DSM-WFP: A Partnership to Advance the Global Nutrition AgendaKanika Bahl, Shubha Jayaram and Benjamin Brown

Results for Development Institute

December 2014

Results for Development Institute (R4D) is a non-profit organization whose

mission is to unlock solutions to tough development challenges that prevent

people in low- and middle-income countries from realizing their full potential.

Using multiple approaches in multiple sectors, including Global Education,

Global Health, Governance and Market Dynamics, R4D supports the discovery

and implementation of new ideas for reducing poverty and improving lives

around the world.

For more information, please contact Shubha Jayaram (sjayaram@r4d.org)

Copyright ©2015

Results for Development Institute1100 15th Street, N.W., Suite #400, Washington, DC 20005

AcknowledgementsThe authors would like to thank Maddie Cleland, Jessica Johnston, and Leith

Greenslade from MDG Health Alliance for their collaboration. Their support

and insightful comments helped to strengthen and shape the report. The

authors would also like to acknowledge the strong support of the DSM-

WFP “Improving Nutrition, Improving Lives” partnership team as well as

senior leaders at both organizations, including Klaus Kraemer, Saskia de Pee,

Anthony Hehir, Georg Kau, Eva Monterrosa, Elizabeth Silvestri, and Alba Tiley.

We also appreciate the generous time and candid insights offered by all our

interviewees. Lastly, the authors thank R4D colleagues Cammie Lee, Leif

Redmond, and Thayer Rosenberg for their analytics, communications, and

research support.

About the authors: Kanika Bahl is a Managing Director at R4D and leads the

Market Dynamics Practice. Shubha Jayaram is a Senior Program Officer and

Benjamin Brown is a Senior Program Associate at R4D.

Cover Picture Credit: Simon Recker Photography, South Africa.

i

Table of Contents

List of Acronyms ii

Executive Summary 1

I. Introduction and methodology 3

II. The nutrition landscape 4

III. The DSM-WFP partnership: a brief background 7

IV. Key characteristics of the DSM-WFP partnership 10

V. Micronutrient Powder (MNP), Super Cereal, and Super Cereal Plus (SC / SC+): product characteristics and programming objectives 13

VI. Lessons from the MNP and Super Cereal experience 20

VII. Advancing the global nutrition agenda 25

VIII. Looking ahead 27

References 29

Annexes 32

Annex I: List of interviewees 32

Annex II: Illustrative list of programs and products developed

by the DSM-WFP partnership 33

Annex III: List of volunteer and secondment placements 35

Annex IV: Joint Sight and Life-WFP publications 36

ii

Acronyms

PLHIV People Living with HIV

PLW Pregnant and Lactating Women

PPP Public-Private Partnership

RUFs Ready-to-Use Foods

RUSF Ready-to-Use Supplementary Food

RNI Recommended Nutrient Intake

R4D Results for Development Institute

RSB Rice Soya Blend

DSM Royal DSM

SUN Scaling Up Nutrition

SNF Specialized Nutritious Food

SC Super Cereal

SC+ Super Cereal Plus

UN United Nations

UNICEF United Nations Children’s Fund

UNHCR United Nations High

Commissioner on Refugees

UNIDO United Nations Industrial

Development Organization

WFP United Nations World Food Programme

USAID United States Agency for

International Development

USDA United States Department of Agriculture

WSB Wheat Soya Blend

WHA World Health Assembly

WHO World Health Organization

ART Antiretroviral Therapy

AMDA Association of Medical Doctors of Asia

B2B Business-to-business

CoP Community of Practice

CPG Consumer Packaged Goods

CSB Corn Soya Blend

DOT Directly Observed Treatment

FBF Fortified Blended Food

GAIN Global Alliance for Improved Nutrition

HF-TAG Global Technical Advisory Group

for Home Fortification

HEB High Energy Biscuit

IYCN Infant and Young Child Nutrition (IYCN)

IBFAN International Baby Food Action Network

ICDDR, B International Centre for Diarrhoeal

Disease Research, Bangladesh

IDA Iron Deficiency Anemia

JHSPH John Hopkins Bloomberg

School of Public Health

LNS Lipid-based Nutrient Supplement

MNT Maternal and Neonatal Tetanus

MoU Memorandum of Understanding

MT Metric Tons

MNP Micronutrient Powder

MDG Millennium Development Goal

MDGHA Millennium Development Goals Health Alliance

MAM Moderate Acute Malnutrition

NGO Non-Governmental Organization

DSM-WFP: A Partnership to Advance the Global Nutrition Agenda 1

Executive Summary

Malnutrition in all of its forms is a global challenge.

Approximately two billion people are deficient in one or

more micronutrients, 1.5 billion people are overweight, and

over 500 million people are obese.1 Unfortunately, children

are particularly at risk of undernutrition, which is the single

biggest cause of under-5 mortality and underlies nearly

half of all child deaths.2 Worldwide, 26% of under-fives are

stunted,3 the consequences of which are irreversible and

affects their health, schooling, income earning potential

as adults, and increases their risk of non-communicable

disease later in life.

Innovative mechanisms and partnerships are needed to

tackle this enormous burden, and there is an increasing

recognition of the role that the private sector can play. The

Scaling Up Nutrition (SUN) Movement, created in 2010,

galvanized the nutrition community and played a key role

in connecting public and private stakeholders in efforts to

address malnutrition. However, while private companies

are slowly engaging with the health and nutrition sector,

lessons learned from Public-Private Partnerships (PPPs)

have not been well-documented.

Results for Development Institute (R4D) – with support

from the MDG Health Alliance (MDGHA) – has undertaken

an external review of the activities and outcomes of one

such partnership, the collaboration between Royal DSM

(DSM)4 and the United Nations World Food Programme

(WFP), to shed light on key lessons that are relevant for other

PPPs operating in this space. Through interviews with 20

stakeholders and peer-reviewed literature analysis, this review

examines the partnership’s impact at both the micro and

macro levels and sheds light on key lessons that are relevant

for other PPPs. In particular, two product and programming

initiatives are studied, namely Micronutrient Powder (MNP)

and Super Cereal / Super Cereal Plus (SC / SC+).

The DSM-WFP “Improving Nutrition, Improving Lives”

partnership has been underway since 2007, with

the objective to improve the nutritional intake of key

demographics served by WFP programs, specifically

children under five years of age and pregnant and lactating

women. In 2013, WFP, enabled by the partnership, reached

20.6 million people with improved food products, and is on

track to reach 25-30 million annually by the end of 2015.

Each partner brings its core strengths to the partnership:

DSM provides its scientific and technical expertise,

products, and financial assistance, while WFP contributes

its beneficiary insight, local stakeholder connections,

food value chain knowledge, and large food distribution

network through its country offices. The collaboration

has been structured over a series of three Memorandums

of Understanding (MoUs), with each progressive MoU

becoming more strategic and far-reaching.

Four fundamental characteristics of the partnership’s

institutional structure have proven critical to its success and

offer valuable lessons to other PPPs. First, the partnership

was jointly initiated, with a clear objective established from

the outset. Based on their “complementary competencies”,5

the two organizations designed common goals that

focused on improving the nutritional status of WFP

beneficiaries and raising awareness on the importance of

adequate nutrition, in particular micronutrients. Second,

the partnership has focused on generating high levels of

employee engagement through volunteer assignments or

secondee placements of DSM staff at WFP offices. This has

motivated employees from both organizations and raised

awareness of the partnership, leading to further buy-in and

closer ties between DSM and WFP. Third, DSM’s business-

to-business (B2B) approach has negated the need to

negotiate co-branding, sponsorship, and cause marketing

agreements, allowing for a smoother labeling process and

marketing campaign and minimizing some of the intrinsic

sources of tension that may be present in other PPPs. Lastly,

both partners have publically committed to a separation

between the philanthropic partnership and corporate

business interests. This firewall strengthens the partnership’s

credibility and has allowed it to jointly and effectively

advocate for improvements in the nutrition agenda.

Leveraging the respective strengths of each organization

has allowed the partnership to innovate along a number

of dimensions, as illustrated by the MNP and Super

Cereal / Super Cereal Plus programs. Qualitative program

evaluations and beneficiary assessments have led to

improvements in MNP packaging to increase its acceptance

among beneficiaries. Specifically, WFP has moved towards a

1 International Food Policy Research Institute. 2014. 2 WHO, 2014b. 3 UNICEF, 20134 A private “science-based company” working in the life sciences and materials science fields. DSM is headquartered in the Netherlands but operates glob-

ally. 5 Society for International Development. Netherlands Chapter, 2012.

2

uniform global design for MNP sachets, while the boxes are

now designed by local artists who consider the context and

culture of end users. The collaboration has also led to new

product specifications, with DSM using the insight of WFP

country offices to test and pilot new formulations based

on the varying needs and circumstances of beneficiaries.

For instance, WFP and DSM tested different supplementary

food formulations for the treatment of moderate acute

malnutrition, leading to the adoption of the partnership’s

Super Cereal / Super Cereal Plus specifications as global

guidelines and a shift in UNICEF procurement from UNIMIX

to Super Cereal products. Additionally, the DSM-WFP model

has allowed for effective advocacy from both a top-down

and bottom-up approach. Supporting and championing

global forums, such as the 2014 Micronutrient Forum Global

Conference in Ethiopia, and participating in international

advocacy events has raised the broader awareness base.

Meanwhile, WFP country offices have built national

influence through implementing pilots and fostering

relationships with local stakeholders.

Both organizations have also evolved as a result of the

joint learning and collaboration garnered through the

partnership. DSM has supported WFP as it effectively

transitioned from a food delivery organization to one

with a focus on nutritional quality and impact by offering

technical guidance. Meanwhile, DSM has increased its

influence in the nutrition space and is seen by external

stakeholders in this sector as a credible partner.

The experience of the partnership has revealed

opportunities for further improvements that are also

applicable to other PPPs, both those wanting to enter

the nutrition sector and those already in this space and

seeking to improve their effectiveness. Most crucially,

the importance of strong metrics to measure impact and

influence cannot be understated. While the DSM-WFP

partnership has clear targets for its most recent MoU

periods, there is scope for both DSM and WFP to not only

aim to achieve their respective organizational objectives,

but also enhance and improve the service delivery of

its joint large-scale nutrition interventions. Emphasis

from both sides could shift toward improving existing

monitoring and assessment tools for program design and

implementation in order to more accurately determine

if beneficiaries are receiving the right nutrition, given

their context and underlying condition. There is also an

opportunity to further improve systems to institutionalize

and share knowledge, both within the partnership as

well as with external stakeholders. For instance, a virtual

Community of Practice (CoP) could be created to increase

communication between the WFP headquarters and

regional and country offices to share more information on

pilot selections and foster productive dialogue between

country offices that are implementing similar programs.

This would enable staff to better communicate and to

share experiences for greater impact. An external-facing

component of such an initiative would also allow the wider

nutrition community to better understand the partnership’s

work and expand the evidence base for PPPs.

The DSM-WFP collaboration has not only led to growth

at each organization, but has shaped the global nutrition

agenda. The partnership played a key role in the formation

of the SUN Movement’s Business Network and the Home

Fortification Technical Advisory Group (HF-TAG), and has

forged connections with nutrition stakeholders to push

forward nutrition awareness. It has also been instrumental to

large-scale interventions at the country level as well as shifts

in global guidelines for products such as SC and SC+.

PPPs that effectively leverage the strengths of each

organization can foster new ideas and allow for

tremendous improvements in the nutrition agenda.

Therefore, PPPs can play a critical role in tackling

malnutrition, increasing the chance of survival and the

possibility of a healthier, more productive life. It is hoped

that this study not only facilitates new and emerging PPPs,

but also allows existing partnerships – including DSM-WFP

– to strengthen their role and impact.

DSM-WFP: A Partnership to Advance the Global Nutrition Agenda 3

I. Introduction and methodology

The purpose of this report is to provide an external review

of the Royal DSM (DSM) and the United Nations World

Food Programme (WFP) ongoing partnership that began in

2007 and its activities and outcomes. The study highlights

the partnership’s impact and effectiveness in improving

nutrition for children and mothers globally. Additionally, it

explores how the partnership’s efforts in two key product

areas – Micronutrient Powder (MNPs) and Super Cereal

/ Super Cereal Plus (SC / SC+) – have contributed to

progress in the broader nutrition ecosystem.

The case study utilizes in-depth primary and secondary

research, including interviews with 20 selected

stakeholders and peer-reviewed literature to synthesize

and examine the DSM-WFP partnership’s experiences,

including the development, piloting, and roll-out of the

MNP and Super Cereal / Super Cereal Plus programs.

