2005-2006 Annual Report

Annual Report 2005-2006

Malnutrition remains the world’s most serious health problem, according to a World Bank Report published in 2006.

It is associated, directly or indirectly, with more than 50 percent of all child mortality.

In low and middle income countries, nearly one-third of all people suffer deficiencies of micronutrients.

These deficiencies can undermine one’s health, education and productivity, cause life-long damage and be passed on from one generation to the next — the children of underweight, stunted mothers are often themselves underweight and stunted.

The report highlights the growing global consensus for large-scale action to improve nutrition and the most promising interventions.

Above all, the World Bank calls for investments in nutrition for pregnant women and children under two. These rank above investments in trade liberalization, malaria, and water and sanitation, in terms of immediate benefits.Repositioning Nutrition as Central to Development: A Strategy for Large-Scale Development, Washington, DC, World Bank, 2006.

2005 - 2006 Annual Report | �

Introduction: A businesslike approach to fighting malnutrition 4

Message from the Chair: A catalyst for ending malnutrition 5

Message from the Executive Director: New alliances promise better nutrition worldwide 6

GAIN makes the 6th Annual Fast 50 List 8

GAIN’s Alliance Role 9

GAIN Business Alliance Progress Report 2005-2006 10

GAIN Business Alliance: the concept 11

Everyone benefits when business tackles malnutrition 12

Accountability governs strategic partnerships 14

Ten Year Strategy for the Reduction of Vitamin and Mineral Deficiencies 15

A world of projects 17

Performance measurement and research 26

Advocacy and communication 28

Infant and young child nutrition 30

Board of Directors 32

Financial Statement 35

Auditor’s Report 38

Acknowledgement and photo credits 39

GAIN’s mission is to reduce malnutrition through the use of food fortification and other strategies aimed at improving the health and nutrition of populations at risk, particularly children and women.

CONTENT

� | Global Alliance for Improved Nutrition

A businesslike approach to fighting malnutrition

GAIN fulfils its mission by building alliances of public and private partners and providing financial support and technical expertise for improving nutrition. In its work with the private sector, GAIN has already distinguished itself by promoting the use of innovative business models to mobilize commercial markets in a sustainable way to fight malnutrition. GAIN also places a critical emphasis on performance management to ensure that its programs provide the maximum benefit to target populations.

GAIN focuses on:

u Food fortification

u Infant and young child nutrition

u Investment and partnerships

u Performance measurement and research

u Communication and advocacy

GAIN was created at the United Nations General Assembly’s Special Session on Children in 2002.

Established as a Swiss foundation, this Global Alliance is now funded by the Bill and Melinda Gates Foundation, the United States Agency for International Development (USAID) and the Canadian International Development Agency (CIDA). A key partner is the World Bank, which acts as interim trustee and supports program implementation. GAIN also has extensive and active partnerships with businesses, governments and civil society organizations and works closely with a range of international agencies.

GAIN has set itself a target of reaching 1 billion people with food fortification programs. Current projects are expected to reach 600 million people when at full scale and new strategies are being developed to reach 400 million more.


A catalyst for ending malnutrition

As a definitive 2006 World Bank report notes, malnutrition is associ-ated with more than half of all deaths among children, and nearly one-third of all people in developing countries suffer from micronutri-ent deficiencies.1 The health and social consequences are appalling, particularly for children and mothers. A diet lacking in vital nutrients stunts a person's growth and results in lower-than-average weight, weak muscles and impaired vision. Poor nutrition also undermines cognitive development and resistance to common illnesses. Those who survive malnutrition in childhood may experience the negative effects throughout their lives, as fragile health limits their growth and undermines their ability to learn in school.

In its first four years, GAIN has focused hard on identifying new ways to overcome nutritional deficiencies. It has used its experience and expertise to help establish innovative public-private investments to put nutritious, affordable foods on the market and reduce malnutri-tion. GAIN's greatest strength is its technical assistance and power as a catalyst–marshalling the technological and commercial acumen of the food industry to meet the nutritional standards set by national governments. This year GAIN has made further progress in develop-ing a global forum of companies working together to identify new business models and mechanisms for meeting the nutritional needs of hundreds of millions of consumers.

With offices in China, India and South Africa, as well as Geneva, GAIN is now at the forefront of efforts to address malnutrition and on track to achieve its goal of helping a billion people worldwide improve their nutrition and lead healthier, more productive lives.

Jay Naidoo

Chair, Global Alliance for Improved Nutrition

1 Repositioning Nutrition as Central to Development: A Strategy for Large-Scale Development, Washington,

DC, World Bank, 2006 p. ix.


New alliances promise better nutrition worldwide

In 2005-2006, GAIN increased its global leverage to improve nutrition, and took strides towards its ambitious goals. Working with business, policy-makers and governments, we have again been able to devise and implement the best solutions to address malnutrition. When the new projects approved in 2006 are added to our portfolio, and all are brought to full scale, GAIN will be supporting the fortification of foods for 600 million people.

Grants awarded by GAIN, mostly through a competitive process, are now funding major projects in 18 countries. Our most recent food fortification projects will add vitamins and minerals to wheat flour in Egypt, vegetable oil in Bangladesh, and oil and flour in Uganda. Four country projects are about to complete their three-year life cycle. GAIN is also funding and providing technical assistance to targeted projects, for example by providing nutrient-dense meals to people living with HIV in India.

More than 200 global and local companies have now joined GAIN’s Business Al-liance, which tackles malnutrition on a global basis through regional Alliances in North America, Europe, Africa, India and China. The Global Annual Forum, held first in Beijing in 2005 and most recently in New Delhi in March 2007, has created a space for companies to learn from each other and collaborate nationally, region-ally and globally in the development and marketing of fortified foods. This report will focus in part on the increasing role that business is now playing in the field of nutrition and examine the partnerships being forged.

GAIN’s partnership program is subject to careful performance measurement and monitoring with results reported regularly to GAIN’s Board.

As the evidence now clearly shows, addressing malnutrition is among the most direct ways of improving the health of people, particularly if we focus on the early years of a child’s life. GAIN has therefore established a second grant program for Infant and Young Child Nutrition (IYCN).

Time is short for those suffering malnutrition and the damage wrought can be life-long. We are mindful of this as we marshal resources and mobilize globally towards our ambitious goals.

Marc Van Ameringen

Executive Director, GAIN

GAIN is included in the 2007 Fast 50!

Geneva-based Global Alliance for Improved Nutrition (GAIN), along with food giants such as Groupe Danone, Unilever, and Cargill, are working to fight “hidden hunger.” Unlike traditional aid campaigns, GAIN looks to build new and sustainable markets for nutritious foods.

“Our job is really to be a catalyst and make sure the private sector delivers food to the poor in the long term,” says Bérangère Magarinos, senior manager of GAIN’s Investments and Partnerships Program. “If the company defines the project as charitable only, we would not be involved. It’s got to go through a business model.”Fast Company March 2007, p 82, ISSN 1085-9241


GAIN makes the 6th Annual Fast 50 List “The Fast 50 is Fast Company magazine’s annual readers’ challenge, a worldwide search for ordinary people doing extraordinary things. Fast 50’s goal is to remind the world of all the good that’s created when passionate people with big ideas and strong convictions are deter-mined to make a difference.

Each year, the challenge generates thousands of entries and tens of thousands of comments from around the world, and results in high-profile recognition of 50 leaders, innovators, and technology pio-neers.”

http://www.fastcompany.com/fast50_07/aboutthefast50.html

A selection of fortified products brought to the market through GAIN’s partnerships.

REPORT FROM THE FUTURE: 50 PROFIT-DRIVEN SOLUTIONS FOR WHAT AILS THE PLANET

The 6th AnnualFAST 50


“Business leaders increasingly go beyond just meeting the bottom line. A growing number are aiming to change the world they live in, find new ways to get things done and contribute to broader goals such as improving the nutrition and health status of those who are at risk, especially the poor. These are the people who make up the GAIN Business Alliance and they are the ones, who, through collaborative action, will help make malnutrition a thing of the past.”

Paulus Verschuren

Senior Director, Partnership Development, Unilever Chair of the GAIN Business Alliance

GAIN’s Alliance Role

10 | Global Alliance for Improved Nutrition

GAIN Business Alliance Progress Report 2005-2006

Events and projects

2005

u September: First GAIN commitment for the Inter-national Clinton Initiative focusing on the Creation of the GAIN Business Alliance.

u September: Signing of the GAIN - Seabord MOU focusing on flour fortification in Democratic Repub-lic of Congo (DRC).

u October: Inaugural meeting of the GAIN Global Business Alliance in Beijing attracts 150 leaders from throughout the food industry, academia, the Chinese government and civil society. The meet-ing concludes with the Beijing Declaration on Food Fortification, the launch of the China Regional Busi-ness Alliance and agreement by Unilever to serve as the first chair of the Business Alliance.

u October: GAIN - Tetra Pak MOU is signed.

u December: First Planning Meeting of the China Regional Business Alliance, Beijing.

u December: Launch of Tetra Pak – Helen Keller International (HKI) Partnership for school feeding program in Nigeria.

