2007-2008 Annual Report

www.gainhealth.org

GAIN fights malnutrition to make people and economies healthier and more productive. GAIN stimulates public-private partnerships and provides financial and technical support to get healthier foods and supplements to

those people most at risk from malnutrition.

www.gainhealth.org

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CONTENT

“ It is clear that nutrition is the foundation on which all human progress is built. Unfortunately too many people, from individuals and families to policymakers and leaders, are unaware of the vital importance of nutrition and how serious undernutrition is around the world .” – Ann M. Veneman, UNICEF, Executive Director (Statement on launch of ‘Progress for Children: A Report Card on Nutrition’, May 2006)

A WORLD FREE OF MALNUTRITION AND UNDERDEVELOPMENT

INTRODUCTION: GAIN’S EXECUTIVE DIRECTOR

HIGHLIGHTS OF 2007 - 2008

INFANT AND YOUNG CHILD NUTRITION

FOOD FORTIFICATION

INVESTMENTS AND PARTNERSHIPS: THE GAIN BUSINESS ALLIANCE

LEARNING FROM GAIN’S PROJECTS

MEASURING GAIN’S IMPACT

FINANCIAL STATEMENTS

GAIN BOARD OF DIRECTORS

GAIN MANAGEMENT

GAIN PROJECT MAP

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© 2009 – Global Alliancefor Improved Nutrition

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“ Micronutrient deficiencies have many invisible economic effects that are widely underestimated. They sap the energy of working-age people, causing billions of dollars in lost productivity in

developing countries that can least afford it. They also hurt the learning ability of children. Vitamins and minerals provide one important key to poverty reduction and economic improvement in the

developing world. ” – Jay Naidoo, GAIN Chair

A WORLD FREE OF MALNUTRITION AND

UNDERDEVELOPMENT

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As the 2015 target for achieving the Millennium Development Goals (MDGs) draws nearer, the challenge to realizing a world free of malnutrition and poverty

becomes all the more pressing.

The MDGs call for an end to extreme poverty, the reduction by two thirds of the mortality rate among children under five and a reduction by half of the people in the world who suffer from hunger. These goals will not be met without a strong alliance with a collective will aimed firmly at addressing malnutrition and the pervasive hidden hunger that results from vitamin and mineral deficiencies.

I am proud that the Global Alliance for Improved Nutrition (GAIN) is at the forefront of the fight against malnutrition and that it continues, with its alliance partners, to develop innovative strategies to extend the reach of its programs. The need is huge. About one quarter of children in low-income countries are considered underweight and likely to suffer from the long term effects of undernourishment. About 178 million children are stunted as a result of insufficient food, a vitamin and mineral-poor diet and disease. About a million and a half

child deaths annually are attributable to wasting. The effects of malnutrition extend beyond health; they impact negatively on cognitive development and limit our potential for full and satisfying lives.

Malnutrition is a key indicator of social inequality. With the effects of the food crisis now compounded not only by environmental stress but also by financial meltdown, close to a billion people are challenged by hunger. The link with infectious diseases such as tuberculosis and HIV/AIDS exacerbates the already devastating impact on the poorest regions of the world, especially in Africa and South Asia.

Malnutrition not only has a high human cost, but also adversely impacts sustainable development, productivity, earnings and economic growth. This report demonstrates the impact and progress made by the GAIN Alliance, through its programs and through its ambitious attempts to ensure sustainability based on new partnerships aimed at accelerating delivery.

Achieving our goals will not be possible without our existing and future partners, the strategic direction of our Board and the hard work and commitment of our Executive Director and his team. We look forward to consolidating our achievements, scaling up our programs and responding to grassroots needs in countries in the most affected parts of the world.

Working together brings us closer to fulfilling our mission of creating a world free of malnutrition, poverty and inequality.

Jay Naidoo - Chair, GAIN Board of Directors

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INTRODUCTION : GAIN’S EXECUTIVE

DIRECTOR

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This year has been one of significant progress and exciting new developments for GAIN. Our Third Annual Performance Report revealed that by June 2008 our programs had

reached 187 million people, more than half of them in our target populations of women and children. GAIN launched new programs in infant and young child nutrition, universal salt iodization and national food fortification. At the same time the Business Alliance continued to add new members.

The Infant and Young Child Nutrition (IYCN) Program aims to improve the health of 10 million children under two years old in Africa, Asia, Latin America and the Caribbean. This is the period of greatest vulnerability to malnutrition and the window of greatest opportunity for establishing the foundation for healthy growth and development. Through the IYCN Program, local companies receive financial and technical support to develop, market and distribute high quality and affordable nutritious food products that complement breast milk for infants in low-income families. Importantly, the program will also contribute to GAIN’s understanding of the role of business in improving nutrition at the base of the pyramid and help identify new business models that can be replicated around the world.