In addition to senior leadership at both organizations,

the perspectives and opinions of leading bilateral and

multilateral donors, academic institutions, and senior

nutrition specialists informed the development of this

report. A full list of stakeholders interviewed can be found

in Annex I. Concurrently, a thorough review of internal

partnership documents and related nutrition literature

was conducted. A full reference list can be found at the

conclusion of the report. Although this is not an impact

evaluation and no site visits were conducted, these

interviews and literature analysis helped capture how the

partnership’s institutional and programmatic approaches

have evolved, and how key lessons could be applied to

other nutrition PPPs.

This report was executed by Results for Development

(R4D), a Washington, DC-based non-profit organization,

with the strong support of the MDG Health Alliance

(MDGHA). R4D develops strategies and policies that unlock

solutions to tough development challenges that prevent

people in low- and middle-income countries from realizing

their full potential. The Market Dynamics team at R4D

focuses on increasing global access to high-quality and

affordable life-saving products for the poor, and has more

than three decades of collective experience working with

stakeholders across the global value chain.

4

II. The nutrition landscape

Malnutrition is a global challenge that encompasses

undernutrition, obesity, and micronutrient deficiency.

Two billion people are estimated to be deficient in one or

more micronutrients, essential nutrients that are crucial to

an individual’s health and development. An estimated 161

million children under the age of five (26%) are stunted

with low height for their age,6 nearly 1.5 billion people are

estimated to be overweight, and over 500 million to be

obese. These conditions all have severe consequences

for survival, morbidity, and the ability of individuals, the

economy, and society to thrive.7

However, globally and locally, nutrition is chronically

underfunded relative to other public health interventions

(Figure 1). In 2011, nutrition represented just over 2% of

official development assistance commitments to health,

including population and reproductive health programs.8

This is despite significant evidence suggesting that

improving nutrition is one of the best investments for

promoting health and alleviating poverty. Recent research

has established that a low-cost integrated package of

nutrition interventions could reduce undernutrition by 20%

and, on average, increase incomes by 11% every year in

countries with high prevalence of stunting.9 At the third

Copenhagen Consensus in 2012, an Expert Panel identified

these interventions as the most cost effective way to

address the challenges related to undernutrition.10

The global health community is now at a critical

inflection point in the run-up to the post-2015 agenda

(the Sustainable Development Goals), with donors,

governments, and the private sector focused on using

Figure 1: Official development assistance commitments, in millions USD

6 WHO, 20137 International Food Policy Research Institute, 2014. 8 OECD, 2013. Estimate derived based on dividing basic nutrition spending (CRS Code 12240, $444 million in 2011) over the sum of Total Health spending

($9.3 billion in 2011, DAC Code 120) and spending on Population Policies/Programmes and Reproductive Health ($10.3 billion in 2011, DAC Code 130).9 Alderman, Harold and Hoddinott, John, 2014. 10 Copenhagen Consensus Center website.

Other Health

Pop. & Repro. HealthIncluding HIV/AIDS

Basic Nutrition

2008

9,671

8,271

259

$18,201

2009

10,043

$20,105

2010

9,463

405

2011

10,283

444

9,515 9,148 8,900

547

$19,016$19,627

Year

DSM-WFP: A Partnership to Advance the Global Nutrition Agenda 5

the momentum built by the Lancet Nutrition Series,11 the

Scaling Up Nutrition (SUN)12 Movement, and the Nutrition

for Growth Summit in London in 2013 to significantly

expand nutrition interventions. These efforts aim to

address the critical gap that exists between current funding

levels and required actions to implement and scale up

proven, highly effective nutrition solutions. The World

Health Assembly (WHA) recognized the need to accelerate

global action and endorsed a set of six global nutrition

targets for 2010-2025 to improve maternal, infant, and

young child nutrition:13

• Reduce by 40% the number of children under 5 who

are stunted

• Reduce by 50% the rate of anemia in women of

reproductive age

• Reduce by 30% the rate of infants born low birth weight

• Ensure that there is no increase in the rate of children

who are overweight

• Increase to at least 50% the rate of exclusive

breastfeeding in the first six months

• Reduce and maintain childhood wasting to less than 5%

The private sector has significant potential to contribute to

this effort. However, historically, constructive engagement

has been hindered by a legacy of mistrust between the

nutrition community and private companies. In the 1970’s,

dozens of stories emerged about ethically questionable

marketing tactics by infant-formula and breast milk

substitute companies in developing countries, causing

a deepening rift to emerge between NGOs and these

transnational companies and arousing the attention of

the international community. In 1981, in response to the

aggressive advertising practices of the private sector,

the World Health Organization (WHO) developed the

International Code of Marketing of Breast-milk Substitutes

(‘the Code’). The Code specifies the appropriate marketing

practices of substitute feeding products for infants to ensure

that mothers are not discouraged from breastfeeding and

that substitutes are used safely, if needed.

However, despite the Code being in place for nearly

thirty years, a 2010 report by the International Baby Food

Action Network’s (IBFAN) identified various violations by

companies promoting substitute feeding products over

breast milk.14 The backlash from breast milk advocates

and activists has been widespread and public. Against this

backdrop, companies have been wary to play a meaningful

role in serving children within low- and middle-income

customer segments of developing countries with nutrition

and food products, particularly children 6-23 months old,

a space which can be seen to potentially ‘compete’ with

breastfeeding.

Although there is still mistrust among some activists,

NGOs, and governments related to breast milk substitutes

and the marketing approaches of food companies, as

well as the feeling that the food industry is responsible

to a large extent for the obesity epidemic around the

world, there remains widespread understanding that the

fight against global malnutrition is vast and cannot be

won without leveraging the strengths and capabilities

of the private sector. The global nutrition community

has increasingly begun to embrace the need for more

effective coordination, active participation, and financial

commitments across all sectors and levels of the

marketplace in order to sustain momentum and translate

these global efforts into results in high-burden countries.

As a result, there is now an expanding focus on supporting

the development of PPPs to tackle global nutrition

challenges, with significant benefits resulting from such

collaboration (Figure 2).

Increasingly, donor policies and scale-up efforts for

nutrition interventions are shifting toward giving the private

sector a more substantial role in promoting a healthy

diet and the human right to food security. Most notably,

the Global Alliance for Improved Nutrition (GAIN) and

the SUN Movement are leveraging the scale, expertise,

reach, and financial resources of the private sector to

enhance nutrition activities globally. GAIN was founded in

2002 as an international alliance between governments,

international NGO and private-sector stakeholders to

reduce malnutrition through sustainable market-based

strategies.15 Similarly, the SUN Movement, which brings

Historically, constructive

engagement has been hindered

by a legacy of mistrust between

the nutrition community

and private companies.

11 Maternal and Child Undernutrition, 2008. 12 Scaling Up Nutrition website13 WHO, 2014c. 14 IBFAN International Code Documentation Center (ICDC), 2011.15 GAIN website.

6

together countries, donors, businesses, civil society

organizations, and UN agencies, has stimulated investment

and reinforced political interest in improving infant and

young child nutrition (IYCN).16

The achievements of both of these efforts over the past

decade in food fortification; maternal, infant, and young

child feeding; and agriculture and nutrition, have spurred

the entry of several more successful PPPs in nutrition.

Although there continue to be challenges in such public/

private sector collaborations, DSM and WFP realized

they have a shared responsibility to provide vulnerable

populations, in particular children 6-59 months and

Figure 2: Overview of benefits and opportunities of PPPs in nutrition17

• Raising the visibility of nutrition and health on policy agendas

• Mobilizing funds and advocating for research

• Strengthening health-policy and food-system processes and delivery systems

• Facilitating technology transfer

• Establishing treatment protocol standards

• Expanding target populations’ access to free or reduced-cost medications, vaccines, healthy food and beverage products

• Distributing ‘essential packages’ of nutrition assistance during humanitarian crises

pregnant and lactating mothers, with increased access to

nutritious complementary food products and services. As

a result of this shared goal, the partnership was launched

in 2007 to leverage the logistics, reach, and food delivery

expertise of a global organization that reaches the most

vulnerable, WFP, with the industry expertise of a global

science company, DSM. The collaboration continues

to prioritize increasing the nutritional intake of WFP

beneficiaries, while partnering around advocacy, nutrition

value chains, technical and scientific research, and

fortification of special nutritious foods as well as staple

foods. The remainder of the report focuses on the lessons

learned from the partnership’s work since its inception.

16 Scaling Up Nutrition (www.scalingupnutrition.org) 17 Kraak, Vivica I, 2012.

DSM-WFP: A Partnership to Advance the Global Nutrition Agenda 7

III. The DSM-WFP partnership: a brief background

In an attempt to counter the global malnutrition burden and

stark micronutrient deficiencies – roughly two billion people

are deficient in one or more micronutrients,18 with nearly

half of all under-5 child deaths due to malnutrition19 – DSM

and WFP initiated the “Improving Nutrition, Improving Lives”

partnership in April 2007. DSM, founded in 1902, is a global

science-based company that focuses on nutrition, health

and materials. It is the world’s leading supplier of a range

of nutritional ingredients, including vitamins, premixes, and

other nutritional solutions for children and women’s health.

It entered this market segment through an acquisition of

Roche’s vitamins division in 2003, and currently employs

about 24,500 people worldwide. Meanwhile, WFP was

established in 1961 as the food aid component of the UN.

It focuses on fighting hunger and nutritional deficiencies

around the world, providing various forms of food

assistance and supporting food security and nutrition

initiatives, particularly in developing countries. In 2013, WFP

reached 80.9 million beneficiaries in 75 different countries

across the globe.

The DSM-WFP “Improving Nutrition, Improving Lives”

partnership was created to further improve the nutritional

status of key populations served by WFP programs,

including children under five years of age and pregnant

and lactating women. The joint overarching goal was to

increase the amount of micronutrients and overall quality of

WFP’s existing food products, as well as to raise awareness

among policymakers around the importance of nutrition,

including micronutrients. In 2013, WFP reached about 20.6

million people with improved food products, and aims to

reach 25-30 million people per year by the end of 2015.

The geographic scope is broad, with programmatic work

reaching countries in Latin America, South Asia, Southeast

Asia, the Middle East, and sub-Saharan Africa.

DSM provides scientific and technical expertise, in-kind

products, and financial assistance to the partnership.

Importantly, the partnership has leveraged the company’s

decades of technical expertise to improve the quality of

WFP food supplies through innovative, tailor-made food

fortification interventions. In return, the collaboration

has given DSM insight into beneficiary needs in different

countries and has helped it to innovate around products

and strategies, fostering future growth. Additionally, DSM

has also used the partnership as a vehicle to encourage

employee engagement and development.

Meanwhile, WFP contributes its beneficiary insight, local

stakeholder connections, food value chain knowledge,

and large food distribution network through its country

offices. WFP has a deep understanding of local cultures

and needs, and the partnership has been able to capitalize

on its trusted brand and governmental and civil society

relationships. As a result, WFP has further expanded its

experience with fortified food commodities and has

secured additional funding for piloting interventions. The

partnership has supported WFP’s strategic objectives to

further save lives and livelihoods in emergencies, and

support food and nutrition access in fragile settings. The

collaboration has not only helped WFP deliver higher

quality food, but has enabled it to “provide the best

quality foods to fight hunger and prevent micronutrient

deficiencies in vulnerable communities.”20 WFP capacity

has been increased by DSM specialist and generalist

volunteers working on projects including the “Cost of the

Diet” and cash and vouchers for food.21

Photo 1: Example of WFP food basket containing

cereal flour/rice/bulgar, pulses, Vitamin A fortified oil,

fortified food blends, sugar, iodized salt. (Source: WFP)

18 International Food Policy Research Institute, 2014. 19 WHO, 2014b. 20 WFP, 2014. 21 The Cost of the Diet (CoD) tool measures the minimum cost of a nutritious diet, which is theoretically possible to consume. Meanwhile, WFP is increas-

ingly using cash and vouchers to deliver nutrition assistance, and expects a third of its programs to use cash, vouchers and “digital food” by 2015. For more details: www.wfp.org

8

Box 1: Project Laser Beam. (Source: Project Laser Beam Final Report, September 2014)

A five-year, multi-million dollar PPP, the aim of Project

Laser Beam was to create a scalable, replicable and

sustainable program model to significantly reduce child

undernutrition, contributing to the achievement of the

first Millennium Development Goal (MDG) of eradicating

poverty and hunger. The project implemented 18

interventions in Bangladesh and Indonesia, and

prioritized food, hygiene, and behavioral change. Work

included fortification of food and development of ready-

to-use-foods, increasing access to water and sanitation,

improving health and hygiene and enhancing livelihoods.

By the project’s conclusion in 2014, the initiative had

reached 2.48 million people in Bangladesh and 424,000

people in Indonesia.