2006

u February: Signing of the GAIN - Danone MOU focusing on GAIN technical assistance in Bangla-desh.

u March: Launch of the GAIN Business Alliance Eu-rope Chapter in London. Twenty European business leaders, academics and public officials meet to pro-mote the involvement of businesses in food fortifi-cation in developing countries.

u June: GAIN Business Alliance Working Group meets in Geneva, Switzerland to further develop the alliance structure.

u August: Inaugural meeting with Captains of Indian Industry, New Delhi. Thirty senior executives from the food and beverage, packaging, condiment and information technology industries meet to explore options to eliminate micronutrient deficiencies and how Indian businesses can help.

u September: Marc Van Ameringen updates the GAIN Commitment to the International Clinton Ini-tiative, announcing the creation of a GAIN Business Alliance India Chapter.

u September: Launch of the Nasarawa School Feed-ing project supported by Tetra Pak (West Africa) and GAIN.

u October: First meeting of the GAIN Business Alliance Africa Advisory Group, Johannesburg. Thirty-one business leaders from eight countries meet to boost actions by companies, development partners and governments, and to advise on ways to expand the role of African business in tackling malnutrition.

u November: Launch of the GAIN Business Alliance North American Chapter in Seattle, USA. More than 150 representatives of food, agribusiness, milling, transportation and retail industries attend. Procter & Gamble agrees to serve as Chair. Cargill commits to work with GAIN on oil production and to increase access to fortified products in emergencies. Cargill GAIN MOU is signed.

u November: GAIN hosts a CEOs’ Dinner in New Delhi in preparation for the 2007 launch of GAIN Business Alliance India. Sixty leaders from the food, flour, media and health sectors attend, to-gether with officials, including the Indian Minister of State for External Affairs Anand Sharma.

u December: Annual Meeting of the China Regional Business Alliance, Beijing. International and Chi-nese producers of fortified food, distributors and retailers, Chinese government officials, media and academic representatives are among the 45 par-ticipants.

u March-December: GAIN develops social market-ing plan for Grameen Danone Foods project. GAIN also began an efficacy study of the product’s im-pact on nutritional status.

French football star Zinedine Zidane signing an auto-graph in Bangladesh during the launch of the Danone fortified dairy project.

“The size and complexity of these public health challenges require a partnership approach that brings together the collective skills, competencies and resources from the public sector, private sector and civil society. I am confident that GAIN and its business alliance partners can develop effective and sustainable solutions.”

Paulus Verschuren Senior Director, Partnership

Development, Unilever

Chair of the

GAIN Business Alliance

2005 - 2006 Annual Report | 11

The GAIN Business Alliance is a global network dedicated to market-based solutions to reduce vitamin and mineral deficiencies. Its work complements GAIN’s national and international programs.

Markets in the developing world are expanding rapidly with purchasing power now in the hands of some 4 billion consumers. Academics and policy experts call this group the “base of the pyramid”, however it is a fragile base as many of its members are among the 2 billion people who lack the vitamins and minerals necessary to lead healthy and productive lives.

Both consumers and companies stand to gain by the development of high-quality fortified foods for growing markets in India, China, Brazil, South Africa and elsewhere. The innovative initiatives of Gra-meen Danone Foods in Bangladesh and of Tetra Pak in Nigeria demon-strate this.

Over the past year, the strength of this business case has convinced a growing number of major players worldwide to join the GAIN Business Alliance. The conceptual framework for the GAIN Business Alliance has been developed with the assistance of partners from the academic, pri-vate, public and civil society sec-tors. Dr. Jane Nelson, Director of Harvard University’s Corporate Social Responsibility Initiative and one of the primary architects of the Business Alliance approach, notes that private sector action is critical

to tackling malnutrition. Govern-ments must take the lead in enact-ing legislation and developing policy guidelines, she notes, but proven interventions and technologies ex-ist to address undernutrition, and the corporate sector’s role is to take them to scale.1

Individual and collective action

The GAIN Business Alliance is based on the principle that companies do best when they address malnutri-tion by working in their own sec-tors and collectively through local and global business alliances. In the words of Dr. Nelson, this “lead-ership alliance” framework helps “harness business resources, pro-vides a potential opportunity for companies to leverage their indi-vidual contributions, spread their risks, share lessons, and over time increase their impact on-the-ground”.2

Food fortification is among the most cost-effective and promising ways to address world hunger and poverty — so it is the right thing to do. But it also makes sound busi-ness sense. Nearly every step in fortified food production and con-sumption offers opportunities for business, as it calls for technical and research expertise, production capacity, distribution systems and community partnerships. It also al-lows for the development of large and sustainable new markets, as it improves not only the health, but also the prosperity, of billions of potential new consumers.

GAIN Business Alliance: the concept

1 Jane Nelson, Business as a Partner in Overcoming Malnutrition: An Agenda for Ac-

tion, Cambridge, Mass./New York/Washington, Harvard University/Clinton Global

Initiative/World Bank, 2006.

2 Jane Nelson, 2006.


Vitamin and mineral deficiencies harm one in three people in low and middle income countries — impairing minds, bodies, productivity, and the economic progress of nations. GAIN and its Business Alliance make the case, therefore, that tackling malnutrition is not only good for global health, it’s good for business.

Bringing better food to the world’s poor is a first step in developing new markets — including up to 4 billion people in the developing world. Although per capita income in this market is low, sheer numbers ensure increased profitability through economies of scale. As well, research has shown that people entering the “base of the pyramid” have purchasing power, are brand conscious and are eager for new products tailored to their needs and aspirations. Companies that focus at this level stand to grow their market share and maintain a competitive advantage.

Everyone benefits when business tackles malnutrition

Grameen Danone feeds children, fuels economiesEstablished in March 2006, Grameen Danone Foods brings together the acumen of the celebrated micro-finance and social business enterprise with the expertise of one of the world’s leading food companies. Grameen Danone Foods’ mission is to make healthy nutritious food accessible on a daily basis to people in Bangladesh with low incomes and vitamin and mineral deficiencies. As well, it aims to alleviate poverty through the implementation of an innovative business model.

Grameen Danone Foods will support, for example, the creation of indepen-dent businesses and job opportuni-ties in the farming, processing, sales and distribution sectors. Special em-phasis will be placed on micro-financing so-lutions together with professional training to local partners. The ini-tiative will begin with the launch of an afford-able yogurt product, specifically developed to meet the nutritional needs of Bangladeshi children.

GAIN is designing and rolling out a social marketing campaign for the yogurt and conducting an efficacy study. The prospective randomized controlled trial will recruit six-to-nine-year-old children living in the Bogra district of Bangladesh to examine how the consumption of the iron-, zinc-, vitamin A- and iodine-fortified yogurt affects their physical growth and mental and motor development and intelligence-quotient.

“P&G has a long history of developing fortified products. We are prepared to share the knowledge, experience and expertise we’ve acquired from the successes and challenges that have come from marketing these products and we hope other companies will follow this example.”

Ethel Cormier, Associate Director, Procter & Gamble and Chair of the North

American chapter of the GAIN Business Alliance, November 2006

2005 - 2006 Annual Report | 1�

Tetra Pak partnership boosts nutrition in Nigerian schoolsIn September 2005, the President of Nigeria endorsed the imple-mentation of a Pilot School Feed-ing Program through a partnership between the State of Nasarawa and Tetra Pak Food for Develop-ment (West Africa) Ltd. The pro-gram, which has the support of Tetra Pak’s Global Office, aims to distribute a fortified liquid supple-ment called Nutri-Sip™ to all pri-mary school children in Nasarawa State, estimated at approximately 400,000. Nutri-Sip is a nutritious drink based on maize and soy, and fortified with 27 micronutrients. Tetra Pak is providing technical ad-vice to the program, assisting in the development of management structures, addressing logistical challenges and helping to raise awareness about the program in communities.

GAIN is assisting Tetra Pak (West Africa) Ltd. by con-ducting an efficacy study of Nutri-Sip among Nigerian primary school children. Conducted in partnership with Helen Keller Interna-tional (HKI) and the Nu-trition Division of Cornell University, the study looks at the effect of Nutri-Sip on blood levels of hemoglobin, iron, zinc, and vitamin A and on growth and school performance. GAIN’s intro-duction of scientific best practices to generate the efficacy data is expected to contribute significantly to the next step in the pro-gram—scaling up to reach 27 million primary school

children throughout Nigeria.