GAIN also announced a new Universal Salt Iodization Partnership with the United Nations Children’s Fund (UNICEF), one of our major alliance partners. The initiative will build on global efforts to eliminate iodine deficiency through programs

in 13 countries with the lowest coverage of iodized salt and the greatest burden of iodine deficiency. It aims to reach more than 700 million people not yet covered by worldwide salt iodization programs, including 20 million new born infants.

In the area of food fortification, we began developing the GAIN Premix Facility, which will enable food fortification programs to buy high quality and affordable premix to fortify staple foods. At the same time, our projects fortifying staple foods and condiments in 18 countries continued to roll out. Because of the central place of food fortification in GAIN, we began in 2007 a mid-term review of our National Food Fortification Program to assess our approach, capture lessons learned and identify areas of opportunity. This review will help us make adjustments to our program as we continue to acquire new knowledge.

I would like to thank all our alliance partners and donors who have played a central role in our achievements over the past year. We should all be proud of the progress we have made in reducing global malnutrition. However, the fight against malnutrition will only be won if current levels of investment are increased. GAIN, in collaboration with its partners, is committed to exploring new and innovative financing mechanisms to boost resources for the nutrition sector. We see significant opportunities in this effort and look forward to working with our many partners in applying an increasing range of tools as we move closer to winning the fight against malnutrition.

Marc Van Ameringen - GAIN Executive Director

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HIGHLIGHTS 2007 - 2008

September 2007With GAIN support, and in cooperation with the World Bank, Bolivia launches its national food fortification project to fortify wheat flour, vegetable oil and milk. GAIN’s contribution supports a three year project developed by the National Council for Food and Nutrition and implemented by the Ministry of Health and Sports.

GAIN announces the start of a global salt iodization program and a premix fund at the Clinton Global Initiative. The Universal Salt Iodization Initiative, undertaken jointly with UNICEF, aims to increase the percentage of households in the world who use iodized salt from 70 percent to 85 percent by increasing salt iodization in 13 priority countries. The GAIN Premix Facility provides loans and grants to enable companies to buy high quality premix at lower prices. It will facilitate the addition of specific vitamins and minerals to foods that can supply national food fortification programs and disaster relief operations.

October 2007The Ghana National Food Fortification Project, launched with support from GAIN, UNICEF and other partners, will fortify vegetable oil and wheat flour for consumption by millions of Ghanaians who are vulnerable to malnutrition. The project is a partnership of thirty five organizations from the public and private sectors.

“This program, developed jointly with GAIN, places

Ghana among countries applying this common-sense

approach to improving public health through the

fortification of staple diets” said Emmanuel Agyarko,

Chief Executive of the Food and Drugs Board.”

November 2007GAIN brings together local and global business leaders, government officials and the Nobel Prize Laureate Professor Muhammad Yunus to discuss partnership opportunities to improve nutrition in Bangladesh and organizes the first-ever meeting of Bangladeshi business leaders to encourage the private sector to play its part in improving nutrition.

At the same time, the Government of Bangladesh, the Vegetable Oil Refiners Association and GAIN launches a national program to add vitamin A to 70 percent of all cooking oil in Bangladesh to improve public health.

January 2008GAIN signs an agreement with the Government of Uganda to support the national fortification program and increase the supply of and demand for fortified wheat and maize flour, and edible oil. The project aims to reduce iron deficiency anemia and vitamin A deficiency in women of reproductive age and in children under 15 years old.

February 2008The case study on Tetra Pak’s school feeding program in Nigeria, implemented by the Institute for Management Development and GAIN, wins the European Foundation for Management Development’s 2007 Award for the best case study on corporate social responsibility (CSR).

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March 2008The Ministry of Health of Côte d’Ivoire, Helen Keller International and GAIN announce the availability on the market of cooking oil fortified by Vitamin A and wheat flour fortified by iron and folic acid. The cooking oil and wheat flour are both produced locally in Côte d’Ivoire and are basic ingredients of many traditional meals.

The UN World Food Program (WFP), GAIN and the Egyptian Ministry of Social Solidarity announce the launch of the fortification with iron and folic acid of Egyptian wheat flour, used in the production of widely-consumed Baladi bread. The project aims to reduce widespread anemia in Egypt, which affects 40 percent of the population, by approximately 30 percent in five years.

May 2008The Lancet Series on Maternal and Child Undernutrition is launched at events in London and Washington DC. It reveals that 11 percent of the global burden of disease is caused by malnutrition and that 3.5 million children under 5 die as a result of it every year.