Vision and missionThe DSM-WFP partnership initially revolved around two

key “initiatives”. The first initiative, nutrition engagement,

was part of an overall goal to increase the micronutrients

available in the ration of WFP products delivered to

beneficiaries, namely its ‘food basket’ (Photo 1). This

initiative involved driving global dialogue on how to add

micronutrients, assisting with large-scale implementation

of distribution of new micronutrient-fortified products,

testing the efficacy of food products, communicating

to stakeholders and beneficiaries, and translating the

science behind this initiative into accessible language

to communicate with a larger audience. DSM’s financial

assistance, coupled with the organization’s expertise in

food technology, research, and food packaging, aided in

the development or improvement of many of the products

launched since 2007, such as Micronutrient Powder

(MNP) and Super Cereal / Super Cereal Plus (SC / SC+).

Both products will be discussed further in Section V. In

addition, the partnership has made tremendous progress

in maximizing nutrient content in WFP’s food basket and

scaling products such as Lipid-based Nutrient Supplements

(LNS) and Ready-to-Use Foods (RUFs).22

The second initiative focused on employee engagement

by setting a joint objective to increase awareness within

both organizations around hunger and malnutrition.

DSM was eager to generate employee enthusiasm and

showcase its commitment to sustainable development.

Employees were provided the opportunity to directly

support WFP programs and activities through in-country

generalist volunteer placements as well as secondments

that leveraged their technical knowledge. These became

a featured professional development opportunity among

DSM employees, and, as a result, many have lent their

time to WFP projects in countries such as Guatemala,

Zambia, Kenya, and Bangladesh.23 Meanwhile, employee

engagement also generates additional funds for WFP

programs through DSM participation in initiatives such as

the WFP Walk the World campaign.

History and evolution of the partnershipSince 2007, the partnership has continued to build and

strengthen its relationship through a series of ongoing

3-year MoUs. The strategic nature of the collaboration

has evolved from developing nutrition concepts (MoU-1)

and testing and scaling products (MoU-2) to focusing now

on long-term sustainability and mechanisms to increase

the partnership’s engagement and leverage with new

stakeholders (MoU-3). The collaboration has sought to

be known as the “go-to” partnership in nutrition, and is

increasingly focused on dissemination and awareness-

raising aspects.24 More focus is now being paid to

communication efforts and engaging new stakeholders;

additionally, a ‘Nutrition Academy’ is being developed

that will boost the nutrition capacity of WFP staff. The

Academy will reach over 3,000 program-level staff at

WFP and includes lesson plans and modules on nutrition,

with classroom training be complemented by an online

platform. The Academy will not only build staff skills and

contribute to the global evidence base, but will position

DSM-WFP as a knowledge-leader in nutrition advocacy. A

description of the activities and achievements under each

MoU follows in Table 1.

The DSM-WFP partnership also works closely with other

partners, including UNICEF, World Vision International,

GAIN, and the Clinton Health Access Initiative. The two

organizations have leveraged their respective technical,

service delivery, and implementation competencies to

test and pilot new interventions, with the ultimate aim

to mainstream successful interventions within WFP to

reach more beneficiaries. The partnership has also been

able to collaborate with other nutrition stakeholders on

new initiatives, such as Project Laser Beam (Box 1). Annex

I provides an illustrative list of the partnership’s major

products and initiatives.

22 DSM-WFP Steering Committee, 2012.23 DSM, 2014.24 DSM-WFP Steering Committee, 2013.

DSM-WFP: A Partnership to Advance the Global Nutrition Agenda 9

Table 1: Evolution of MoUs

Period 1: April 2007-March 2010

Period 2: March 2010-Jan 2013

Period 3: Jan 2013-Dec 2015

Objectives

Two broad initiatives: (1) Nutrition enhancement of WFP foods delivered to beneficiaries; (2) Employee engagement and awareness around issues of hunger and malnutrition (this was also a part of MoU 2 and 3)

(1) Test and scale the use of new and improved products in developing countries, including those produced under MoU 1; (2) Jointly raise awareness globally among policymakers

(1) Creation of new and improved nutritional products; (2) Further geographic expansion of the partnership; (3) Engagement of new stakeholders and funding streams and alignment with nutrition players (e.g. SUN and the 1,000 Days Partnership); (4) Increase in number of beneficiaries reached.

Targets

• Test and pilot new or modified micronutrient-products, and confirm efficacy through scientific tests

• Reach 80% of all beneficiaries with improved nutrition.

• Double the number of people who benefit from improved nutrition to 25-30 million per year by 2015.

• Reach 100% of WFP’s most vulnerable beneficiaries with improved nutrition.

• Position the partnership as the go-to partnership on nutrition

Key activities

• MNPs were developed and piloted in Nepal, Kenya, Indonesia, Philippines, and Bangladesh.

• Global Technical Advisory Group for Home Fortification (HF-TAG) was established, and formulations of the MNPs were developed for both non-malaria and malaria-endemic areas.

• Aimed to develop a sustainable business model for rice fortification in Asia.

• MNPs were further tested and scaled, with attention paid to cost-effectiveness

• Products such as Lipid-based nutrient supplements (LNS) and ready-to-use supplementary foods (RUSF) were further adapted and tested for specific contexts.

• Super Cereal and Super Cereal Plus were improved due to new commodity and premix specifications

• Action plan developed for nutrition in emergencies based on lessons learned from programs in Haiti, Pakistan and Niger.

• High-level nutrition advocacy events hosted in Davos, Brussels and Tokyo

MoU is ongoing, and key workstreams are:

• Thought leadership, communications, and nutrition fundraising to build further capacity on the WFP side.

• Nutrition Academy to build WFP staff skills

• MNP scale-up to reach 3 million young and school-age children.

• Rice fortification scale-up, and supporting its emergence as a default commodity for governments, WFP interventions, NGOs, industry, and consumers.

• Product development, improvement and efficacy/effectiveness, quality assurance.

Budget

€5.25 million over three years, of which, €1.5 million in cash, €2.25 million in-kind (product), and €1.5 million through services.

€6.25 million over three years, as well as $1million specifically for rice fortification.

€6.25 million over three years.

Other highlights

2008: DSM and WFP won ICIS Business Innovation Award (2008) for MixMe™ micronutrient powder.

2010: DSM received a World Business and Development Award at the UN Millennium Development Goals Summit for its commitment as part of the partnership

2010: DSM’s CEO, Feike Sijbesma received the 2010 Humanitarian of the Year Award from the United Nations Association of New York in recognition of the partnership

2013: Approx. US$5 million grant received from the Dutch Embassy in Bangladesh for the Bangladesh rice fortification project in 2013

10

IV. Key characteristics of the DSM-WFP partnership

The DSM-WFP partnership’s continued strength, defined

by its relatively flexible and expansive modality, is a sign

of the close institutional relationship that has formed

between the two organizations since 2007. A combination

of the partnership’s deliberately designed structure as

well as some intrinsic features of each organization have

contributed to its strengths over the years. Four key

partnership characteristics that may offer valuable lessons

to other PPPs are described below:

(a) Alignment on goals, supported by well-designed institutional structures for joint ownership. The DSM-WFP partnership was jointly initiated, with an

overarching vision to develop and provide improved

nutritious food interventions for the poor. Based on the

individual strengths or “complementary competencies”25

of the two organizations, common goals were designed

that focused on improving the nutritional status of WFP

beneficiaries and raising awareness on the importance of

micronutrients. Strategic objectives for each MoU period

were clearly defined, with each subsequent period building

on the knowledge gained in the last. The first MoU laid the

foundation for a deep relationship. Both partners dedicated

time to understanding each other’s organizations,

advocated internally to boost awareness and support for

the collaboration, and deliberately built common ground.

According to a DSM representative on the Steering

Committee, the principle of “common and non-competing

agendas” is one of the drivers of the partnership’s success.

Importantly, there was also a commitment to jointly tackle

challenges that arose in execution of these objectives.

Additionally, there has been senior management buy-in

and commitment from both sides since the partnership’s

initiation. The overseeing Steering Committee and

Management Team includes senior staff from both

organizations, with the former convening twice a year and

the latter holding meetings every 6-8 weeks to track and

monitor projects. Senior DSM leaders such as Stephan

Tanda and CEO Feike Sijbesma have also undertaken

trips to WFP country projects, further signaling the deep

commitment from top management to the partnership.

Each project that the partnership undertakes is attributed

to two project owners, one from each organization, who

in turn oversee two project managers representing both

organizations. The joint ownership model reiterates the

close relationship between the two institutions. Interestingly,

within DSM, the partnership is heavily supported not just

by its Corporate Sustainability Department (with its Vice-

President as partnership co-chair), but also by Sight and Life,

its nutrition think tank that supports research, knowledge

dissemination, and advocacy. Sight and Life’s Director

co-chairs the partnership, and his presence reinforces the

focus on advancing nutrition and the holistic nature of

the partnership. This structure – where the private entity

is largely represented by its Corporate Sustainability team,

technical experts from its Nutrition Improvement Program26

and senior leaders of its humanitarian nutrition think

tank – is atypical, and contributes to the strength of the

partnership.

(b) High level of employee engagement.The partnership placed significant importance on

generating high levels of employee engagement and

interest. This was intended to inspire pride and motivate

employees, leading to further buy-in and closer ties

between the two organizations.

The partnership dedicated time

to understanding each other’s

organizations, advocated

internally to boost awareness and

support for the collaboration,

and was deliberate about

building common ground.

25 Society for International Development. Netherlands Chapter. 2012. 26 DSM’s Nutritional Improvement Program (NIP) provides scientific and technical support and supplies micronutrients to combat malnutrition.

DSM-WFP: A Partnership to Advance the Global Nutrition Agenda 11

DSM employees have been actively fundraising for WFP

since the beginning of the partnership. For example, DSM

staff host local initiatives such as bake sales and raffles on

World Food Day to raise awareness and money.

Given that the majority of DSM employees are quite

removed from the partnership’s decision-making

processes and may not fully understand the needs and

challenges of specific demographics where partnership

pilots are being undertaken, DSM supports short-term

volunteer or secondment opportunities at WFP offices.

This has led to two key benefits.

First, it has served to nurture and motivate over 55 DSM

employees who have directly worked with WFP programs,

contributing to their professional development (see

Annex III for a full list of placements). This policy is directly

aligned with DSM’s core corporate strategy around staff

development and has contributed to greater satisfaction

and staff retention.

Additionally, these placements have allowed DSM to

better understand the specific needs of the vulnerable

populations that WFP serves. For example, a DSM

employee worked with the WFP Indonesia Country

Office for six weeks to determine the minimal cost of a

nutritious diet in different regions of the country (Photo

2). In-country tasks range from communications-related

activities to more specialized technical roles. DSM’s staff

return from assignments to share findings from the field

through blog posts and lunch time forums, and have even

used their experience to design and test new solutions that

respond to the issues they witnessed firsthand overseas. As

a result of their involvement, employees are more eager

to lead fundraising and advocacy events to support the

partnership.

Second, the DSM placements allow WFP country staff

to benefit from their hands-on technical guidance. The

practical and in-person support has increased the technical

capacity and knowledge of local staff. For instance,

following Typhoon Aila in Bangladesh in 2009, a DSM

technical advisor supported the WFP Bangladesh Country

Office in MNP distribution, and developed monitoring and

evaluation tools to assess the joint intervention.

(c) Business-to-business (B2B) nature of DSM’s business model allows for smoother transactions in the public health arena.Although DSM has begun to brand some of its nutritional

products, particularly its MNP MixMe™, the company’s

B2B nature means that its products are not typically sold

directly to end users but rather through other businesses

and institutional buyers.

As a result, a WFP representative on the DSM-WFP

Management Team noted that WFP and other UN

organizations have had a smooth process agreeing on

joint labeling, communications, and advocacy efforts with

DSM. The modified and improved premix formulations

developed by the partnership have been publically

shared, and joint partnership lessons are also shared

through HF-TAG. DSM also does not place stipulations

on incorporating its role in any corporate marketing

campaigns following the intervention. Indeed, as WFP

moves toward uniform packaging across its offered

interventions, the products only list the nutrient content

and manufacturer, and not the premix source. This means

that WFP suppliers – such as DSM – do not have their

brand or logos displayed on any product.

In contrast, for the vast number of PPPs, co-branding,

sponsorship, and cause marketing are frequently used

for brand promotion.27 For instance, co-branding is often

the norm in partnerships with consumer packaged goods

(CPG) companies, with the CPG company’s name and

logo in nutrition interventions often visible. Typically, strong

emphasis is also placed on marketing the product rollout,

which may take focus away from the intervention itself.

As one interviewee from a UN-organization remarked,

challenges are occasionally seen with CPGs due to cause

marketing and its sometimes contradictory incentives.

Photo 2: DSM staff member on assignment in

Indonesia (Source: DSM)

27 Kraak VI1, Harrigan PB, et al., 2012.

12

(d) Firewall between philanthropic partnership and business interests.For any PPP to be considered credible and truly succeed

– particularly in the nutrition space – it is vital to operate

with transparency. Many interviewees noted that there is

often a “perceived conflict of interest from private sector

engagement” and that this often inhibits bilateral and

multilateral agencies from entering a PPP.