Increasing the supply of, and access to, fortified foods also provides long-term support for local economies by building infrastructure, creating jobs and stimulating sustained demand for products. Governments, civil society and philanthropic agencies all have a role to play in food fortification, but businesses are best equipped to develop and deliver fortified foods.

GAIN’s partnerships encourage the participation of a wide range of public and private stakeholders and this approach is already bearing fruit. By partnering with private companies, public and not-for-profit agencies can enhance their influence within industry sectors and communities. By partnering with public agencies and civil society groups, businesses benefit in complex ways that may lead to improvements in their core operations, research and development opportunities and market expansion.

GAIN and its Business Alliance are demonstrating that it is both economically viable and socially responsible to harness the capacity of industry and market-based approaches to improve nutrition.

1� | Global Alliance for Improved Nutrition

GAIN's raison d'être has always been to forge a dynamic public-private alliance in which the corporate sector plays a central role in innovative food fortification programs. One of its first tasks in 2003, therefore, was to develop guidelines for partnerships in this alliance, with a clear definition of roles and responsibilities and an emphasis on due diligence.

Updated guidelines for GAIN’s business partnerships were approved by the GAIN Board in November 2006. They are adapted from the Partnership Governance and Accountability (PGA) Framework developed by AccountAbility1 and USAID. The Guidelines provide management tools or filters to enhance the effectiveness, accountability and governance of partnerships, from

Accountability governs strategic partnerships

partner and project selection through work planning and monitoring to evaluation.

Partnership projects are also subject to the same design and review process as other GAIN projects. This means that decisions are based not only on the selection of a corporate partner, but also on other strategic considerations. These include the expected beneficiary reach of a project, its outreach to specific vulnerable groups and its coherence with the national nutrition program and with other GAIN activities in the country. As well, GAIN looks for projects that have the potential to raise awareness about malnutrition, and that can leverage other resources — globally and locally — for its elimination.

1 AccountAbility is a London-based, not-for-profit research institute dedicated to the

promotion of approaches to accountability that support sustainable development.

The institute's Chief Executive Officer is Dr. Simon Zadek.

"Well designed food fortification programs are essential to improving the health of people in the developing world, especially children. Partnership initiatives like the GAIN Business Alliance have the opportunity to help tackle these issues in the most effective and efficient way possible."

Daniel Runde Director, Office of Global Development Alliances,

U.S. Agency for International Development, Seattle, November 2006.


trient malnutrition, and the feasi-bility of promoting a global strat-egy to reduce vitamin and mineral deficiencies.

The resulting Vitamin and Mineral Deficiencies Technical Situation Analysis looks at four key issues: the magnitude of malnutrition worldwide; ways of reducing defi-ciencies in vitamin A, iron, iodine, zinc and folate; the costs and ben-efits of reducing these deficiencies; and the role of international orga-nizations in the drive to improve the micronutrient health of those most in need. It argues that seri-ous gaps remain in addressing this public health crisis and there are few safeguards to ensure that the gains already made are sustained. It also emphasizes that malnutri-tion has long-lasting effects on in-dividuals and can undermine the socio-economic development of countries.

The Stakeholder Perceptions Anal-ysis, meanwhile, reveals that key inter-governmental and nongov-ernmental organizations, private corporations, academic institutions and donor agencies would support a global strategy to address the challenges of micronutrient malnu-trition.

Phase II: Strategic FrameworkThe Reference Group’s other key task was to outline a framework for the Strategy. A founding premise was that different solutions to micronutrient malnutrition are needed in different contexts, and that the combination of fortification, supplementation and

Ten Year Strategy for the Reduction of Vitamin and Mineral Deficiencies

Improving nutrition is now widely understood as key to achieving the United Nations Millennium Devel-opment Goals by 2015 and to re-ducing poverty. With this in mind, individuals representing govern-ments, non-governmental organi-zations, academia and the private sector have forged a global coali-tion to promote a Ten Year Strategy for the Reduction of Vitamin and Mineral Deficiencies.

GAIN has facilitated the develop-ment of the Strategy which receives operational support from the World Bank. Members of the Strategy’s executive Reference Group include GAIN as well as the Academy for Educational Development, the Bill & Melinda Gates Foundation, the Development Bank of Southern Africa, H.J. Heinz Company, Har-vest Plus/IFPRI, Helen Keller In-ternational, International Business Leaders Forum, the Micronutrient Initiative, New Economic Partner-ship for Africa’s Development, Uni-lever, UNICEF, United States Agen-cy for International Development, U.S. Centers for Disease Control and Prevention, the World Bank, World Food Programme, and World Health Organization. New partners will come on board as the process evolves.

Work on the Strategy began in 2005 and has, to date, unfolded in two phases.

Phase I: Situational analysis During its first year, September 2005 – August 2006, the Reference Group commissioned a study of the nature and magnitude of micronu-

other food-based approaches will vary depending on local needs. Another was that public-private collaboration should be integral to the framework. Working Groups serve as the pillars of the framework, and are responsible for informing the strategy.

Working Groups have been formed to address: data; fortification; supplementation; other food-based approaches; regional strategies for Africa, Asia and Latin America; and advocacy, social mobilization and communications. The Groups bring together expertise from across the spectrum of partner organiza-tions, including the private sector and civil society; a different agency is responsible for overseeing each Group. The Working Groups have four global objectives all aimed at integrated programing on mi-cronutrients at the country level: identifying priority actions for the short and medium terms; agree-ing on the division of labour, roles and responsibilities; identifying champions and projects worthy of pilot studies and scale-up; and as-sessing resource requirements and planning for the mobilization of these resources.


Group rallies support for strategy in Africa

The Africa Working Group pro-vides an example of a Working Group in action. Its objective is to formulate a regional strat-egy that respects national spe-cificities, builds on existing ini-

tiatives in countries, allows for the scale-up of chosen projects, and enables greater investment in reducing vitamin and mineral deficiencies.

To begin work towards this objective, the Group created a technical team of experts from the Development Bank of Southern Africa, New Partner-ship for Africa’s Development and GAIN to consult widely in the region, hear national con-cerns and mobilize support for the Ten Year Strategy. At the end of this process, the team presented a policy brief, which won the endorsement of African states attending the Food Secu-rity Summit in Abuja, Nigeria in December 2006.

This official endorsement sets the stage for implementation at the sub-regional and national levels. The second phase of the Group’s work program is focused on strengthening and creating new strategic partnerships, facilitating the design and implementation of pilot projects in high-burden countries, and increasing coordination for more effective alignment of resources.

Ten Year Strategy for the Reduction of Vitamin and Mineral Deficiencies


A world of projectsAs well as forging alliances, GAIN provides grants on a competitive basis to support food fortification projects at the national and regional levels. This seed money acts as a catalyst for promising multisectoral initiatives to add essential vitamins and minerals to basic foods — flour, cooking oil, fish and soy sauce, for example — that are consumed by populations most in need.

The next section of this report gives an overview of GAIN’s growing portfolio of projects, underway, worldwide. It also provides snapshots of four of GAIN’s most advanced country-level projects: in China, Pakistan, South Africa and Morocco.

National projectsGAIN has awarded grants worth US$ 44.2 million, supporting 19 projects in 17 countries around the world. Some are new projects, others have been running for almost three years and are nearing full-scale. By 2011, when at full-scale, GAIN estimates that they will provide affordable, high-quality fortified foods to no fewer than 600 million people in Asia, Africa and the Americas.

Wherever GAIN funds a national project, it also supports the establishment of a National Fortification Alliance which helps businesses partner with government agencies and civil society groups to fast-track food fortification. Most national projects support five components: • production and distribution of fortified food; • strengthening the regulatory and legislative environ-

ment in support of quality assurance and food safety;• social marketing and communication; • public health monitoring and evaluation; and • program management.

GAIN awards grants through a competitive bidding process open to National Fortification Alliances. Depending on the grants, GAIN may cover the development of legislation, the cost of new fortification equipment and premix, the strength-ening of food control systems, and the initial vitamins and minerals to be added to foods. GAIN also provides technical support and training to its project partners — factory manag-ers and millers, business and community leaders, government officials and others — so that they are able take over owner-ship of the project as GAIN’s involvement comes to an end.

Project profilesOver the next year, four of GAIN’s projects will be coming to the end of their initial three year phase; the following synopses gives an indication of results achieved and lessons learnt.