Jay Naidoo and Marc Van Ameringen meet EU Commissioner Louis Michel at a high-level meeting on 8 May. The Commissioner expressed the interest of the European Union in stimulating business action that benefits the nutrition of the poor at the ‘bottom of the pyramid’. The Commissioner subsequently attended a special lunch hosted in partnership with CSR Europe and organized in conjunction with the second Business Alliance Global Forum. The GAIN Board was invited to the lunch and members were able to network with members of the CSR Europe Base of the Pyramid Laboratory. Commissioner Michel’s commitment to action on nutrition helped build awareness of the need for the European Commission to consider innovative partnership approaches to development issues, including malnutrition.

In 2008, country food fortification project teams received significant technical support to plan and execute pre-project (baseline) surveys. Field work was conducted in Ghana in May and in Côte d’Ivoire in July. These surveys not only provide information against which future progress can be gauged but are also challenging some long-held assumptions regarding the prevalence and causes of micronutrient deficiencies in Africa.

June 2008Once again in 2008 the Copenhagen Consensus gives priority to nutrition interventions. It lists the provision of micronutrients to malnourished children in developing countries as the most effective development investment. At an estimated cost of US$ 60 million per year, the benefits in terms of improved health, reduced deaths, and increased income opportunities would be US$ 1 billion annually.

GAIN and the International Business Leaders Forum invite applications for a new annual award for companies who apply innovative business models or develop new products and services that fight malnutrition, improve public health and support sustainable development. The first GAIN Business Award for Innovation in Nutrition will be presented in May 2009.

In 2008 the Business Alliance formalized its relationship with members and began receiving membership fees. As of February 2008, members included Britannia, Cargill, Danone, DSM, Firmenich, Mars, Pepsi, Tetra Pak and Unilever.

HIGHLIGHTS 2007 - 2008

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“ More than 3.5 million children under five die unnecessarily each year in poor countries due to the underlying cause of undernutrition, and millions more are permanently disabled by the physical and mental effects of poor dietary intake in the earliest months of life. Unfortunately, the consequences

of insufficient diets carry into adulthood and can irreversibly impact height, susceptibility to cardiovascular and metabolic disease, intellectual capacity, human capital, and offspring bodyweight. Thus, improving nutrition not only benefits current generations, but also improves the health status of

generations to come. ” – Dr Robert Black, The Lancet’s Series on Maternal and Child Undernutrition, January 2008

INFANT AND YOUNG

CHILD NUTRITION

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Infants under the age of two are most vulnerable to the long term negative consequences of malnutrition. The first twenty four months of life represent the greatest period of

vulnerability but also the greatest window of opportunity for healthy development.

GAIN’s Infant and Young Child Nutrition (IYCN) Program aims to take advantage of this window of opportunity to improve the health and nutrition of ten million children.

The program works through market-based approaches that harness innovative partnerships between the public and private sectors. This approach aims to ensure that babies in low income households have access to adequately nutritious foods from 6 months of age to two years as a complement to, and not a replacement for, breastfeeding. These comple-mentary foods are in the form of cereal-based porridge and supplements (ie single-serving sachets of multiple nutrients or lipid-based spreads that can be added to local comple-mentary foods). GAIN helps companies improve their products, upgrade their equipment, improve their quality control and assurance processes, develop their marketing capacity, diver-sify their distribution channels and ensure compliance with national and international rules and regulations. By supporting national companies that buy locally, GAIN encourages local food production that improves nutrition, boosts local econo-mies and fosters job creation.

The foundation of the IYCN approach is the 2003 WHO/UNICEF Global Strategy for Infant and Young Child Feeding. The IYCN Program reinforces a comprehensive strategy that includes attention to maternal health during and after pregnancy as well as optimal infant and young child feeding practices. The program has been designed to draw on GAIN’s demonstrated capacity to:

Facilitate multi-stakeholder alliances and public private •partnerships to explore improved feeding practices;

Apply • innovative business models and financing mecha-nisms to partnerships with the private and public sector, providing incentives for sustainable business initiatives that have the potential to produce, market and distribute high quality, low cost complementary foods for the benefit of the poor;

Ad• vocate for policies and resources that improve infant and young child nutrition;

Document pro• gress, measure impact and generate lessons learned through monitoring and evaluation; and

Mob• ilize public and private sector resources.

IYCN IN ACTION

The GAIN IYCN Program has funded four pilot projects that are innovative in their approach and have laid the foundation for IYCN’s first Call for Expressions of Interest.

SCALING UP: COMPLEMENTARY FOOD FORTIFICATION IN CHINA

This pilot project is a partnership between the Chinese Centers for Disease Control, the Capital Institute of Pediatrics and the Bai Le Mai Food Company. The partnership aims to improve the nutritional status of infants aged 6 to 24 months through the commercialization of a soy enriched vitamin and mineral sup-plement, Ying Yang Bao. Ying Yang Bao is a single serving sa-chet used for home fortification by families in rural areas. The pilot study is designed to build a strong base for the project expansion phase.