Although senior leaders at DSM remark that the

“partnership is [always] held at arm’s length from business,”

the partnership nonetheless addressed the potential

conflict issue explicitly in its third MoU. WFP is in the midst

of developing a new manual, the Rules of Engagement,

to ensure there is a firewall between the philanthropic

partnership and commercial supplier relationship it has

with DSM. Additionally, WFP’s procurement process is well

documented, and entails registration on the WFP supplier

roster to receive tenders and submit bids; all awards are

subsequently publically posted. Finalizing and publishing

the Rules of Engagement will be an important step taken

by the partnership to indicate its commitment to a firewall.

Leveraging the partnership’s synergyBoth organizations have also evolved as a result of the

joint learning and collaboration garnered through the

partnership. The WFP has been further supported and

strengthened by its transition from a food aid to a food

assistance agency. By putting greater emphasis on nutrition,

the nutritional value of foods, and the nutrient needs of

different target populations, WFP has increased its overall

impact and reach. The partnership donates funds that

enable WFP to hire long-term consultants on nutrition and

food technology, which has allowed WFP to enhance its

expertise to deliver improved, high-quality nutrition products

and nutrition assistance. A WFP manager remarked that they

transitioned from “transferring calories to the people we

serve” to prioritizing the nutritional impact, and that DSM

helped them successfully drive this shift forward on the

global nutrition agenda. Moreover the technical guidance

from DSM has given WFP increased internal capacity to

develop key tools on nutrition policy, diet analysis, and other

training modules.

Meanwhile, the partnership has given DSM a “seat

at the table” with global nutrition leaders and has

allowed it to have a voice in the nutrition space. A DSM

representative on the Steering Committee admits that

even following DSM’s acquisition of Roche Vitamins in

2003, the company’s name was not recognized in the

world of nutrition until the partnership began in 2007. He

notes that since then, DSM has “received quite a lot of

media coverage”, despite the fact that B2B companies

are typically not very visible in the mainstream media.

Internally, the partnership has been a source of pride for

DSM, and the opportunity for direct engagement has been

a big motivational factor for employees. A DSM manager

remarks that although the volunteer and secondment

opportunities started as a result of encouragement

by senior management, staff participation is now very

high. Participating in such opportunities has “changed

viewpoints” of employees, and there is now a deeper

company-wide level of motivation and engagement.

Senior leaders at DSM believe that this partnership has also

“made it easier” for the company to collaborate with other

nutrition stakeholders and be seen as a credible partner. As

a result, DSM has developed a strong ability to form lasting

relationships with leading nutrition NGOs, governments,

and UN agencies including through leadership roles within

the SUN Business Network and in Project Laser Beam (Box

1); indeed, WFP is also deeply involved in both initiatives.

DSM has also embarked on other nutrition efforts,

including Partners in Food Solutions, an initiative where

corporations provide technical support to small food

processers in Africa, Sustainable Evidence-based Actions

for Change (SEAChange) seminar-workshop series, and

the Amsterdam Initiative on Malnutrition (AIM).

Lastly, the partnership has allowed DSM to better

understand new emerging markets and beneficiary needs,

which in turn has helped it increase its product portfolio.

Indeed, as will be discussed in Section V, its micronutrient

powders were tailor-made for the partnership.

WFP has transitioned from

“transferring calories to the

people we serve” to prioritizing

the nutritional impact, while

the partnership has given

DSM a “seat at the table” with

global nutrition leaders.

DSM-WFP: A Partnership to Advance the Global Nutrition Agenda 13

V. Micronutrient Powder (MNP), Super Cereal, and Super Cereal Plus (SC / SC+): product characteristics and programming objectives

The World Bank declared delivering micronutrients

through food fortification one of the most cost-effective

strategies for saving lives,28 while the Copenhagen

Consensus in 2012 ranked bundled micronutrient

interventions to fight hunger and improve education as the

best investment proposal and the top priority for policy-

makers. Indeed, research indicates that investment of

US$60 million a year in micronutrient provision could yield

benefits in terms of improved health, reduced mortality

and increased income opportunities worth US$1 billion.29

In response to this growing demand for improved food

products, the DSM-WFP partnership adapted and developed

formulated supplementary food products. This section

focuses on two such products, namely MNPs and SC / SC+,

which were designed to support the nutritional needs of

children under five years of age and pregnant and lactating

women (Figure 3). It is important to note that MNPs were

not used by the WFP prior to the DSM-WFP partnership,

and that it was their combined expertise that allowed them

to test and roll out new formulations of fortified blended

foods, also known as Super Cereal and Super Cereal Plus.

MNPs for infants and young childrenMNPs, which are also known under the trademark names

Sprinkles™ or MixMe™ (the brand developed by DSM),

treat and prevent iron deficiency anemia (IDA) and also

provide a more complete set of vitamins and minerals

to address an infant’s critical micronutrient needs. MNPs

were invented in the late 1990s in response to a request by

UNICEF to develop an alternative to existing iron/folic acid

tablets, which children cannot swallow, and syrups, which

stain teeth and are bulky to transport and store.

MNPs are mixed with an infant’s or young child’s food after

preparation and do not alter the taste of the meal. They are

typically packaged in single-dose 1-gram sachets, which

contain enough vitamins and minerals to comprise one

full RNI (recommended nutrient intake). The duration of

intervention can vary by situation, context, and objectives.

Figure 3: MNP and Super Cereal products

MNPs

Powders with bland taste that contain 15 vitamins and minerals, including iron, vitamin A, vitamin C, and folic acid, and can be sprinkled over a child’s food for instatn home fortification.

Super Cereal (also known as CSB+)

A blend of maize, whole soya beans, and vitamin & mineral premix; sugar or vegetable oil may be added before distribution. It is for children above 24 months and adults, particularly pregnant and nursing mothers and malnourished individuals on ART/DOTS.

Super Cereal Plus (also known as CSB++)

Contains maize, de-hulled soya beans, sugar, refined soya bean oil, vitamin & mineral premix, and dried skimmed milk powder; specifically for the nutritional needs of the 6–23 months age group and treatment of children with moderate acute malnutrition (MAM).

28 WFP, 2008.29 DSM, 2012.

14

As per the HF-TAG guidance, MNPs consist of at least

15 vitamins and minerals and the amount of each

micronutrient corresponds with WHO/FAO recommended

nutrient intakes. Slight adjustments may be made to

account for country regulations or variations in nutrient

requirements if there is a clear case for doing so. Figure

4 indicates the ingredients and their relative amounts in

a single 1-gram sachet of a typical MNP available in WFP

programs. MNPs are a powerful intervention because

their tasteless powder allows caregivers to fortify locally

acceptable, homemade foods. Additionally, since MNPs

must be given with food, they promote the introduction

of complementary foods to infants at six months of age,

ensuring that children receive timely and adequate food

intake. MNPs cost approximately US$0.03 per sachet

for public sector buyers and are highly cost-effective,

lightweight for low-cost transport, and easy to administer

when proper counseling is provided.

Roles of DSM and WFP in producing and delivering MNPsGiven strong evidence on the importance of

micronutrients and food quality for health, DSM and

WFP follow a joint strategy that combines research and

communication to reach 100% of WFP’s most vulnerable

beneficiaries with improved nutrition. Prior to the

partnership, WFP recognized the need to expand the

quality and diversity of its interventions to better reach its

beneficiaries, but had not used MNP in its interventions.

The partnership therefore embarked on a joint effort to

adapt and test new MNP formulations to better serve

WFP’s target populations. Large-scale MNP interventions

were piloted in different contexts, including at refugee

camps in Nepal and Kenya and with cyclone victims in

Bangladesh.

In order to effectively develop and test MNP interventions,

both organizations have established clear roles and

responsibilities that leverage their individual core

competencies. DSM invests both financial and technical

Figure 4: Official development assistance commitments, in millions USD

30 Home Fortification Technical Advisory Group (HF-TAG), 2013. 31 Home Fortification Technical Advisory Group (HF-TAG), 2014. 32 Complementary feeding is the transition from exclusive breast-feeding to solid family foods; exclusive breast-feeding should be maintained until 6 months

of age, with continued breast-feeding along with complementary foods through 23 months. See WHO, 2014a. Complementary Feeding, www.who.int/nutrition/topics/complementary_feeding/en/index.html.

33 All monetary amounts are expressed in U.S. currency.34 Public purchase prices range from approximately $0.017 to $0.03 per sachet, though new tender agreements may include higher prices.

B2

IRON CZINC

COPPER

NIACIN

MNPSACHET

B6B1E

ASELENIUM

IODINE

VITAMINS

MINERALS

D

B12

FOLIC ACID

DSM-WFP: A Partnership to Advance the Global Nutrition Agenda 15

support to adjust MNP formulations and conducts quality

assurance activities, including testing shelf-life at typical

temperatures and humidity to which the product is

exposed, at each step of the way to ensure all international

standards and protocols are sufficiently met. DSM also

maintains close coordination with WFP and its country

staff in order to gather necessary insights on the needs

and habits of beneficiaries in different geographies and

contexts. This collaboration is effectively facilitated

through regular steering committee meetings, project

updates, and various communication and feedback loops,

as well as through DSM employees’ participation in short-

term volunteer and direct engagement opportunities with

WFP programs. These activities, as described in Section

IV, have been critical to DSM’s success in facilitating

groundbreaking research on improving and innovating

MNP formulations and packaging.

WFP, on the other hand, chiefly focuses on the

procurement and roll-out activities for MNPs at the

country and community levels. WFP is responsible for

liaising with DSM and other MNP manufacturers to ensure

the products cost-effectively meet the micronutrient

challenges of target populations as well as confirm

that all premix and distribution specifications are met,

including package design and desired composition,

before delivery to mothers and children. The UN agency

further coordinates with global-level stakeholders through

HF-TAG on MNP guidance and programming, while

also closely engaging and building networks with key

federal and local government stakeholders, NGOs, and

influential community members to support the successful

implementation of MNP programs. WFP has become a

respected global leader in delivering food aid and nutrition

interventions by developing long-standing relationships

with these various groups; a key success factor in its

delivery of MNPs. These on-the-ground partnerships

remain critical to WFP’s ability to carefully design and

implement targeted social marketing messages and

awareness-building efforts to generate demand for MNPs

within the communities it serves.

WFP sources its MNP premix and products from a select

number of suppliers, including DSM, and both value chains

can be seen in Figure 5.

For a number of its MNP programs, WFP gathers

qualitative and quantitative data on the efficacy of the

MNP formulation and design; the behaviors of the

targeted population before, during, and after delivery;

and the overall impact of the intervention. These findings

are regularly shared with DSM to ensure the lessons,

accomplishments, and challenges of each program are

captured by both organizations. This transparency and

consistent dialogue gives leadership within both DSM and

WFP a comprehensive understanding of one another’s

activities and allows them to disseminate evaluations and

publications on their MNP programs or the partnership’s

joint learnings to the global community. With this shared

knowledge, each organization participates in global

nutrition advocacy efforts, builds interest within the

HF-TAG on the impact of effective delivery of MNPs,

and convenes with key international stakeholders to

move the nutrition agenda forward toward providing

more investment for MNP and proven cost-effective

interventions. The potential to further institutionalize and

disseminate this knowledge is described in Section VI.

Figure 5: DSM-WFP value chain for the manufacturing, design and delivery of MNPs

Premix production

• Premix produced in a DSM factory

Foil printing

• Boxes and packaging ordered from a local vendor

• Sachet design standardized across geographies

Sachet filling

• Packed via high-throughput filling machine

Quality Control

• QC activities take place during premix and packaging phases

Procurement

• WFP, UNICEF, other agencies purchase directly from mfg

• Package design and composition specified by purchasing agency

Distribution

• Country o�ces receive direct orders to then deliver via local programs

Monitoring

• Evaluate e�cacy of product formulation and design

• Assess overall impact

DSM WFP

16

Evolution of MNP programmingInitially, the partnership’s focus was on discovering how,

when, and where to best use MNPs in WFP’s programs.

The goal was to first build consensus among governments,

NGOs, and donors that there was a demand in high-

burden areas for the product and, subsequently, ensure

that MNPs were included in WFP’s standard food basket

and programming. One of the leading priorities of the

DSM-WFP partnership has been to effectively scale up

the delivery of cost-effective and high-quality MNPs that

improve the nutritional situation of children.35 In one of

the initial MNP pilots, 22 million sachets of MixMe™ were

successfully developed and delivered by the partnership

to more than 160,000 women and children affected by

Cyclone Sidr in Bangladesh in 2008. Since then, WFP has

integrated MNPs into its broader nutrition programming

and has designed and implemented MNP pilots in

more than 20 high-burden countries – most notably in

Bangladesh, Nepal, Indonesia, Philippines, and Kenya –

and in various contexts, including emergency response,

refugee camps, and school feeding programs.