Boliviaql™

´©o°Æt

Fortified food

n Cotton seed oil

u Fish sauce

m Maize meal

q Milk

¢ Soy sauce

p Sugar

l Vegetable oil

™ Wheat flour

Vitamins and nutrients

´ Iron

© Folic acid

o Vitamin A

° Other B-vitamins

Æ Zinc

t Vitamine C, D and E

Malin o

Moroccol™

´©o°t

Côte d’Ivoire™l ´©o

Ghana™l

´©o°Æ

DominicanRepublicp™ ´©o°

Country Food vehicleProjected reach (number of people in millions) when at full-scale

FortificantGrant awarded US$ millions

Bangladesh Vegetable oil 128.4 Vitamin A 3.0Bolivia Vegetable oil,

wheat flour, milk7.7 Oil: vitamin A

Wheat: iron, folic acid, and other B-vitamins Milk: iron, zinc, vitamin A, C, D and E

2.6

China (flour) Wheat flour 9.4 Iron (NaFeEDTA), zinc, folic acid and other B-vitamins

1.8

China (flour policy) Wheat flour N/A N/A 0.6China (soy) Soy sauce 97.0 Iron (NaFeEDTA) 3.0Côte d’Ivoire Vegetable oil,

wheat flour15.0 Oil: vitamin A

Wheat: Iron, folic acid3.0

Dominican Republic Sugar, wheat flour

6.9 Sugar: vitamin A Wheat: iron, folic acid, and other B-vitamins

1.9

Egypt Wheat flour 50.0 Iron, folic acid 3.0Georgia Wheat flour 4.3 Iron, folic acid 1.2Ghana Vegetable oil,

wheat flour19.5 Oil: vitamin A

Wheat: iron, zinc, vitamin A, folic acid, and other B-vitamins

1.8

Egypt™ ´©


Nigeriapl™ ´o°

South Africam™ ´©o°Æ

Zambiam ´©o°Æ

Uganda™lm ´©o°Æ

Egypt™ ´©

Georgia™ ´©

Uzbekistan™ ´©°Æ

Pakistan™ ´©

China (soy)¢ ´

Bangladeshl o

China (wheat)™ ´©°Æ

Viet Namu ´

Country Food vehicleProjected reach (number of people in millions) when at full-scale

FortificantGrant awarded US$ millions

Mali Cottonseed oil 10.0 Vitamin A 1.1

Morocco Vegetable oil, wheat flour

30.5 Oil: vitamin A, vitamin D Wheat: iron, folic acid and other B-vitamins

3.0

Nigeria Wheat flour, vegetable oil, sugar

95.9 Wheat: iron, vitamin A, B-vitamins Oil: vitamin A Sugar: vitamin A

2.4

Pakistan Wheat flour (Atta) 74.2 Iron (NaFeEDTA), folic acid 3.0

South Africa Maize meal, wheat flour

38.7 Iron, zinc, vitamin A, folic acid, and other B-vitamins

2.8

Uganda Vegetable oil, wheat flour, maize meal

26.4 Oil: vitamin AWheat and Maize: iron, vitamin A, folic acid, zinc, and other B-vitamins

2.4

Uzbekistan Wheat flour 9.6 Iron, zinc, folic acid, and other B-vitamins

2.2

Viet Nam Fish sauce 21.0 Iron (NaFeEDTA) 3.0

Zambia Maize meal 6.1 Iron (NaFeEDTA), zinc, vitamin A, folic acid and other B-vitamins

2.4


BackgroundPrevalence rates of iron deficiency anemia in many rural areas of China can be as high as 41.2% among women of reproductive age and 50.3% among chil-dren aged 6-12 months.

The government of China has recognized the urgent need to address the problem of vitamin and mineral deficiencies. Food fortification was identified as a key strategy in 1997 and has been integrated into several national strategic plans and government policy papers related to nutrition.

GAIN’s soy sauce projectSoy sauce was identified as an ideal vehicle for for-tification with iron since it is widely consumed on a consistent basis by 70% of the population.

The project is managed by the Chinese Center for Dis-ease Control and Prevention in cooperation with the NFA.

GAIN provides seed money to establish large-scale iron fortification of soy sauce in seven Chinese prov-inces. National legislation allows for participation on a voluntary basis.

Fortifying soy sauce in China

Guangxi

GuizhouGuangdong

Jiangsu

BEIJINGHebei

Jilin

Achievements

¸ 19 manufacturers have been registered, trained and equipped to fortify soy sauce. Production exceeded over 80,000 MT/year.

¸ 20 sentinel sites established for monitoring im-pact on iron deficiency and knowledge, attitude and practice (KAP) among those consuming the soy sauce. Sixteen sites have completed a one-year survey after launching and found on aver-age a reduction of 28% in anemia rates among women of reproductive age.

¸ Quality control and assurance system estab-lished. Regular inspections and testing found soy sauce samples in compliance with existing national standards.

¸ Consumer education launched in seven provinc-es, attracting extensive media coverage.

¸ Chinese (www.cdc-ffo.cn) and English (www.cdc-ffo.cn/en) project web sites created.

Project period September 2003 - March 2007

Food Vehicle Soy sauce

Fortificant Iron (NaFeEDTA)

Grant awarded US$ 3 million

Population reach* 97 million

Executing agency

Chinese Center for Disease Control and Prevention

*Projection of those reached when project is at full scale (five years after its start).


Jilin Fortifying flour in Pakistan

BackgroundIn response to anemia prevalence among women of reproductive age and young children at 50% percent and 36% respectively, Pakistan developed a ten-year program to fortify atta wheat flour with iron and folic acid.

Wheat is the major staple food in Pakistan with people at all levels of society consuming up to 9.27 kg per month. The country is self-sufficient in wheat production. In its first five years, the project is focusing on enabling large- and medium-sized millers to fortify their production. Thereafter, 50,000 small-scale grinders, known as chakkies, will be included in the program.

Lessons learnt from other food fortification projects un-derway in Pakistan, including those for salt and ghee oil, will inform the new project.

GAIN’s atta flour projectThe GAIN-funded atta wheat flour fortification project started in July 2005. The project is managed by a highly motivated Project Management Unit under the Nutrition Wing of the Ministry of Health in collaboration with the multi-sectoral NFA, the Micronutrient Initiative (MI) and the Flour Millers Association.

The GAIN grant was awarded to establish large-scale wheat flour fortification in Pakistan and to lay the founda-tion for universal wheat flour fortification. Within the first three years, 300 roller mills will be gradually upgraded and by year five, 600 mills will participate in the program. Quality assurance as well as advocacy and public educa-tion campaigns are being made a priority to ensure the availability of high–quality, affordable fortified flour and to stimulate demand. It is estimated that when the proj-ect is running at full scale in 2010, 45% of Pakistan’s atta flour will be fortified and 74.2 million people will be con-suming this product regularly. Efforts will also be made to pass legislation that makes flour fortification mandatory.

Achievements

¸ Project Management Unit (PMU) under the Nu-trition Wing of the Ministry of Health has been established and is fully functional.

¸ The atta wheat flour market study is underway, with results to be available mid 2007.

¸ Bids for micro-feeders and fortificant have been reviewed and final selection of firms will take place mid 2007.

¸ Guidelines and training materials for industrial quality assurance and control, as well as for in-spection and enforcement, will be finalized soon.

¸ The case for the initiation of the legislative proc-ess has been forwarded to the Minister.

¸ A comprehensive social marketing and communi-cation strategy, covering education and advocacy materials, as well as fortification logo and tag-line, has been finalized.

¸ Baseline survey of consumer knowledge, atti-tudes and practices (KAP) is nearing completion.

¸ Project launched at national level with participa-tion of Prime Minister Shaukat Aziz.

¸ Launch of the fortification process at mill-level with Minister of Health MOHammed Naseer Khan.

Project period July 2005 - June 2008

Food vehicle Wheat flour (atta)

Fortificant Iron (NaFeEDTA), folic acid

Grant awarded US$ 3 million

Population reach* 74.2 million

Executing agency

Nutrition Wing, Ministry of Health


GAIN funding used to leverage additional contributions from public and private partners and send micronutrient malnutrition to the top of the national agenda.

In Pakistan, the GAIN project has been used to increase the visibility of micronutrient malnutrition and catalyse na-tional action. The PMU/MOH and other NFA partners have successfully advocated for additional resources from both public and private sector sources. The US$ 3 million GAIN grant will leverage an additional US$ 2.5 million commit-ment from the Ministry of Health and an additional US$ 7.7 million commitment from private sector partners during the next two years to ensure that atta flour prices remain stable and affordable to low income consumers.


BackgroundWheat flour and maize meal are widely consumed in South Africa with maize meal being the staple food for the poorest segment of the population, including over 80% of all children under three.

