritious foods. Underpinning this must be an environment that supports the finding of solutions: it needs the policy, legislation, codes of conduct, accountability mechanisms, and data to support partnerships that can improve diet and advance nutritional status.

What we work on

To support these goals, GAIN and our partners in India undertake a range of programs within the food system. The graphic below shows where we work within the Indian food system to improve nutrition across the population.

Consumption &food utilization

Marketing & retail Distribution Processing Post-harvest

storage & loss Production

Large scale food fortification: national and multi-state

Production & distribution of nutritious fortified foods:Karnataka, Bihar & Rajasthan

Workplace nutrition initiatives: Tea industry in Tamil Nadu & Assam

Community management of acute malnutrition: Rajasthan

GAIN products and services in the food system

Creating a more enabling environment for increasing the consumption of safe, nutritious food

• Alliance building and strengthening between governments, business and civil society

• Developing innovative finance for improving consumption of safe nutritious food

• Tools development: impact, prioritization, accountability

• Knowledge mobilization

• New challenges and opprortunities in urban spaces

Making street foods in urban India safe and nutritious

How we work

Country focused. We are committed to directly supporting policies and actions at the national level, while ensuring that our programs prioritize those states that are grappling with the largest burdens of malnutrition.

Context driven. We consider the needs and preferences of the Government of India and state governments as the starting point in guiding our work. We assess the nutrition situation, examine what other stakeholders are doing, and we carefully identify areas where we can add value, working with others.

Alliance strengthening. We aim to build and work in alliances, because overcoming malnutrition in a sustainable way requires contributions from all corners of society.

Gender sensitive. We recognize that power asymmetries within the food system often run along gendered lines. For example, men tend to have better access to land, water, finance, information and decision-making. Our work is gender sensitive as well as responsive to other imbalances such as those related to wealth, ethnicity, caste, and geographic lines.

Critical engagement. We engage critically with all stakeholders, including businesses. We know there are controversies to be navigated and managed when working with businesses, but we believe that critical engagement is much better than no engagement.

Independence. We treasure our independent voice. Our work is evidence based. We have a wide set of donors. We have a strong governance structure with a diverse and independent Board of Directors and Partnership Council.

Skills. Our staff skillset is fit for purpose with technical experience in nutrition, food systems, business and programme delivery, monitoring and management.

Values. Our values are clear. Our work must have an impact, be ethical and sustainable in every sense, and show innovation when needed, while being open and collaborative.

Our recent and current partners in India include:

Partner Focus areas

Bill & Melinda Gates Foundation

Food fortification: edible oil, multi-state; DFS: Uttar Pradesh

Children’s Investment Fund Foundation

Community management of acute malnutrition; Food fortification: Rajasthan

Government of Netherlands, Unilever Tea & IDH Sustainable Trade Initiative

Improving dietary diversity and hygiene of tea workers in Assam & Tamil Nadu

Bestseller Foundation

Production of fortified blended foods (FBF) in Karnataka & Bihar

Tata Trusts Edible oil fortification: co-implementation in Rajasthan, Madhya Pradesh, Punjab, Haryana, Maharashtra, Gujarat, Andhra Pradesh, Telangana

Food Fortification Resource Center, Food Safety and Standards Authority of India (FSSAI)

Nodal resource within FSSAI for staple food fortification in India

Poshtik Network Network of development partners for policy advocacy and coordination on food fortification: UNICEF, WHO, World Bank, WFP,GAIN, PATH, FFI, CHAI, ICCIDD, NI

National & state implementing partnerships

National Health Mission, Rajasthan; ACF, IIHMR University, CECOEDECON, Vatsalya, Karnataka Health Promotion Trust, NIDAN, Karnataka Nutrition Mission, Bihar Rural Livelihoods Promotion Society (JEEViKA)

Our recent work in India

Large Scale Food Fortification Funded by the Bill & Melinda Gates Foundation since 2011, GAIN’s large scale food fortification projects in Rajasthan and Madhya Pradesh promoted the fortification of wheat flour, edible oil, milk, and lentils and reached large sections of the population, particularly the most vulnerable, through commercial channels and publically funded programs such as the Public Distribution System, the Integrated Child Development Services program, and the Mid-Day Meal program. These initiatives have had a ripple effect and several state governments, including West Bengal, Delhi, Haryana, Karnataka, and Jammu and Kashmir have initiated the process of mainstreaming fortified staple foods into publically funded distribution programs.

In partnership with the Tata Trusts, GAIN is currently implementing scale up of edible oil fortification across eight Indian States: Rajasthan, Gujarat, Maharashtra, Madhya Pradesh, Haryana, Punjab, Andhra Pradesh, and Telangana. In doing so, GAIN is providing technical input and working in collaboration with the Food Safety and Standards Authority of India (FSSAI) which has established a Food Fortification Resource Centre to convene the food industry, state governments and related central ministries to synergistically scale up fortification of staple foods nationally. With proposed funding from the Government of Netherlands, GAIN is now preparing an expansion of its fortification footprint to more states and additional foods.

Decentralized Production of Fortified Blended FoodFunded by the Bestseller Foundation, GAIN is facilitating the establishment and operationalization of four

production facilities to produce and distribute a quality assured fortified blended nutritious food product to approximately 70,000 targeted beneficiaries (children and pregnant and lactating mothers) in the states of Karnataka and Bihar. GAIN’s model for community owned production units that can be operated and managed independently by women’s groups is a sustainable and cost-effective solution. The food production is undertaken as an industrial, quality-assured process, that is easy to monitor and replicate.

Promoting Diverse Diet and Hygiene in Tea Supply ChainWith funding from the Government of Netherlands, Unilever Tea and IDH Sustainable Trade Initiative, GAIN is reaching out to 37,500 small scale farmers and workers in the tea supply chains in Assam and Tamil Nadu through the ‘Seeds of Prosperity’ program. The purpose of this program is to to build awareness of the health benefits of diverse diets and proper hand washing and to improve access to nutritious food.

Community Based Management of Acute Malnutrition (CMAM): POSHAN Funded by the Children’s Investment Fund Foundation and Bestseller Foundation, POSHAN (Positive and Optimum care of children through a Social Household Approach for Nutrition) is a project that implements community-based management of acute malnutrition in Rajasthan. Led by the National Health Mission, Government of Rajasthan, and supported by development partners GAIN, Action Contre la Faim and UNICEF, POSHAN has been implemented in 13 districts, through 41 developmental blocks, 584 sub-centers and 1,574 villages. The project successfully concluded its Phase I with high recovery rates for children affected by severe

acute malnutrition (97.4 percent) it will scale up in 20 districts in Rajasthan, through 50 development blocks, 1,000 health sub-centers and 3,000 villages in 2017.

Double Fortified Salt Evaluation StudyFunded by the Bill & Melinda Gates Foundation, GAIN conducted a cross-sectional state-wide survey to examine nutritional indicators and their determinants in preschool-aged children and women of reproductive age in Uttar Pradesh. Simultaneously, this survey will serve as a baseline to a double fortified salt program in the state.

What does success look like for our work?

Our work will be successful if it can: 1) increase the quality of people’s

diets in a sustainable way;2) increase the number of people

consuming adequately fortified foods;

3) increase the affordability of safe, nutritious foods; and

4) promote country policy, legislative, and accountability frameworks that bring about more effective partnerships focused on improving nutrition

GiveWell and The Life You Can Save recommend GAIN and its salt iodization efforts as a standout program

Join us in the fight against malnutrition! www.gainhealth.org

info@gainhealth.org@GAINalliance www.facebook.com/GAINallianceGlobal Alliance for Improved Nutrition