Beginning in 2008, the partnership developed MNP

formulations with lower iron content, which could safely

and effectively be used in malaria-endemic areas, as well

as designed packaging options that are suitable for hot

tropical climates, to support the successful launch of pilots

in Bangladesh, Nepal, Kenya, Philippines, and Madagascar.

The initiatives successfully reached a total of 375,000

beneficiaries and reported a decrease in the prevalence of

moderate anemia via the improvement in the iron status of

children and lactating mothers.36

DSM and WFP were proud of their early achievements and,

more importantly, developed significant lessons around

the challenges of effective delivery, demand-generation,

and training caregivers. For example, at the Kakuma

Refugee Camp in Kenya in 2008, WFP learned the extreme

importance of careful program design and early strategic

communications efforts in a beneficiary community. Without

a comprehensive set of customized marketing activities,

package labeling and instructions in the local language,

community members were left skeptical and unaware of

the MixMe™ product’s purpose and benefits. As a result of

this knowledge gap, a significant majority of the participating

refugees developed ill-conceived notions about the side

effects of MNP, resulting in low adherence to the product.37

The partnership reflected these essential lessons from Kenya

and Bangladesh in MoU-2 (Mar 2010 – Jan 2013), where

the focus shifted to building more strategic and carefully

designed MNP programs with an emphasis on conducting

thorough formative research and involving community

members early in communication and messaging

activities. In doing so, DSM and WFP worked intensively to

appropriately improve product forms that met the specific

needs and behaviors of each targeted population, as well

as successfully bolster monitoring and evaluation schemes

to determine which indicators most accurately measure

impact. For example, DSM and WFP began testing variations

of MixMe™ with a phytase supplement which breaks down

phytate, and so improves the absorption of iron and zinc.38

Results show that the addition of phytase to iron-fortified

food, especially with vitamin C, significantly increases iron

absorption from a meal. In addition, adding phytase to food

also has the potential to increase absorption of magnesium,

calcium, and phosphorus as well as zinc, an important

development in regions where mineral deficiencies exist.

Additionally, WFP expanded its monitoring activities to include

regular household visits with comprehensively structured

questionnaires to determine key outcome indicators from

its programs – including knowledge and practices on

breastfeeding and complementary feeding, MNP supply

and consumption, observed benefits of MNP utilization,

and effects of MNPs on food consumed by users. These

evaluation tactics were prominently applied in the Philippines

in 2010 where MNP programming was implemented as an

emergency response to communities affected by typhoons

Ketsana and Parma. Based on the positive findings and

experiences WFP was able to demonstrate, the Philippines

government updated national guidelines for micronutrient

supplementation and the Department of Health ultimately

issued an Administrative Order for MNP supplementation

for children between 6-23 months.”39 Later in 2012, the

government used its own funding to procure MNPs for

550,000 young children and is now planning to continue

increasing coverage of the program. Similar efforts have

been executed across several other countries, translating into

the development of standardized formulations, toolkits and

guidance, and publications to support the scale up of MNP

programs. As a result of these efforts, WFP’s large-scale MNP

programs reached more than 4 million children under five

years of age in 2012 and 2013.

Additionally, to improve the packaging and appeal of

MNPs, WFP identified specific environments where local

capacity for packaging and distribution already existed.

In the Philippines, a small usability trial was conducted to

35 It should be noted that currently, there is limited evidence available to assess the potential benefits of the use of micronutrient powders for home fortifica-tion of foods consumed by pregnant women with regard to maternal and infant health outcomes.

36 Rah JH; et al., 2012.37 Kodish, Stephen; et al., 2011.38 Troesch, B.; Egli, I. et al., 2009.39 Asis, R, van Hees, J, de Pee, S, 2013.

DSM-WFP: A Partnership to Advance the Global Nutrition Agenda 17

develop the local box design and product name; in Nepal,

the local partner, Association of Medical Doctors of Asia

(AMDA), was responsible for program implementation;

and in Indonesia, the partnership coordinated with local

nutrition workers to develop locally-tailored graphics

and interactive sessions for marketing purposes. The

addition of several pilots in different geographies, multi-

year programs in Kenya and Bolivia, as well as large-

scale programs in Bangladesh and Indonesia increased

procurement of MNPs from 17 metric tons (MT) in 2009 to

more than 120 MT in 2012.

Now operating under MoU-3 (2013-2016), WFP and

DSM have set their sights on reaching 3 million young

and school age children with MNPs each year in more

than 15 countries, and the roll-out now incorporates

other delivery mechanisms including vouchers, social

protection programs and market-based models. In order to

successfully work in this growing number of geographies

and mitigate in-country regulatory risks, the partnership

is advocating and supporting relevant ministries in their

formulation of nutrition policies, especially policies on

fortification and micronutrients, and DSM is assisting

many of WFP’s country offices, located in more than 70

countries, with their implementation plans.

Super Cereal and Super Cereal PlusSuper Cereals were formulated in 2010 to replace corn/

wheat/rice soya blends (CSB, WSB, RSB), a fortified

blended food (FBF) used for decades to treat moderate

acute malnutrition (MAM), support pregnant and lactating

women, and increase the intake of micronutrients of

target populations, such as refugees. MAM, also known as

“wasting”,40 develops as a result of recent rapid weight loss

or a failure to gain weight. Approximately 33 million children

under 5 could be classified as having MAM, or roughly one

in ten children in the world’s least developed countries.41

CSB was one of the original FBF offerings, but its

formulation – 80% maize, 20% whole soya, and 0.4%

vitamins and minerals – has since been deemed

inadequate to effectively treat MAM. Its formulations

were bulky, lacked dried skimmed milk and other easily

absorbed nutrients, and contained an incomplete range

of vitamins and minerals for MAM treatment. International

health groups and academics widely argued that animal-

source proteins, such as milk, better promote the growth

of muscle tissue and resistance to infections, and are

critical to help children recover from severe malnutrition.

WFP, UNICEF, USAID’s Office of Food for Peace, and

the United States Department of Agriculture (USDA)

took notice and engaged in a product specification and

improvement process aimed at streamlining the premix

and product blends. The result was the formulation of

Super Cereal (SC) and Super Cereal Plus (SC+) (Box 242, 43).

SC is an improved formulation of CSB, containing a vitamin

and mineral premix formulated for children over the age of

24 months and adults and provides 380 kcal/ 100g of dry

product and 56 kcal/100 g of porridge. This formulation

is not used to treat MAM, as it is a lower nutrition and

energy density than the WHO recommends for MAM

treatment and does not have dairy (strongly recommend

by WHO).44 By contrast, SC+ is primarily intended for

children 6-59 months of age suffering from MAM and for

children aged 6-23 months as a complement to breast

milk with the inclusion of dried skimmed milk powder.45

SC+ provides 410 kcal/ 100g of dry product and 70

kcal/100 g of porridge (see Box 2 for ingredients of each

product). Both products are available as corn-, wheat-, or

rice-soya blends; sugar is also always included in SC+ and

is sometimes included in SC.

40 MAM is defined by a weight-for-height indicator between -3 and -2 standard deviations of the international standard or by a mid-upper arm circumference (MUAC) between 11.5 cm and 12.5 cm.

41 Least developed countries are classified by UNICEF as countries with a low gross national income, weak human assets, and high level of economic vulnerability.

42 Nguyen, Van Hoan, 2014a.43 Nguyen, Van Hoan. 2014d.44 WHO, 2012.45 “The inclusion of milk powder as an ingredient improves the amino acid profile (has a high Protein Digestibility Corrected Amino Acid Score) and it is a good

contributor of bioavailable calcium and potassium. In addition, it has a specific stimulating effect on linear growth and insulin growth factor 1 (IGF-1) levels in the child and does not contain anti-nutrients.” – Saskia de Pee, WFP’s development, testing and roll out of Super Cereal Plus – in collaboration with DSM.

Box 2: Super Cereal and Super Cereal Plus ingredients42, 43

Ingredients (%)Super

Cereal Plus (SC+)

Super Cereal (SC)

Corn 58.30 78.30

Soybeans (de-hulled) 20.0 20.0

Refined soybean oil 3.0 –

Dried skim milk 8.0 –

Sugar 9.0 –

Vitamin / mineral premix 0.20 0.20

Dicalcium Phosphate anhydrous

1.23 1.23

Potassium chloride 0.27 0.27

18

The growth of Super CerealsThe WHO’s technical note in 2012 that set nutritional

programming requirements and guidelines for the

composition of supplementary foods used to treat children

with MAM spurred the development of these new specialized

nutritious foods (SNF) by WFP and the nutrition community.46

WFP innovated SNFs in its food basket to be aligned with

these new standards as well as using the guidance as a

benchmark for its MoU-3 goals with DSM to scale up its

reach through innovative supplementary food products.

DSM provided WFP with the technical inputs for a markedly

improved micronutrient premix (Figure 6) that, when

added to SC and SC+, could improve the nutrition status

of its consumers, including children 6-59 months, school

children, pregnant and lactating women, and malnourished

Figure 6: Micronutrient premix per 100g of SC / SC+47, 48

Vitamin A 3460 IU

Vitamin D3 441.6 IU

Vitamin E TE 8.3 mg

Vitamin K1 30 µg

Vitamin B1 0.2 mg

Vitamin B2 1.4 mg

Vitamin B6 1 mg

Vitamin C 90 mcg

Pantothenic acid 1.6 mg

Folate, (DFE) 110 µg

Niacin 8 mg

Vitamin B12 2 µg

Biotin 8.2 mg

Iodine 40 mg

Iron (Ferrous fumarate fine powder) 4 mg

Iron (Iron-sodium EDTA) 2.5 mg

Zinc 5 mg

Potassium 140 mg

Calcium 362 mg

Phosphorous 280 mg

Photo 3: SC+ packaging (Source: WPF)

individuals on antiretroviral therapy (ART) / directly observed

therapy (DOT). In parallel, WFP re-branded its FBF offerings

to ‘Super Cereal’ and ‘Super Cereal Plus’ with a new design,

improved packaging material, and a smaller ration size for

SC+ for easier distribution and storage as well as to provide

more information to the consumer (Photo 3). The intended

advantages of the new SC+ product included increased

acceptability by children due to an improved taste and lower

viscosity, as well as proper preparation and consumption

due to the targeted small packaging that included specific

instructions and health benefits for infants.49

In field trials, the new SC+ demonstrated positive results.

In Malawi, among children receiving SC+, it proved to be

equally effective as large quantity Lipid-based Nutrient

Supplements (LNS) / Ready-to-use supplementary food

(RUSF) (peanut and soya based supplementary food) in the

treatment of MAM.50

Due to WFP’s ability to shift relatively easily from the

original CSB formulation to the improved SC offering,

as well as the noticeable benefits of SC+ and its positive

results from pilots in the field, WFP’s procurement grew

dramatically from 2010 to 2012. The purchase of SC+

increased from ~1,000 MT in 2010 to 14,000 MT in 2011

and 46,600 MT in 2012.51, 52 As illustrated in Figure 7, the

emphasis on these specialized FBF products allowed

WFP to reach approximately 5 million more children and

46 WHO, 2012.47 Nguyen, Van Hoan, 2014b.48 Nguyen, Van Hoan, 2014c.49 de Pee, Saskia and Kraemer, Klaus. WFP’s development, testing and roll out of Super Cereal Plus – in collaboration with DSM.(n.d.)50 LaGrone LN, et al., 2012.51 WFP, 2013a.52 1 MT = 1000 kg, each child receives 100-200 g/d for a limited number of months.

DSM-WFP: A Partnership to Advance the Global Nutrition Agenda 19

pregnant and lactating women over that time period.53, 54

Of course, the number of beneficiaries reached depends

upon the situation, specifically the emergencies that occur

and how WFP chooses to respond.

The partnership’s success in the delivery of MNPs and SC / SC+The experiences and lessons learned by WFP and DSM in

the successful roll-out of MNPs and SC / SC+ have been

different for each product.

The production, design, and delivery of MNPs required

significant collaboration at each step in order to effectively

build a global market for the new product type. Both

organizations were heavily involved in developing premix

formulations that met the nutrition needs of targeted

populations, building demand for the product across

geographies, and developing a global agenda around the

scale up of MNP and micronutrient fortification. Stakeholders

such as UNICEF and CDC also played a valuable role through

coordinating regional workshops and bringing together

government representatives and other partners at the

country-level.

In contrast, the scale up of SC and SC+ focused on

product improvement and strengthening an established

market. Multiple suppliers of CSB already existed and other

proven varieties of FBFs had been available for several

years. Therefore, WFP’s focus was primarily on ensuring an

adequate supply could meet growing demand for these

products by targeting specific beneficiary groups with “the

right food, at the right time, at the right place.”55 WFP did not

require new tools to conduct research and field trials as it did

for MNPs, but rather it needed to improve internal processes

and ensure sufficient manufacturing capacity was in place to

develop, produce and rapidly deliver a higher-quality product.