As early as 1996, stakeholders discussed the develop-ment of a national staple food fortification program and produced a set of recommendations. The follow-ing year this led to the formation of a multisectoral National Food Fortification Task Group and, prior to 2001, several preparatory activities were implement-ed with support from the Micronutrient Initiative (MI) and UNICEF.

These activities generated broad political support. Fresh research meanwhile highlighted the scope of micronutrient deficiencies in the country, leading to calls for further government action. In October 2002, the South African government introduced legislation in support of mandatory fortification of wheat flour and maize meal with eight vitamins and minerals. These fortifying elements are expected to provide up to 40% of the Recommended Daily Allowance.

GAIN’s projectGAIN’s grant allowed the national fortification program, previously supported by MI, UNICEF and USAID/MOST, to expand throughout South Africa.

The country’s milling industry is highly centralized and an important number of millers are affiliated to the National Chamber of Millers (NCM) and the Nation-al Association of Maize Millers (NAMM). Members of these two bodies produce 97% of the wheat flour and 70-85% of the maize meal in South Africa.

The large market share and strong commitment of the associated millers and other stakeholders made it possible to rapidly scale up and provide almost univer-sal fortification of the two staple foods within a short period. It remains a challenge, however, to develop the commitment of small-scale millers at the local lev-el, as these producers are largely unregulated. Small maize millers account for up to 30% of market share and serve some of the poorest people.

Fortifying flour in South Africa

Achievements

¸ Over 90% of wheat flour and 70-85% of maize meal is now fortified.

¸ These fortified foods are now estimated to be benefiting 30 million South Africans.

¸ The multisectoral National Fortification Alliance, one of the first public-private alliances in the field of public health in South Africa, has dem-onstrated its worth and widespread benefits.

¸ A large-scale, 14-week radio campaign aired on nine African-language stations.

¸ The project helped establish a regulatory moni-toring program supported by more than 1,500 trained environmental health practitioners.

Project period January 2004 – June 2007

Food vehicle Maize meal and wheat flour

Fortificant Iron, vitamin A, zinc, folic acid and other B-vitamins

Grant awarded US$ 2.8 million


Executing agency UNICEF



Fortifying flour and oil in Morocco

BackgroundIron deficiency anemia affects about a third of women of childbearing age and children under five in Morocco. At least one third of young children also suffer from vitamin A deficiency, which compromises immune systems, opening the doors to disease and causing an estimated 1,500 deaths each year.

Faced with this problem, the Kingdom of Morocco has set objectives for the reduction of micronutrient deficiencies and the Ministry of Health has developed an integrated strategy with four principal components: supplementation for vulnerable population groups; fortification of staple foods; nutritional education; and the reinforcement of nutrition-related health programs. The action plan includes full implementation of wheat flour fortification and a new program to fortify vegetable oil. These are both staple foods available to low-income populations at affordable prices, distributed through nationwide networks.

The GAIN flour and oil projectFortification of staple foods through the GAIN project is an essential element of the Ministry of Health's integrated micronutrient deficiency control program. The project was developed in 2002 by a National Fortification Alliance, comprised of public, private and non-governmental organizations, led by the Ministry of Health. Launched in April 2005, the project enables mills to produce flour fortified with iron, folic acid and B vitamins, and major producers of cooking oil to fortify their products with vitamin A and D.

The project is managed by the Rabat office of UNICEF, in close collaboration with the MOH.

The seed money provided by GAIN, US$ 2.92 million, was timely and tactical: supporting the development of legislation, training of mill staff and laboratory technicians, supplies and training for inspection, a communication campaign for fortified foods, and a monitoring and evaluation system. Most important, perhaps, it helped to secure government and industry contributions that bring the project budget to a total US$35.5 million. Among other components, this provides for food production and distribution, food control, communication, program monitoring and evaluation and program management support.

Achievements

¸ 95% of oil available in commercial markets is now fortified.

¸ The Moroccan government has passed the legislation that makes the fortification of flour mandatory as of May 2007.

¸ 17 millers were participating in the wheat flour fortification project at the end of 2006.

¸ Suppliers of fortificants have trained government laboratory staff.

¸ Project has established a sentinel monitoring system, which tracks the consumption and availability of fortified wheat and oil throughout a network of 38 health clinics, schools, and retail stores throughout the 16 regions of Morocco.

Project period December 2004 – December 2007

Food vehicle Wheat flour and vegetable oil

FortificantWheat: Iron, folic acid and other B-vitamins Oil: Vitamin A, vitamin D

Grant awarded US$ 2.92 million


Executing agency UNICEF

*Projection of those reached when project is at full

scale (five years after its start).


Targeted projects To support innovative sub-national and regional food fortifi-cation projects, GAIN has initiated a second stream of fund-ing that facilitates the development of projects outside the full National Fortification Alliance framework. India is one country that has benefited from this more flexible funding.

GAIN’s contribution to tackling malnutrition in IndiaIn India GAIN’s program focus is on food fortification, uti-lizing the well developed existing publicly-funded food aid programs which are aimed at the most vulnerable sec-tions of society: the Integrated Child Development Scheme (ICDS), the Midday Meal (MDM) and the Public Distribution System (PDS).

ICDS targets children under 6 and pregnant or lactating mothers. Along with health education and propagation of exclusive breast feeding until 6 months, the scheme pro-vides supplementary nutrition for mother and child. 36 mil-lion children are fed under the scheme. GAIN would like to ensure that over the next 2 years around 10% of these 36 million children receive nutritionally appropriate comple-mentary foods that is fortified with essential vitamins and minerals.

The Midday Meal program supplies free meals to some 120 million primary school children all over India. Menus differ in different parts of the country and food is prepared locally so fortification is a challenging task. GAIN hopes to cover 10 million children in the next 2 to 3 years through innova-tions to fortify midday meals. Focus will be on innovations that can be scaled.

The PDS has a distribution network of 465,000 fair price shops where subsidized cereals, fuel and sugar are sold along with cooking oil. GAIN plans on conducting demon-stration projects where wheat flour and cooking oil that is distributed to the population below the poverty line is forti-fied with iron and vitamins.

Targeted projects in India• In partnership with the World

Food Programme (WFP), GAIN will support the provision of fortified complementary food for children 6 months to 36 months in the ICDS centres throughout Gujarat.

• In Tamil Nadu in association with WFP and NACO (National Aids Control Organisation) GAIN will support the provision of nutrient dense meals to people living with HIV.

• Large scale activities are planned in Rajasthan where GAIN, in collaboration with UNICEF, expects to support home fortification of complementary foods with sprinkles. Sachets containing essential nutrients will be distributed to mothers at ICDS centres.

• In collaboration with the Naandi Foundation GAIN is working on a project to provide fortified midday meals in all kitchens run by the foundation which supplies meals to schools in both Andhra Pradesh and Rajasthan.

• GAIN will be making a major investment to further the cause of food fortification in all three public food aid programs, ICDS, MDM and PDS, throughout Rajasthan. The state government, civil society, academia and the private sector are involved in deliberations to devise the most appropriate strategy.

• A pilot project for fortified rice is planned in cooperation with the Naandi foundation in Andhra Pradesh.

Britannia’s fortified biscuits distributed with school meals delivered by the Naandi Foundation in Andra Predesh and Rajasthan


Performance measurement and research


Performance measurement and research

A distinguishing feature of GAIN is the strong emphasis it gives to measuring the outcomes and im-pacts of its programs.

In 2006, GAIN began implement-ing its Performance Measurement Framework. This establishes 17 indicators for tracking organiza-tional performance (see Figure 1), including commercial avail-ability of fortified foods, cover-age of target groups, reduction in micronutrient deficiencies and Dis-ability Adjusted Life Years (DALYs) saved. The framework also allows for the measurement of fund-rais-ing, overhead costs and private sector commitment.

To implement the new framework, GAIN has collaborated with country teams in China, Côte d’Ivoire, Pakistan, Zambia and Ghana. These joint efforts are allowing for the development of comprehensive monitoring and evaluation plans, peer review of protocols for fortified food, knowledge, attitudes and practices (KAP) surveys and for

surveys of micronutrient deficiency. GAIN also passed an important milestone in supporting Mali’s first-ever survey of vitamin A deficiency among women of reproductive age. The results provide a solid baseline for Mali’s oil fortification program.

GAIN is in the final stages of devel-oping a performance measurement tool-kit and arranging for technical assistance to build the capacity of research institutes in develop-ing countries to ensure that stud-ies and surveys are well designed with standardized methodologies and indicators. Key partners here include the U.S. Centers for Dis-ease Control (CDC), UNICEF, the A 2 Z project (funded by the United States Agency for International De-velopment), and individual public health and nutrition experts. The tool-kit will be published in 2007 following peer-reviews by GAIN’s Technical Advisory Group and its Board.

In 2006, GAIN presented to its Board of Directors its first Annual

Performance Report using the new framework. The report set a baseline and estimated five-year population reach and coverage targets for GAIN’s existing project portfolio. The organization also conducted a series of case studies to draw lessons learnt from its most mature country projects (for soy sauce in China and wheat flour and maize meal in South Africa and cottonseed oil in Mali).

In 2005-2006, GAIN also added research to its Performance Measurement program. This will fill knowledge gaps in the micronutrient sector and assist in developing new strategies to reach target groups. The first research to be completed includes a study to develop sustainable business models to eliminate iodine deficiency and an analysis of the global investment required for large-scale expansion of fortification programs over the next 10 years.


Figure 1: GAIN’s Performance Measurement Framework

RESULTS PERFORMANCE INDICATORS

GOAL • To save lives and

improve health, productivity and cognitive function

1. DALYs (Disability-Adjusted Life Years) gained (specific micronutrient impact indicators include mortality rate, disability incidence, physical growth, intelligence quotient, school performance, productivity, etc)

2. Cost-per-DALY gained

PURPOSE• To reduce the

prevalence of micronutrient deficiencies by 30% among target groups

3. Numbers (and % prevalence) of individuals with micronutrient deficiencies

KEY PROGRAM OBJECTIVE• To increase regular

consumption of fortified foods among target groups

4. Coverage: numbers (and %) of target populations consuming fortified foods (disaggregated according to age-sex groups most affected by specific deficiencies and by income)

5. Cost-per-target individual covered6. Reach: absolute numbers of individuals

consuming fortified foods

COMPONENT PROGRAM OBJECTIVES• Increase

production and distribution of high-quality, affordable, fortified foods

7. Absolute aMOUnt (and market share) of fortified food available (domestic production and imports)

8. Absolute aMOUnt of sales of fortified foods

• Increase consumer awareness of benefits of fortified foods

9. % of targeted consumers who correctly recall health messages associated with logo / fortified foods / specific micronutrient deficiencies

• Increase public and private commitment

10. Existence of legislation and additional financial commitments by governments (US$)

11. Additional financial commitments by private sector (US$)

12. Additional donor investment in GAIN’s programs

GAIN PROGRAM ACTIVITIES • Deliver financial

and technical resources to countries

13. Actual disbursements against cash forecast 14. Total overhead costs as % of disbursements

• Build national and international alliances

15. Action and commitment rating index for national and international fortification alliances and partnerships

• Create an enabling international policy environment

16. Description of international plans and declarations that commit public and private sector bodies to action

• Consolidate the evidence base for fortification

17. GAIN board, staff and alliance partners’ quality ratings for performance information validity, clarity and utility


Advocacy and communication

Moving malnutrition up the global agendaStaff and members of the Board meet regularly with decision-mak-ers in the public and private sec-tors to press for action to address vitamin and mineral deficiencies—often with success. In March 2006, for example, a meeting with senior officials at the United Kingdom’s Department for International De-velopment led to an invitation to GAIN Chair of the Board Jay Nai-doo to address the International Development Committee of the British House of Commons. As a result, GAIN’s market-driven pro-grams were described as “a model of success” in the formal recom-mendations of the Committee on private sector development issued in July 2006.

After three years of operations the Global Alliance for Improved Nutrition is in a new phase of activity, shifting towards increased receptivity and appreciation of the tangible contributions to the micronutrient challenge that can be made by the private sector.

BBC documentary focuses on GAIN project in ZambiaIn September 2006, BBC World broadcast a 30-minute program (titled We are what we eat) on micronutrient deficiencies to its global audience of over 250 million households. Filmed in Zambia, the documentary touched on the history of food fortification in that country and focused on the current GAIN-funded program to fortify maize meal with vitamins and minerals. The documentary was shot in the country’s capital, Lusaka, and in Mansa, an area where sight problems linked to vitamin A deficiency are common. The filmmakers interviewed teachers, nutritionists, millers, sugar producers, Ministry of Health officials and GAIN staff, among others, and showed the necessity of having all sectors work together for effective food fortification.

BBC World documentaries such as this one have proved very popular with global audiences and have served to raise awareness about a number of health and development issues. The episode on micronutrients was given an 80% approval rating by the BBC’s viewer panel — where anything over 70% is considered excellent. Copies of the film are available from GAIN and footage from the production will be used to produce a corporate DVD,

and used as b-roll supplied to media outlets.

Swiss media coverage of an interview with Regina Moench-Pfanner (left) and Bérangère Magarinos (right).


Publications In addition to the Annual Report, GAIN has published two reports in the past year, both linked to the global Ten Year Strategy:

• Vitamin and Mineral Defi-ciencies: Technical Situation Analysis. Geneva, GAIN (Ten Year Strategy for the Reduc-tion of Vitamin and Mineral Deficiencies), 2006.

• Vitamin and Mineral Defi-ciencies: Stakeholder Per-ceptions Analysis. Geneva, GAIN (Ten Year Strategy for the Reduction of Vitamin and Mineral Deficiencies), 2006.

The Technical Situation Analysis report will also be published as a special supplement to the Food and Nutrition Bulletin (FNB), a peer-reviewed journal published in hard-copy and online by the United Nations University.

GAIN was the focus of a Harvard University School of Government case study:

• Bekefi T. Business as a Part-ner in Tackling Micronutrient Deficiency: Lessons in Mul-tisector Partnership. Cam-bridge, MA, Harvard Univer-sity, 2006 (John F. Kennedy School of Government Cor-porate Social Responsibility Initiative Report, No.7).

GAIN’s partnership model was also featured in a book published by the United Nations Global Compact Office:

• Witte, Jan Martin et al. Busi-ness UNusual: Facilitat-ing United Nations Reform Through Partnerships. New York, UN Global Compact Of-fice, 2005.

News coverage promotes GAINMeetings of GAIN’s Business Alliances and milestones in GAIN’s country projects have attracted extensive media coverage in the last year. London’s Financial Times, The New York Times, Fortune Maga-zine, World Grain Magazine and media in China, India, South Africa, and Uzbekistan are among those that have highlighted GAIN’s work. Events that have generated coverage include:

• Beijing launch of the GAIN Business Alliance in October 2005 and the first meeting of the China Business Alliance in Decem-ber 2005 drew extensive coverage in Chinese and international newspapers as well as on the internet.

• Interview with GAIN Senior Manager, Investments and Partner-ships Program, Bérangère Magarinos led to a Financial Times (London) Special Report in January 2006 describing how the GAIN Business Alliance for food fortification goes beyond cor-porate social responsibility (www.undp.org/partners/business/gsb/FT_article06.pdf).

• Inaugural European Business Alliance meeting, in London in March 2006, and the simultaneous announcement of a US$ 20 million grant from the Bill & Melinda Gates Foundation, gen-erated television coverage in Africa and Asia, radio coverage in South Africa, and print and web coverage from a range of countries including the UK and Europe.

• News releases about GAIN’s country projects in Zambia and Mali triggered reports in national and international media.

• News about Muhammad Yunus and social business enterprise led to an article in Fortune featuring ‘the yogurt experiment’ in Bangladesh, Danone and GAIN’s views on new business part-nership models.

• The launch of the India Business Alliance and the signing of the MOU between GAIN and Brittania Biscuits attracted wide cover-age in the Indian press.

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Infant and young child nutrition

Improved nutrition for children, particularly those under two, is key to limiting the lifelong damage wrought by malnutrition.

Mindful of this, GAIN has estab-lished a second grant program for Infant and Young Child Nutri-tion (IYCN), linked closely to that of food fortification and mobilizing additional parterships including business investment.

While exclusive breastfeeding meets nutritional needs until six months, from this age onwards, children need high quality, nutrient-dense foods to complement breast milk. High quality complementary foods are available in developed countries and for the rich in developing countries, yet affordable quality products for the poor in developing countries — those most

at risk of undernutrition — are not available.

GAIN’s IYCN program will stimu-late new partnerships and pri-vate sector innovation to produce high-quality, affordable fortified complementary foods and com-plementary food supplements for low income groups. Funding from the Bill & Melinda Gates Founda-tion will allow GAIN to support eight projects that will focus on high-burden regions and be se-lected through competitive bid-ding. The program is expected to reach 10 million children. In ad-dition, as part of a USAID-funded consortium on IYCN, GAIN will also work with alliance partners to build the regulatory and policy environ-ment to support the expansion and replication of IYCN programs in developing countries.