Although the scale up of MNPs and SC / SC+ required

varying levels of involvement from WFP and DSM, one of the

common success factors has been the joint establishment of

targets and timelines. The organizations’ diligence in setting

concrete objectives during each MoU period has facilitated

effective coordination between both groups and has raised

the visibility of their efforts on policy agendas at the global

and country levels. This coordination has enabled WFP to

reach 20.6 million beneficiaries with improved nutrition in

2013 – primarily with MNPs, SC or SC+, and LNS – and be on

pace to meet its goal of impacting 25-30 million beneficiaries

per year by the close of 2015.56

Figure 7: Increase in beneficiaries reached

53 Trends in nutrition beneficiaries mirror an overall decrease in total beneficiaries reached by WFP in 2013 relative to previous years. This relative decrease is based on the nature of the emergencies requiring humanitarian action in 2013.

54 DSM-WFP Steering Committee. 2014.55 WFP, 2013b. 56 DSM-WFP Steering Committee, 2014.

Tota

l Ben

efici

arie

s

Year

18,000,000

16,000,000

14,000,000

12,000,000

10,000,000

8,000,000

6,000,000

4,000,000

2,000,000

0

PLW: treatment and prevention

Prevention of acute malnutrition (6–59 months)

Treatment of MAM(6–59 months)

2010 2011 2012 2013

20

VI. Lessons from the MNP and Super Cereal experience

As described in Section V, the partnership has developed

and strengthened nutrition interventions, including MNP

for home-based fortification and Super Cereal products.

The section below explores key lessons emerging from the

partnership’s work on both products, including identifying

potential areas for further improvement.

Key lessons emerging from the partnershipLeveraging the respective strengths of each organization

has allowed the partnership to innovate along a number

of different dimensions. Three key areas that have been

driven by the collective knowledge and experience of the

partnership are described below.

(a) Packaging innovation to increase product uptake driven by a critical assessment of beneficiary needs and characteristics.

Large-scale interventions at the Kakuma refugee camp

in Kenya in 2009 taught the partnership crucial lessons

on the importance of acceptability and adherence of any

nutrition product rollout. One of the primary objectives of

the 17-month MNP delivery program was to reduce the

prevalence of micronutrient malnutrition among Kakuma’s

population through the provision of home fortification

with MNPs. However, the collection rate for the MixMe™

product from distribution points was just ~45-50%. The

average rate of uptake – actual collection of MNPs – fell

from a high of 99% at the start of the program in February

2009 to a low of 30% in July 2009, before bouncing back

slightly. Additional inquires revealed that adherence or

compliance rates were less than 50%, implying that not

only were less than half the targeted beneficiaries actually

picking up the product, but out of those beneficiaries that

did pick it up, less half were using the product as intended.

Worryingly, many who picked up the sachet were seen to

later simply discard it.

Following the Kakuma intervention, senior leaders from

the DSM-WFP partnership collaborated with colleagues

from the Johns Hopkins Bloomberg School of Public

Health on a qualitative study to understand the causes

behind the low acceptance rate.57 The study evaluated

the contextual factors at Kakuma, and also made

recommendations for future MNP implementations. In-

depth interviews with key stakeholders, beneficiaries, and

community leaders revealed that inappropriate packaging,

insufficient social marketing, and superficial formative

research all contributed to the low uptake.58 Both images

on MixMe™ box – which provided a 30- day supply of

MNPs – and the color, size and shape of the individual

aluminum foil sachets resembled contraceptives and were

therefore perceived as family planning measures (Photo 4).

The camp residents’ demographics had also shifted to a

majority Somali population – compared to a 75% Sudanese

population at the time of the initial acceptability study –

and many community leaders felt that sufficient attention

had not been paid to clarifying whether the product was

suitable for observant Muslims. Specifically, the cartoon

logo led to concerns about the MNP’s ingredients. Many

beneficiaries questioned whether the product was made

out of ingredients from the ‘genie,’ the image displayed

on the MixMe™ packaging, and therefore off-limits to

Muslims. This confusion was compounded by incorrect

information given to beneficiaries by community health

representatives.59 Training was likely insufficient for

these community health workers, leaving them unable

to respond adequately to product-related questions and

57 Kodish, Stephen; et al., 2011.58 Rah, Jee Hyun; et al., 2011. 59 Kodish, Stephen; et al., 2011.

Photo 4: Image on MixMe™ sachets (left) and box

(right) used in Kakuma refugee camp.

DSM-WFP: A Partnership to Advance the Global Nutrition Agenda 21

concerns. The study showed that the partnership had not

developed adequate culturally sensitive communication

and messaging strategies on the product’s benefits,

and more could have been done to understand the

beneficiaries’ context.

As a member of the DSM-WFP management team

himself noted, the “disaster” in Kakuma was a humbling

experience. It led the partnership to not only launch the

in-depth inquiry into the MNP program, but to jointly

develop a rapid assessment tool to undertake high-quality,

multistage formative research at the beginning of any food

product-related intervention that is new to the targeted

community. This tool allows for an extensive context

assessment to better understand beneficiary needs and

characteristics, which in turn has led to targeted social

marketing and product messaging. It is clear that the

low uptake in Kakuma led to a shift in the partnership’s

mindset, with a senior WFP representative of the

management team remarking that “[Before Kakuma], we

were just worried about providing food, [and] didn’t worry

as much about acceptance.” A DSM representative of the

management team agrees, noting, “Before [Kakuma], this

type of thorough qualitative and formative work wasn’t

part of WFP’s focus.” As a result of the thorough inquiry

following the Kakuma experience, the partnership learned

that product benefits need to be well communicated and

accessible to beneficiaries and recommended that clear

information, education, and communication materials

be combined with a strong social marketing campaign.60

Indeed, program delivery mechanisms are now seen to be

as important as the actual product.

The formative research also led to the design of culturally

appropriate, context-relevant packaging. MNPs packets

were modified to appeal to the local context: the

partnership moved towards a uniform sachet design

which could be centrally manufactured and combined

it with tailored box designs to appeal to specific groups

of beneficiaries (Photo 5).61 The latter is now developed

through engaging local artists, who are more attuned to

the sensitivities of the local culture.

Through the lessons shared by WFP country offices,

DSM has also developed a better understanding of the

intricacies and challenges in packaging complementary

food products to ensure that they retain the highest levels

of quality when they reach beneficiaries. This insight

prompted DSM to improve the package sealing of MNPs

to guarantee the product’s 24-month shelf-life. DSM

is also currently in the early stages of moving towards

packing sachets into resealable pouches to further protect

contents from harsh climatic elements such as UV light

and humidity. Additionally, Sight and Life, DSM’s nutrition

think tank, held an open competition in 2012 to find more

sustainable ways of packaging products, with three ideas

– including an innovative MNP double sack packaging

technique, with a biodegradable inner film sack and a

paper outer sack – eventually selected for further testing.

(b) Product innovation has achieved improved MNP and Super Cereal formulations.

WFP’s country knowledge has allowed DSM to better

assess the nutritional and contextual needs in targeted

areas, leading to the development of new product

innovations and formulations.

As discussed in Section V, DSM tailored the MixMe™

MNP pre-mix formulation based on the physiological

needs of the beneficiary population. For instance, DSM

adjusted the iron formulation for the intervention at the

Kakuma refugee camp in Kenya as well as for pilots in

other malaria-endemic areas where malaria control is not

in place.62 Additionally, the standard 12-month MNP shelf

storage was also increased to a two-year shelf life for

finished sachets, allowing for a greater number to be kept

in stock at regional warehouses preventing stock shortages

and accommodating any delays across the distribution

channel. Following a request from UNICEF, DSM is now

also developing a three-year shelf life product.

Photo 5: Examples of WFP’s standardized MNP sachet

designs (top) and tailored box design (bottom).

60 Ibid.61 For example, the standardized sachet design on top left is used for institutional feeding, namely in schools, while the sachet design on the bottom left is

for individual use.62 WHO, Iron supplementation of young children in regions where malaria transmission is intense and infectious diseases highly prevalent. http://www.who.

int/maternal_child_adolescent/documents/pdfs/who_statement_iron.pdf

22

Meanwhile, the partnership has capitalized on DSM’s

technical knowledge and WFP’s in-country presence to

develop, test and roll out new formulations of fortified

blended foods, specifically Super Cereal products. An

emphasis was placed on developing differentiated pre-mix

formulations for specific demographics and increasing

the variety of products to treat distinct conditions, such as

MAM. Following WHO’s technical note on supplementary

foods for the treatment of MAM in June 2012, the WFP

and DSM together successfully developed and tested

different formulations, with the WFP’s specifications for SC

/ SC+ eventually being adopted as global guidelines, and

resulting in UNICEF procurement changing from UNIMIX

to Super Cereal.63

SC and SC+ both contain the improved micronutrient

premix to respond better to nutritional needs. The latter

was specifically formulated together by DSM and WFP

to contain 8% dried skimmed milk powder, 9% sugar,

and 3% oil, to better meet the nutrient requirements of

children under-two and those with MAM. The product is

less viscous and better tasting than previous formulations,

thereby increasing its acceptability by young children.

Importantly there is no variation in the specifications of

SC premixes, which is advantageous for sourcing, creating

wider reach, and developing scalable impact.64

Building on its fruitful collaboration in designing and

testing product innovations for children, the partnership is

now looking to replicate its success for other products and

demographics. Specifically, food products are now being

developed for malnourished adults, particularly people

living with HIV/AIDS or TB, in Southern Africa.

(c) Successful advocacy driven by both top-down and bottom-up approach.

Achieving country buy-in for the introduction and scale

up of new nutrition interventions requires both strong

scientific and political advocacy efforts targeted at global

and national policymakers, donors, and nutrition thought

leaders, including academia. Substantive evidence

that demonstrates the effectiveness and quality of an

improved or new product, like MNPs or SC+, should

first be developed to influence global guidelines or

specifications by the WHO. This evidence helps build

country governments’ interest, which can be further driven

by showcasing successful program trials across other

geographies. These mechanisms, supplemented by WFP’s

extensive advocacy capacity and communication activities,

can help shift the global dialogue and set the stage for

a supportive in-country environment for local trials and

pilots, ultimately leading to building a local evidence base

for program scale-up.

The DSM-WFP model allows for this type of effective

advocacy from both global and local directions. Global

forums, such as the recent Micronutrient Forum Global

Conference in Ethiopia in June 2014 and the recurring

World Public Health Nutrition Congress, raise nutrition and

micronutrient awareness among a broader audience, and

are a platform for the partnership to explore collaboration

and engagement with other stakeholders. In order to

increase the regional evidence base, the partnership has

also championed and participated in regional forums on

food fortification interventions. For instance, the recent

“Scaling Up Rice Fortification in Asia” forum in September

2014 was co-organized by the WFP and other partners. It

brought together government representatives, suppliers,

nutrition experts, and multilateral organizations to discuss

their experiences with scaling up rice fortification. Such

forums allow various key stakeholders to share best

practices, raise challenges, and increase awareness of

regional needs.

Simultaneously, the WFP carries strong influence via its

country offices and distribution efforts. The WFP country

offices leverage their close relationships with local

stakeholders and policymakers to advocate on behalf of

the partnership’s work and to broaden scale up of nutrition

commodities. For instance, the Government of Nepal

was particularly interested in supporting an MNP rollout

program because of its positive experience with the prior

WFP and UNHCR nutrition interventions in refugee camps

in the country (Photo 6). The success of these initial

programs helped achieve government buy-in for larger

MNP scale-up initiatives in the country, which included

Photo 6: Food fortification taking place in Nepal.

(Source: WPF)

63 UNICEF, Supercereal products. 64 Although USAID had considered a reformulation of the calcium in the product, the decision was made to ultimately proceed with WFP formulations

DSM-WFP: A Partnership to Advance the Global Nutrition Agenda 23

non-refugee programs in far western Nepal led by WFP

and in several other regions of Nepal led by UNICEF. The

MoU-3 between DSM and WFP also explicitly focuses on

a bottom-up approach, with an emphasis on country-

level rollout of new tools and mechanisms for senior

management to participate in national nutrition dialogues

to help shape country agendas.

Potential areas for further improvementsA holistic assessment of the partnership also indicates that

areas for further strengthening remain, which may help

improve its effectiveness and influence.

(a) Need for investment in key metrics to measure vision of success.

Research shows that the most effective partnerships have

agreement on clear goals and success metrics to measure

their progress.65 While a measurement and tracking system

was not set up as part of the first MoU – the focus was on

developing concepts and pilots, in contrast to reaching

hard numbers – the DSM-WFP partnership established

clear targets for both its second and third MoU periods.

These targets measure the number of beneficiaries

reached with improved nutrition and link to the broader

partnership objectives. The partnership has already achieved

its objective to reach 100% of WFP’s most vulnerable

beneficiaries with improved nutrition and is on track to

reach 25-30 million beneficiaries by the end of 2015.