‘All age groups benefit from micronutrients but the deficiencies are particularly damaging and difficult to reverse when they occur during fetal development and in early childhood.’Tina Sanghvi, Jay Ross, Helen Heyman, The links between VMDs and survival, health, education and productivity in Food and Nutrition Bulletin, vol. 28, no 1 (supplement); Tina Sanghvi, Marc Van Ameringen, Jean Barker, John Fiedler, guest editors; ISSN: 0379-5721; p S167-173

Infant and young child nutrition

�2 | Global Alliance for Improved Nutrition

Board of Directors

Jay Naidoo, ChairChairman, Development Bank of Southern Africa; Chairman, J&J Group, Johannesburg, South Africa.

In his role as Chair of the GAIN Board, Mr Naidoo is a tireless proponent for the Global Alliance for Improved Nutrition. His rich background in development includes experience as the Minister for Reconstruction and Development, and subsequently Minister of Telecommunications, Post and Broadcasting, in the government of President Nelson Mandela in South Africa. His contribution to international development includes membership of the Advisory Committee on Information and Communication Technologies (ICT) set up by the former UN Secretary General Kofi Annan. His commitment to global development was recently recognized by the award of the Chevalier de la Légion d’Honneur, the French Government’s highest honour.

David Fleming, Vice-chairDirector for Global Health Strategies, Bill & Melinda Gates Foundation, Seattle, USA.

Dr Fleming oversees the Bill and Melinda Gates Foundation’s portfolios in vaccine-preventable diseases, nutrition, newborn and child health, leadership, emergency relief, and cross-cutting strategies to improve access to health tools in developing countries. He came to the Foundation from the US Centers for Disease Control and Prevention (CDC).

Chunming Chen Senior Advisor, Chinese Center for Disease Control and Prevention; Director, International Life Science Institute, Beijing, China.

Professor Chen is an international expert in nutrition and shifting dietary patterns related to economic change. She is founder of the Union School of Public Health, Beijing Union Medical University and was a member of WHO’s Expert Advisory Panel on Nutrition, and a member of FAO’s Expert Panel on Ethics of Food and Agriculture.

Frances Davidson Health Science Specialist, Office of Health and Nutrition, Bureau for Global Programs, U.S. Agency for International Development, Washington DC, USA.

Christopher Elias President, PATH, Seattle, USA.

As President of PATH, Dr Elias is responsible for strategic, programmatic, financial, and management operations aimed at identifying sustainable, culturally relevant solutions that enable communities worldwide to break long-standing cycles of poor health. Prior to joining PATH, Dr Elias was a Senior Associate in the International Programs Division of the Population Council.

Kul Gautam Deputy Executive Director, UNICEF, New York, USA.

Mr Gautam has had a distinguished career with UNICEF, beginning in 1973. He is now responsible for providing leadership in strategic planning, policy guidance, program development, research, and promoting partnerships for children and development among UN agencies, donors and civil society organizations.

Pierre Henchoz Partner, Lombard Odier Darier Hentsch & Co, Lausanne, Switzerland.

Mr Henchoz has a wealth of financial experience in both public and private sectors. He serves on the boards of a number of pension funds and other organisations and from 1986 to 1990 was Chief of Investment Management Services for the UN Joint Staff Pension Fund. He is currently a member of the Economic Advisory Board of the Canton de Vaud.

Richard Hurrell Professor, Institute of Food Science and Nutrition, Swiss Federal Institute of Technology, Zurich, Switzerland.

Dr Hurrell is an experienced nutritionist, who specializes in iron fortification. Together with Dr P.A. Finot, he was awarded the International Prize for Modern Nutrition for studies on the influence of food processing and preparation on food quality.

Catherine Le Galès-Camus Assistant Director General, Noncommunicable Dis-eases and Mental Health, World Health Organization, Geneva, Switzerland.

Dr Le Galès-Camus is a leading authority on the growing epidemic of noncommunicable diseases that are imposing a double-burden on the world’s poorest countries. She has also served as a scientific advisor to the Director General of Health in France, responsible for defining the country’s public health objectives for 2004 to 2008.

Ernest Loevinsohn Director General, Program Against Malnutrition and Disease, Multilateral Programs Branch, Canadian International Development Agency.

Dr Loevinsohn was a founding board member of the Micronutrient Initiative and serves on the boards of numerous national and international organizations. He is Chairman of the board of Results, a non-governmental organization working on hunger and poverty, economic empowerment, health and education.

2005 - 2006 Annual Report | ��

Franck Riboud Président Directeur Général, Groupe Danone, Paris, France.

Mr Riboud joined Groupe Danone in 1980 and has since then amassed extensive experience in many aspects of the food industry. In 1990 he was nominated Managing Director of Evian Mineral Waters and in 1992 took on the role of VP Corporate Development. Following his appointment as Vice-Chairman in 1994, he was nominated in 1996 to his present position.

Anji Reddy Executive Chairman, Dr Reddy’s Laboratories Ltd, India.

Under Dr Reddy’s leadership, Dr Reddy’s Laboratories has become a pioneer in transforming the Indian pharmaceutical industry into the innovative, export-oriented industry that it is today. Dr Reddy serves on numerous boards, including the Prime Minister’s Council on Trade & Industry and the National Institute of Pharmaceutical Education and Research.

Nicolas Tsikhlakis Vice-President, Modern Flour Mills & Macaroni Factories Co, Amman, Jordan.

Nicolas Tsikhlakis is Chief Operations Officer and Partner of the Modern Flour Mills and Pasta Factories in Amman, Jordan. The company conducts extensive research and development work on new products and adaptations. Mr Tsikhlakis has over 15 years of experience in milling.

Paulus Verschuren Senior Director, Partnership Development, Unilever Health Institute, Unilever R&D, Vlaardingen, Netherlands.

Apart from his wide experience with Unilever dating from 1981, Paulus Verschuren has served as Executive Director of the International Life Sciences Institute (ILSI Europe), as Chairman of the Board of ILSI Europe and as member of the ILSI Global Executive Committee. With the Unilever Partnership Development Group he aims to develop global nutrition and health partnerships creating both social and business value.

Ex-officio membersJacques Baudouy

Director, Health, Nutrition and Population International Bank for Reconstruction and Development, The World Bank, Washington DC, USA.

Marc Van Ameringen Executive Director, Global Alliance for Improved Nutrition, Geneva, Switzerland

A Canadian national, with a background in international political economy, Mr Van Ameringen has spent most of his career in Africa implementing and managing programs, across a range of areas. Prior to joining GAIN, he was Vice-President of the Canadian-based Micronutrient Initiative. From 1992 to 2002, Mr Van Ameringen was a Director based in Johannesburg, South Africa for the International Development Research Centre (IDRC).

Observers Venkatesh Mannar, Executive Director, The Micronutrient

Initiative, Ottawa, Canada.

Kei Kawabata, Sector Manager, Health, Nutrition and Popu-lation Sector Unit, World Bank, Washington DC, USA.

Katharine Kreis, Senior Program Officer, Maternal & Child Health and Nutrition, Global Health Program, Bill & Melinda Gates Foundation, Seattle, USA.

Ian Darnton-Hill, Senior Adviser, OIC, Nutrition Section, Child Survival and Nutrition UNICEF, New York, USA.

Executive CommitteeJay Naidoo, Chair

David Fleming

Catherine Le Galès-Camus

Ernest Loevinsohn

Marc Van Ameringen (ex officio)

Finance and Audit Committee

Pierre Henchoz, Chair

Chunming Chen

Frances R. Davidson

Paulus Verschuren

Marc Van Ameringen (ex officio)

Edward Atkinson (ex officio), Chief Financial Officer, Global Alliance for Improved Nutrition

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2005 - 2006 Annual Report | ��

Financial StatementStatement of Income and expendIture for the Year ended June 30, 2006 and audItor’S report

Balance sheet at June 30, 2005

(with 2005 comparative figures) (expressed in US dollars)

2006 2005

INCOME:

Donations received 7,053,713 9,550,000Bank interest 554,490 98,377Sundry income 77 -

Total income 7,608,280 9,648,377

EXPENDITURE:

Project related costs:Project grant expenditures 6,148,260 4,452,951Project supervision fees 25,000 405,248

6,173,260 4,858,199

General administration expenses:Staff related expenses 3,994,828 2,173,982Office rental 177,367 170,832Secretariat operational expenses 390,502 662,138Professional, technical and legal fees 1,699,343 1,228,349Travel and meeting expenses 953,540 874,208Depreciation 72,938 47,608Other miscellaneous 42,465 40,813Finance related expenses:Bank charges 35,936 34,991Exchange difference, net 29,054

47

Total expenditure 13,569,233 10,091,167

EXCESS OF EXPENDITURE OVER INCOME

(5,960,953) (442,790)

Surplus, beginning of year 6,915,199 7,357,989

Surplus, end year 954,246 6,915,199

See notes to financial statement


Balance Sheet as at June 30, 2006

(with 2005 comparative figures) (expressed in US dollars)

NOTES 2006 2005

ASSETS

CURRENT ASSETSCash at bank 10,580,590 14,588,510

Advances to UNDP and UNOPS 311,223 1,056,991

Other receivables 236,108 -

Prepaid expenses 62,626 322,388

Total current assets 11,190,547 15,967,889

FIXED ASSETS, net 3 189,131 144,114

TOTAL ASSETS 11,�7�,�7� 1�,112,00�

LIABILITIES

CURRENT LIABILITIESBank overdraft 47,859 164,757

Accounts payable 240,120 362,872

Other creditors 21,150 -

Accrued expenses 608,802 440,492

Grants payable 4 6,797,524 1,965,643

Project supervision fee 4 328,793 479,057

Total current liabilities 8,044,248 3,412,821

LONG TERM LIABILITIESGrants payable after one year 2,344,997 5,747,796

CAPITAL AND RESERVESFoundation capital 5 36,187 36,187

Surplus 954,246 6,915,199

Total capital and reserves 990,433 6,951,386

Total LIABILITIES 11,379,678 16,112,003

NOTES TO FINANCIAL STATEMENTS FOR THE YEAR ENDED JUNE 30, 2006(with 2005 comparative figures) (expressed in US dollars)1. GENERAL The Global Alliance for Improved Nutrition (GAIN) is an independent non-profit Foundation created under Article 80 of the Swiss Civil Code, and is registered with the Geneva Register of Commerce under statutes dated March 26, 2003.

The Foundation has been established to support food fortification and other sustainable nutrition strategies in order to save and improve health, productivity and cognitive function. In pursuing this objective, the Foundation intends to improve the micronutrient status of indi-viduals living in developing countries, contributing to the following goals:

• Reduce child and maternal morbidity and mortality;• Improve productivity;• Promote the ability of populations to achieve their physical and intellectual potential;• Reduce healthcare costs.

In order to attain these goals, the Foundation shall support developing countries in food fortification efforts, undertaken in the context of broader micronutrient strategies that will reduce micronutrient malnutrition in developing countries, particularly through increased con-sumption of micronutrient-rich foods.

The Bill & Melinda Gates Foundation and certain governments and other contributors have made available initial resources to support the projects and programs to be supported by GAIN.

2005 - 2006 Annual Report | �7

These resources are managed by the International Bank for Reconstruction and Development (World Bank) via a Trust Fund administered by the World Bank as trustee on behalf of GAIN.

Donations may also be received directly by GAIN.The initial projects satisfactorily appraised by the World Bank and approved by the GAIN Board of Directors shall be administered and supervised directly by the World Bank in accordance with the written agreement between the World Bank and GAIN. With respect to each such project, the World Bank shall, as administrator on behalf of GAIN, enter into a grant agreement with the recipient of such grant. The World Bank shall solely be responsible for the supervision of the project activities under the Grant Agreement. Any other projects approved by the GAIN Board of Directors shall be administered and supervised by the GAIN.

The World Bank shall provide to GAIN an aMOUnt equal to the budgeted annual operating costs of the GAIN Secretariat as approved by the GAIN Board of Directors.

Until June 30, 2005, GAIN had no direct employees. The majority of personnel and related costs, including current and post employment benefits were provided and managed by the UNDP and WHO (World Health Organization) and charged in full to GAIN, covered by written agreements. Following agreement with UNDP and WHO, GAIN starting employing staff directly is no longer relying on the services of UNDP and WHO.

Certain personnel and related costs are provided and managed by the World Bank, and are paid directly from the Trust Fund and are not charged to GAIN.

2. SIGNIFICANT ACCOUNTING POLICIES Basis of accounting - The accounting policies comply with the Swiss Code of Obligations.Donations received - The donations received are recorded on a cash basis.Foreign currency - Accounting records are maintained is US dollars. Income and expenditures in the other currencies are recorded at the

rates ruling at the date of the transactions. Period-end balances for assets and liabilities in other currencies are translated into US dollars at rates of exchange prevailing at balance sheet date. Exchange gains and losses are included in the determination of the net income.

Fixed assets - Fixed assets are stated at cost less accumulated depreciation. The Foundation applies the straight-line method for the de-preciation of these assets using a rate of 20% per year for office equipment and 50% per year for computer equipment.

Grants committed for projects - All grants are governed by a written grant agreement. All expenses are accounted for at the moment of the signature of the agreement. Grants or portions of grants that have not been disbursed at the balance sheet date are recorded as short and long-term liabilities. Certain agreements provide that the payments of part of the grants occur when defined milestones have been met.

3. FIXED ASSETS, net Fixed assets held at June 30, 2006, are as follows :

Office equipment Computer equipment TotalGross Book value 227,982 110,637 338,619

Accumulated depreciation (89,205) (60,283) (149,488)

Net book value 138,777 50,354 189,131

The fire insurance covers aMOUnts to : USD 160,400 - CHF 200,000 (2005 - USD 158,128 - CHF 200,000).

4. GRANTS AND PROJECT SUPERVISION FEES PAYABLE

5. Foundation CapitalThe Foundation capital aMOUnts to CHF 50,000 (equivalent at USD 36,187 at the March 26, 2003 exchange rate).

6. RENT AND LEASING COMMITMENTSAt June 30, 2006, the Foundation had future minimum office rental commitments aMOUnting to USD 821,295 (2004 - USD 126,832), cor-responding to expected rental fees until the end of the lease (April 30, 2011).

The Foundation has also entered into a leasing contract for computer equipment for which the remaining commitments as at June 30, 2005 aMOUnt to USD 22,510 (2005 - USD 55,457).


Auditor’s Report

Published by:Global Alliance for Improved NutritionRue de Vermont 37-39PO Box 55CH- 1211 Geneva SwitzerlandTel: +41 22 749 1850Fax: +41 22 749 1851Email: [email protected]: www.gainhealth.org

Executive Director: Marc Van Ameringen

Written and complied by GAIN staff

Photos:

CoverTop row: Child’s face, Françoise Chomé, Burkina Faso. Oil bottles,

Françoise Chomé, Burkina Faso. Mother child, Clipart photos, India.Middle row: Deep fried dumplings Miklos Fejes, Zambia.

Girls face, UNICEF, Central Asia. Bread, Africa. Bottom row: Two children, Matt Green, Hungry Eye Images, China.

Hand shake, Ashish Sabharwal, India. Boy, Miklos Fejes, Zambia.

Page 2: Bags of wheat, Miklos Fejes.Page 6: Marc Van Ameringen, Françoise Chomé, Switzerland.Page 7: Children, Sebastien Rich, Hungry Eye Images, Nicaragua.Page 8: Food products, Gelise McCullough, Switzerland.Page 9: Women of Rajesthan, Felix Topete, India.Page 10: Signing photos, Bérangère Magarinos, Bangladesh.Page 12: Football, Bérangère Magarinos, Bangladesh.Page 13: Nutri-Sip project, Mandla Mbau, Nigeria.Page 14: Mother and child, Richard S. Ehrlich, Hungry Eye Images, Bangladesh.Page 16: Boys jumping, Alex Saint-Hilaire, Dominican Republic.Page 17: Man working, Miklos Fejes, Zambia.Page 20: Man with bottle of soy sauce, Guiyang, China.Page 22: Women flour, Miklos Fejes. South Africa.Page 23: Flour products, Ministry of Health, Morocco.Page 24: Tiger biscuits, Gelise McCullough, Switzerland.Page 25: Girls with flour, Maia Tskitishvili, Georgia.Page 26: Research, Louise Sserungogi, Uganda.Page 27: Women and baby, HKI, Mali.Page 28: Three photos from film, Sebastien Rich, Hungry Eye Images, Nicaragua.Page 28: Office photo, Gelise McCullough, Switzerland.Page 30: Group of children, Miklos Fejes, Zambia.Page 29: Nursery worker, Greg English, Hungry Eye Images, China.Page 30: Nutri-Sip project, Mandla Mbau, Nigeria.Page 39: Girl, Françoise Chomé, Mali.

Copyright © The Global Alliance for Improved Nutrition, 2007All rights reserved.

Any use of information contained in this Annual Report is subject to a permission request to be addressed to GAIN, to the attention of the Manager, Communications.

Acknowledgement and photo credits

Rue de Vermont 37-39 PO Box 551211 Geneva 20 Switzerland

Tel. +41 22 749 1850Fax +41 22 749 1851www.gainhealth.org

“Investments in micronutrients rank above those in trade liberalization, malaria, and water and sanitation, in terms of immediate benefits for eradicating disease and poverty.”

World Bank, 2006.

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2005-2006 Annual Report

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