As the partnership continues to enable WFP to scale

up its reach of beneficiaries with improved nutrition,

there is scope for both DSM and WFP to not only aim to

achieve their respective organizational objectives, but also

enhance and improve service delivery of joint large-scale

nutrition interventions. Both sides could improve existing

monitoring and assessment tools for program design and

implementation in order to more accurately determine if

beneficiaries are receiving the right nutrition, given their

context and underlying condition. Understandably, each

community DSM and WFP work in will have its own unique

challenges, behaviors, and circumstances; therefore,

specific success metrics should be set by DSM and WFP

for each target population and should be clearly reflected

in the design of each nutrition program.

Currently, the partnership tracks the number of

beneficiaries whose nutritional intake improved since

the partnership’s inception through the application

of existing WFP metrics. However, program design,

delivery, and implementation can be better integrated

so that the partnership can measure broader outcomes

and impact metrics that go beyond the number of

beneficiaries reached. For instance, USAID programs

promoting maternal and child health (MCH) and nutrition

interventions track improved access to diverse and quality

foods through the minimum acceptable diet indicator and

women’s diet diversity scores – both measurements of

dietary diversity, although not necessarily a measure for

fortified foods.66 Indeed, the HF-TAG recommends that

monitoring and evaluation extends to not only measuring

access to products and knowledge about appropriate

use, but exploring improvement in physical and cognitive

functioning, educational attainment levels, and future

productivity.67

Though it’s not feasible in many programs to track some

of these longer-term outcomes, such as educational

attainment and growth in income levels, going

forward, DSM-WFP would be able to paint a far more

comprehensive narrative of its impact by incorporating

such broader metrics early on in the design and

theory of change stages of its nutrition programs to

better understand the nutrition intake of beneficiaries.

Interventions such as the rapid assessment tool (discussed

earlier) could also be applied as a formal component

of programs enabled by the partnership’s efforts in

order to institutionalize assessing beneficiary reach,

program delivery, and the replicability and scalability of

each initiative. Importantly, such assessments could be

externally conducted to ensure no bias with the results,

positioning the partnership as an effective model for joint

interventions. In turn, this can strengthen its country-level

advocacy efforts and help extend its reach.

(b) Opportunities for improved systems to institutionalize and share knowledge.

The partnership supports and strengthens programs

across the globe, reaching countries in Asia, Africa, and

Latin America. Lessons within and across regions have

potential to be transferable, and more can be done to

ensure appropriate structures are in place to institutionalize

knowledge. A WFP country representative reports that

the different WFP offices often “don’t talk to each other”

to share lessons, and a senior nutrition expert also noted

65 The Connect U.S. Fund, “Best Practices for Effective Donor Collaboratives”. http://www.connectusfund.org/files/Best%20Practices%20-%20Donor%20Col-laborative.pdf

66 USAID, 2013a.67 Home Fortification Technical Advisory Group, 2013.

24

that there is a “huge disconnect” between WFP’s on-

the-ground staff and those at the headquarters who

develop the policy-level tasks. There is scope to increase

communication between DSM and WFP’s central offices

and country offices to share more information on pilot

selections and proactively connect country offices

implementing similar programs. Importantly, country office

staff may benefit from communication on why countries

have been selected for pilots and how program delivery is

designed in other contexts.

Currently, knowledge is shared within the partnership

primarily through reports authored by DSM and WFP

experts involved in various projects, Sight and Life

publications and scientific papers, organic transitions

of WFP staff from one country office to another, and

blogs and internal DSM articles written by staff that

have completed volunteer placements. A mechanism

to formalize this exchange of information between the

two partners may be an internal virtual platform or a

‘Community of Practice’ (CoP) accessible across DSM

and WFP to effectively manage and distribute the myriad

of knowledge being developed by the partnership.

A CoP could provide a mechanism to not only keep

communication channels open between headquarters and

country offices, but also serve as a knowledge platform that

can enable the partnership and both organizations to more

broadly connect people and facilitate dialogue on shared

topics. Experience shows that CoPs can prove valuable to

capitalize on different learning styles, gather knowledge,

and create networks across boundaries.68 Such an initiative

to share knowledge would complement the partnership’s

existing work to build staff skills via its nutrition advocacy

training modules and the Nutrition Academy.

If a portion of such a CoP – or a similar initiative – were to

be externally facing and open to all stakeholders, it could

make it easier for the partnership to share its activities and

knowledge with the broader nutrition community. Indeed,

many interviewees that were not part of the PPP itself

were not fully aware of its objectives and programmatic

areas. More technical and detailed information on the

partnership’s interventions and pilots would likely be

well received by external stakeholders, and could serve

to complement the HF-TAG community of practice. A

nutrition expert interviewed noted that such transparency

and knowledge sharing would counter the frustration

that “no one else knows what they [DSM-WFP] are doing.”

Going forward, a DSM-WFP CoP could serve as a tool

to raise awareness of the partnership, institutionalize

knowledge generated across different countries, and

ensure that future interventions are building upon the

lessons from past pilots.

A mechanism to formalize this

exchange of knowledge may be to

develop an internal virtual platform

or a ‘Community of Practice’

(CoP) accessible across DSM and

WFP, to effectively manage and

distribute the myriad of knowledge.

68 USAID, 2013a.

DSM-WFP: A Partnership to Advance the Global Nutrition Agenda 25

VII. Advancing the global nutrition agenda

The 2008 Lancet Nutrition Series set the stage for greater

momentum in the nutrition field, and contributed to

the formation of the SUN Movement in 2010 to further

bring together governments, civil society, businesses,

and researchers.69 The DSM-WFP partnership has been

at the forefront of the changing nutrition ecosystem and

has contributed to its progress both at the macro and

micro levels. Crucially, the partnership has contributed to

increasing the nutritional intake of WFP beneficiaries over

time, while both organizations also jointly take part in high-

level global advocacy events and forums, including the UN

General Assembly and World Economic Forum.

First, the partnership has played a key role in forging

connections with nutrition stakeholders and initiating

cross-sectorial collaborations in this space. Both

organizations played key roles in the formation of the SUN

Movement’s Business Network co-hosted by WFP and

GAIN, and with the CEO of DSM serving as co-chair of its

Advisory Group. Additionally, the partnership played an

important role in the formation of the Home Fortification

Technical Advisory Group (HF-TAG), a global network of

stakeholders engaged in home fortification programs.

HF-TAG was initiated in May 2009 to provide evidence-

based guidance and resources on home fortification, and

both WFP and DSM’s Sight and Life continue to serve as

key partners in the network. DSM and WFP were also both

founding partners in Project Laser Beam, initiated in 2009

as a multi-stakeholder PPP (Box 1).

DSM and WFP have also separately embarked on other

PPPs in nutrition; for DSM in particular, this has been a

new undertaking. It has now initiated PPPs with UNICEF

and World Vision International, and is involved with

multi-stakeholder initiatives to address nutrition and other

challenges via the One Goal campaign in collaboration

with the Asian Football Confederation, GAIN, World Vision,

and the Asian Football Development Project; Partners in

Food Solutions with General Mills, Cargill, TechnoServe,

and USAID; SEAChange; and AIM. Meanwhile, WFP has

developed its own partnerships, for example with Unilever,

Kemin, and the Children’s Investment Fund Foundation

(CIFF).

Second, the collaboration has illustrated that successful

partnerships can transform interventions at the country

level and lead to shifts in regulations. As mentioned in

Section VI, the partnership undertook initial development

and piloting of MNP in Nepal in 2009-2010; both the

partnership’s program and the parallel UNICEF MNP

program in the country helped stimulate the Government

of Nepal to develop a national protocol on MNP

supplementation. Following the lessons learned from

the pilot, the partnership successfully collaborated with

UNICEF and the Ministry of Health in Nepal to support

the national MNPs supplementation program for children

under-two.

Meanwhile, the partnership’s work has also led to

improvements and shifts in formulations and packaging

of key products such as Super Cereal and Super Cereal

Plus (as described in Section V). WFP’s guidelines on these

two products have been globally adopted, and showcase

the product innovation and learning that can result

from PPPs. By 2011, the partnership had reformulated

or innovated nine products (Box 3).70 Additionally, the

partnership has published 36 peer-reviewed scientific

papers and participated in more than 20 international

advocacy events and conferences, including annual World

Economic Forums and Micronutrient Forums (a full list of

Box 3: Partnership’s programmatic impact

Innovated Projects Reformulated Products

• Input for rice-based and chick-pea based LNS products (Bangladesh)

• Input for chick-pea based LNS products (Pakistan)

• Forified Rice

• Micronutrient Powders

• Date bars

• Input for high energy biscuits

• Super Cereal

• Super Cereal Plus

69 Gillespie S, Haddad L, et al., 2013.70 DSM-WFP Steering Committee, 2012.

26

joint publications can be seen in Annex IV). All these efforts

have served to showcase the partnership’s learnings and

knowledge generated over the course of its collaboration.

Going forward, it will be important for the partnership to

further showcase such success stories and undertake peer

reviewed external studies of its activities – this will not only

disseminate best practices and lessons, but can help ease

the entry of other private actors in nutrition.

Lastly, the partnership has achieved its goal of reaching

100% of WFP’s most vulnerable beneficiaries with

improved nutrition. The latest data shows that although

there has been a decrease in WFP beneficiaries in 2013

– due to the nature of humanitarian emergencies in

2013 – the proportion reached with the right nutrition

has increased. For instance, Figure 8 shows that 72%

of children under 2 received the right food in 2013, up

from 60% in 2012. Although there is no data available

for all beneficiary demographics reached with different

micronutrient fortified products by country to analyze the

trends over time, 100% of nutrition beneficiaries (pregnant

and lactating women and children under 5) received

MNPs, LNS, Super Cereal Plus, or Super Cereal in 2013.71

Figure 8: Nutrition trends for children under 2

71 DSM-WFP Steering Committee, 2014.

Year

Ch

ildre

n u

nd

er 2

rec

eivi

ng

th

e ri

gh

t fo

od

4,500,000

4,000,000

3,500,000

3,000,000

2,500,000

2,000,000

1,500,000

1,000,000

500,000

02008 2009

55,000 125,000

2010 2011 2012 2013

2,500,000

3,184,000

4,050,000

3,419,219

72%60%

DSM-WFP: A Partnership to Advance the Global Nutrition Agenda 27

72 Tina van den Briel, Edith Cheung et al. “Fortifying food in the field to boost nutrition: case studies from Afghanistan, Angola and Zambia.” WFP. Occasional Paper No. 16. http://www.unhcr.org/4b751d3d9.pdf

73 “Timor-Leste: UN helps set up local factory to produce fortified food.” UN News Centre. May 26, 2010. http://www.un.org/apps/news/story.asp?NewsID=34810#.VHOaZsnfs-8

74 Chenomics International, 2009. 75 Dykstra, Jeff, 2014. 76 Ibid; Chenomics International. 77 Partners in Food Solutions website. http://www.partnersinfoodsolutions.com/who-we-are.78 Ibid; “Timor-Leste: UN helps set up local factory to produce fortified food.”79 DSM-WFP Steering Committee, 2014.

VIII. Looking ahead

Having been established since 2007, the DSM-WFP

partnership is well-placed to take stock of its progress

and assess emerging priorities and themes. Crucially, the

strong institutional foundation of the partnership cannot

be underestimated. The shared mission, complementary

competencies, and deep commitment and engagement

from both organizations have played a key role in

sustaining momentum and fostering broader shifts in the

nutrition ecosystem.

Going forward, there is scope for the partnership to build

upon the objectives of MoU-3 and continue to serve as

a leader in the nutrition space. In addition to scaling the

use of proven interventions and increasing the number

of beneficiaries reached, insights gained from expert

interviews and the evidence base indicate there may be

two potential opportunities:

(i) Further shape in-country production: Local

production of fortified foods could be considered

by the partnership for a number of reasons related

to food quality, delivery time, price, and demand.

Producing fortified foods has led to numerous

successes in a variety of countries, including Bolivia,

Angola, Zambia, Timor Leste, and Afghanistan.72, 73

Local production has enabled fresh goods to reach

beneficiaries earlier, resulting in increased shelf life of

products and, consequently, decreased transportation

costs, averted stock-outs, and more rapid response to

emergencies.74 Costs are also controlled when crops

are purchased from local farmers and local workers

are hired, with the added benefit of supporting local

agriculture and employment.75 By making the final

product less expensive, demand for fortified foods may

move beyond WFP beneficiaries. Demand may also

increase with the use of local foods, which are more

familiar to the target population. Although developing

local manufacturing capacity would require substantial

investment and an initial ramp-up period to reach large

enough volumes to realize a financial return, local

suppliers have significant potential to rapidly and cost-

effectively reach targeted communities and additional

beneficiaries with MNPs, super cereals, and other

fortified foods.

Local fortification requires strong processing capability,

as well as a sustainable business argument. DSM and

WFP have participated in a number of initiatives to

support local fortification of foods where appropriate.

For example, DSM consults with local food processers

and millers through Partners in Food Solutions77 and

WFP has assisted in the set-up of food fortification

factories.78 The partnership is also supporting efforts

to increase local production of its food basket where

appropriate in South Africa79 as well as through Project

Laser Beam by building local capacity in Indonesia to

produce LNS for children. There remains scope for

further engagement and coordination in this area. For

instance, a specific, targeted intervention could be

useful, such as the development of a technical toolkit,

or the partnership could potentially collaborate with

other stakeholders on a broader initiative.

(ii) Strengthen communication and advocacy strategy:

Although the partnership has existed for a number of

years with some striking accomplishments, a number

of external and internal stakeholders interviewed were

not fully aware of the formal DSM-WFP collaboration,

its interventions, and its impact. Interviewees knew of

each organization’s individual programming, but were

unclear about the partnership’s joint objectives.

As discussed in Section VI, more can be done to

strengthen messaging around the partnership to

external and internal stakeholders; many people within

WFP itself are not fully aware of the partnership or DSM.

Importantly, the partnership also has an opportunity to

increase the nutrition evidence base. For instance, there

are many different ways that nutrition interventions

are designed, delivered, and measured, and indeed, an

interviewee from GAIN noted the gap in guidelines on

effective program delivery and impact measurement

tools. Given the vast experience that the partnership

28

has in piloting and scaling up interventions in high-

burden countries, it may be valuable to record and

disseminate the knowledge acquired through delivery

in different contexts. Such guidelines or lessons can

further help position the DSM-WFP partnership as a

leader in the nutrition community. Importantly, such

communication can also spur the uptake of effective

interventions within the broader nutrition landscape and

other partnerships.

Sight and Life’s unique role in the partnership could also

be better highlighted. As a nutrition expert noted, “many

[partnerships] can’t do advocacy”, and Sight and Life’s

presence allows the partnership to advocate its impact and

push the nutrition agenda forward.

Any efforts in these areas – either by the partnership

itself or in collaboration with others – offers a valuable

opportunity for DSM-WFP to showcase itself as a

continued leader in this space, and advance the

momentum in the nutrition sector. Since its inception,

new products have been developed, tested, and scaled

up, and the partnership has been able to affect change

at both the global and country levels. The partnership is

now at a juncture where it is able to not only showcase

its accomplishments, but also to leverage its knowledge

and influence to innovate further in order to reach more

beneficiaries. Through these efforts, the DSM-WFP

partnership can continue to shape the nutrition agenda

in the years ahead, while paving the way for similarly

successful public-private collaborations.

DSM-WFP: A Partnership to Advance the Global Nutrition Agenda 29

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32

Annexes

Annex I: List of interviewees

Organization Name TitleInterview Date (all 2014)

DSM Klaus Kramer Director of Sight and Life August 14

DSM Georg SteigerHead NIP Product and Technology Development – HNH

August 18

DSM Ronnie PankhurstManaging Director of DSM Nutritional Products South Africa

September 18

WFP Saskia de Pee Consultant, Nutrition Advisory Office (OSN) August 12

WFP – Indonesia Elviyanti Martini Nutrition Officer August 18

WFP – Uganda Siti Halati Nutrition Officer August 19

WFP – Indonesia Nils GredeSenior Officer, Office of the Director Policy, Strategy and Programme Support Division WFP

August 19

WFP Charles JelenspergerFood Technologist, Food Safety & Quality (WFP OSPFQ)

August 28

WFP – Bangladesh Rezaul Karim Head Programme Implementation September 9

WFP Marco Selva Head, Private Partnerships Europe (WFP PGP) September 10

HFTAG Stan ZlotkinChief, Center for Global Health at the Hospital for Sick Children

August 27

HFTAG Luz Maria de RegilDirector of Research and Evaluation, Micronutrient Initiative (MI)

August 29

HFTAG Lynette NeufeldCurrently Director, Monitoring Learning and Research at GAIN

September 12

HFTAG Rafa Flores Senior Service Fellow, CDC October 8

USAID Judy Canahuati MCH, Nutrition & HIV Advisor August 28

USAID Jay DaniliukPrivate Sector Advisor, Bureau for Food Security, USAID

September 24

UNICEF Arnold TimmerHead of Nutrition at UNICEF Ethiopia; previously was Senior Advisor, Micronutrients Unit

August 21

Project Peanut Butter / Washington University, St Louis

Mark Manary Senior Researcher August 27

Bangladesh - JHSPH Parul Christian Professor of International Health September 18

Tufts University Patrick WebbDean for Academic Affairs and Alexander MacFarlane Professor of Public Policy at the Friedman School of Nutrition Science and Policy

September 19

DSM-WFP: A Partnership to Advance the Global Nutrition Agenda 33

Annex II: Illustrative list of programs and products developed by the DSM-WFP partnership

Product Type Title Countries Timeline Budget (USD) Program details

MNPProgram / Product Dev.

MNPKenya, Bolivia, others

2007-2009

Data not available

• Development of powders for use in malaria-endemic areas, of packaging solutions for target groups

• Efficacy study to evaluate impact of new product, and development of generic materials for training / marketing

MNPProgram / Product Dev.

MixMe distr. in Bangladesh

Bangladesh2008-2009

Data not available

• MixMe distribution to some 160,153 people was part of a comprehensive 13-month relief and rehabilitation assistance program to those affected by Cyclone Sidr, that included the provision of a general food ration, emergency school feeding and cash and food for work activities.

MNPProgram / Product Dev.

MixMe distr. in Nepal

Kenya (Kakuma refugee camp)

2009 2009: $28K

• Acceptability study for MixMe in Kakuma camp

• Communications efforts to support introduction included video and educational messages in the community

MNPProgram / Product Dev.

Vita-Mix-It distr. in Nepal

SE Nepal (7 refugee camps)

N/AData not available

• Aimed to reach all 8,500 children aged 6–59 months living in the camps. Mothers/caregivers were instructed to add a single one gram sachet, called Vita-Mix-It, into the child’s home-prepared food every other day.

MNPProgram / Product Dev.

MixMe distr. in Philippines

Philippines 2009-20122009-2012: $428K

• Enhance micronutrient intake among 16,600 children aged 6–23 months in selected areas of Central Luzon (Region III), in the form of MNP provided in single-dose sachets. The local product name was Vita Sangkap.

MNP Program

Prototype Nutrition Programming (part of PLB)

Indonesia2009-2014

2013: $136K

2014: $229K

• MNP added to local, food-based school meals

MNP ProgramMNP distribution

Indonesia 2013-20142013: $138K

2014: $238K

• Product testing, advocacy, and adjustments to meet local market needs

• 1000 day programming (local, instant FBF for 6-24 mo; developed LNS to prevent wasting during lean season; identifying product for PLW – currently using HEBs)

MNPProgram / Product Dev.

Vita-Sangkap distr. in response to Typhoons

Bangladesh 2013-20142013: $30K

2014: $73K

• Developed by ICDDR,B; production realized by Olympic Industries in close collaboration with WFP; now tested for impact on prevention of undernutrition in study by JHSPH, ICDDR,B, WFP.

34

Product Type Title Countries Timeline Budget (USD) Program details

Rice Program

School feeding fortification trials

Cambodia 2011-2013Data not available

• Results used to support rice fortification efforts beyond Cambodia, given the different rice fortification technologies tested and the number of partners involved

Rice ProgramSchool and safety net rice fortification

Bangladesh 2011-2013Data not available

• Government distribution of fortified rice in two major food based social safety net programs and WFP in their school feeding program

RiceProgram / Product Dev

Rice fortification

SE Asia, Ecuador

2014 2014: $495K

• Build strong partnerships in the rice value chain to support the scale up of rice fortification and strengthen the evidence base through field trials

• Develop communication material: articles, video, flyers, interviews, presentations

RUSFProgram / Product Dev

Corn-soya blend

Various locations

2007-2011Data not available

• Provide a learning platform for the wider nutrition community, as well as target capacity building within WFP. Modules co-developed in collaboration with the DSM Business Academy.

RUSF ProgramRUCFS in Bangladesh (part of PLB)

Various locations

2010-2013Data not available

• Develop special fortified blended food, Super Cereal Plus

• WFP High Energy Biscuits (HEB) – Small baked bread or cakes supplemented with a premix of vitamins and minerals - covers urgent needs in acute phase of an emergency situation; and to provide vitamins and minerals in regions/population where diet is subjected to nutritional deficiencies.

RUSF Program

Identification of food preferences among adults living with HIV in Thailand, Malawi

Thailand, Malawi

2011 – present

2012: $50

2013: $55K

2014: $50K

2015: $39K

• Develop culturally adapted nutritional supplements to treat malnutrition among adults, in particular among PLHIV and TB patients (qualitative research in Malawi & Thailand, product development, acceptability assessment)

RUSF Program LNS project Global 2013-20142013: $160K

2014: $175K

• Plans to further scale up of MNP within WFP reaching 3 million young and school age children

• Working to align with national policies, UNICEF and HFTAG, and innovate through product development

Annex II: Illustrative list of programs and products developed by the DSM-WFP partnership (continued)

DSM-WFP: A Partnership to Advance the Global Nutrition Agenda 35

2007

Bangladesh

Biagio, Coletto

Lederer, Silke

Reinartz, Wim

Wiarda, Lucas

Guatemala Crnomarkovic, Mladen

Kenya Eikelschulte, Mirka

WFP headquarters

(Rome)

Nieuwstad, Margot

Sambeek-van, Mascha

Turenhout-van, Dieuwke

2008

Bangladesh

Baijards, Richard

Bok, Josephine

Houtenbos, Nel

Kooij-van-de, Pank*

Zambia

Geerts, Joan

Geeve, Adri

Goosens, Elise

Graaf-van-de, Maarten

Heerebeek-van, Carolien

Kandarajah, Nandi

Kuppens, Marianne

Sharma, Vikram

Soemardji, Alfi

Tiersch, Petra

Twigt, Aad

Wunnik-van, Margot

Zimmer, Sabine

2009

Bangladesh

Ivan Bael, Patrick

Nabil, Enas

Nouwens, Ingrid

Roks, Eveline*

Ruiter, Helen

Theunissen, Claire

Egypt Bernsmeier, Thomas*

KenyaKoenders, Damiet

Roks, Eveline*

2010

MozambiqueGoralczyk, Regina

Vogel, Nicole

Zambia

Bernsmeier, Thomas*

Heeswijk-van, Monique

Kreutzer, Andrea

Kuciak, Marta

Nuijten, Saskia

Rahardjo, Yovita

Snakkers, Tom

Wierts, Aron

2011

Indonesia Dariiciuc, Dorina

Nepal McLean, Don

Philippines

Selin, Coralie

Smelker-Cheeseman, Tricia

ZambiaRyckembusch, David

Shuenquener, Rafael

2012

Colombia Monterrosa, Eva

Indonesia Ndayiragije, Prosper

Kenya Van Egmond, Ingrid

2013

Thailand Smit, Judith

WFP headquarters

(Rome)Gobert, Simon

2014

Congo Knossalla, Martin

Zambia Kuo, Grace

WFP headquarters

(Rome)Kooij-van-de, Pank*

Annex III: List of volunteer and secondment placements

*: Multiple placements

36

Annex IV: Joint Sight and Life-WFP publicationsAssessing the impact of micronutrient intervention

programs implemented under special circumstances—

Meeting report. de Pee S, Spiegel P, Kraemer K, Wilkinson

C, Bilukha O, Seal A, Macias K, Oman A, Fall AB, Yip R;

Peña-Rosas JP, West K, Zlotkin S, Bloem MW. Food Butr

Bull. 2011 Sept; 32(3):256-263(8).

“Castel Gandolfo Workshop: An introduction to the

impact of climate change, the economic crisis, and the

increase in the food prices on malnutrition.” Supplement:

The Impact of Climate Change, the Economic Crisis, and

the Increase in Food Prices on Malnutrition. Bloem MW,

Semba RD, Kraemer K. J. Nutr. 2010 Jan; 140:132S-135S.

Consumption of micronutrient-fortified milk and noodles

is associated with lower risk of stunting in preschool-

aged children in Indonesia. Semba RD, Moench-Pfanner

R, Sun K, de Pee S, Akhter N, Rah JH, Campbell AA,

Badham J, Bloem MW, Kraemer K. Food Nutr Bull. 2011

Dec; 32(4):347-53.

Cost of the Diet (CoD) tool: first results from Indonesia

and applications for policy discussion on food and

nutrition security. Baldi G, Martini E, Catharina M,

Muslimatun S, Fahmida U, Jahari AB, Hardinsyah, Frega R,

Geniez P, Grede N, Minarto, Bloem MW, de Pee S. Food

Nutr Bull. 2013 Jun; 34(2 Suppl):S35-42.

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