Bai Le Mai, a local food company, manufactures high quality, low cost fortified cereal food products for infants and young children.

EXPANDING DISTRIBUTION: HOME FORTIFICATION OF COMPLEMENTARY FOODS IN BANGLADESH

Led by the Social Marketing Company in partnership with Renata Ltd this project aims to improve the nutritional status of children under five, particularly those with iron deficiency ane-mia. The project produces micronutrient powders to be added to complementary foods. Social marketing strategies will en-gage private sector distribution channels in the delivery of af-fordable sachets containing micronutrient powder (MonoMix). After one year, approximately one million sachets are being sold each month.

SMC is recognised as a leader in condom distribution and has 60 percent of the market in Bangladesh for oral rehydration salts. Renata Limited is one of the biggest local producers of human and animal health products in Bangladesh.

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ASSESSING ACCEPTABILITY, EFFECTIVENESS AND SAFETY: SPRINKLES IN RURAL WESTERN KENYA

In March 2007, CDC joined with the Safe Water and AIDS Project (SWAP) and other partners to implement the Nyando Integrated Child Health Project (NICHE) which includes an effectiveness study that combines social marketing with mobilization of local institutions to promote the sale of Sprinkles. Sprinkles are multi-micronutrient powder sachets used for home fortification of complementary foods and sold by vendors who sell health products to their neighbours. The project assesses the feasibility and effectiveness of Sprinkles distribution in western Kenya as part of an existing integrated health promotion and income-generation program. It also measures the impact of Sprinkles sales and use on iron deficiency among children aged 6 to 59 months.

SWAP is an organisation that provides support to AIDS orphans and to women with HIV/AIDS through a range of services includ-ing counseling, emotional support, paralegal assistance and health and nutrition education in addition to income generating activities.

ESTABLISHING LARGE SCALE FEASIBILITY: HOME FORTIFI-CATION OF COMPLEMENTARY FOOD IN RAJASTHAN, INDIA

This project, carried out in collaboration with UNICEF, is part of the Government of India’s Integrated Child Development Services (ICDS) Program. It aims to reduce the prevalence of micronutrient deficiency disorders amongst children aged 6 to 36 months and to determine the effectiveness of large-scale home fortifi-cation in improving iron status and its impact on growth.

The Integrated Child Development Services, a national deve-lopment program started by the Government of India in 1975, aims to improve the health of mothers and children under age 6 by providing health and nutrition education, health services, supplementary food, and pre-school education.

GAIN works to mobilize national governments through policy work.

REACHING THE MILLENNIUM DEVELOPMENT GOALS – UGANDAN CHILD SURVIVAL STRATEGY

In 2008, the Ugandan Ministry of Health asked for GAIN’s assistance with the nutrition component of its Child Survival Strategy. The strategy includes general health, nutrition, water and sanitation. Implementing the nutrition component will strengthen the Ministry’s contribution to achieving the Millennium Development Goals by reducing the numbers of underweight children and the under-five child mortality rate.

GUIDELINES ON SUPPLEMENTARY FOODS – CODEX REVISION

GAIN provided technical input into the 30th session of the CODEX Committee on Nutrition and Foods for Special Dietary Uses (CCFSNDU) held in South Africa. A position paper on changes needed for the Codex standards related to comple-mentary feeding and enhancing support for breastfeeding was prepared with the help of technical experts from India, Malawi, Ghana, China, South Africa, Canada, and the US. This paper (in both English and French) was distributed at the meeting. GAIN supported participants from Uganda and Ghana.

GAIN works to mobilize international agencies through work on standards and guidelines.

BENEFITING FROM LESSONS LEARNED

GAIN, as the coordinator of the Maternal Infant and Young Child Nutrition (MIYCN) working group of the Ten Year Strategy to Reduce Vitamin and Mineral Deficiencies, has made a significant contribution to the development of the Guidebook on Marketing Complementary Foods and Supplements for the protection, promotion and support of optimal infant and young child feeding. This guidebook was developed through collabo-ration among international agencies including UNICEF and WHO and numerous NGOs, and is currently being reviewed by a MIYCN working group subcommittee.

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The Guidebook builds on the many lessons learned over the years of implementing the International Code of Marketing of Breastmilk Substitutes (1981), and specifically focuses on issues related to the marketing of fortified blended cereals, complementary food supplements and multi-nutrient powders for infants and young children. It covers aspects of promotion and labeling to ensure that breastfeeding is protected and encouraged.

PARTNERING TO PROTECT CONSUMER HEALTH

In addition to supporting national stakeholders to strengthen standards for complementary feeding products, GAIN is seeking recognition as an international non-governmental organization within CODEX in order to strengthen CODEX’s role in ensuring the development of food standards, guidelines and related texts that protect the health of consumers.

ADDING THE PRIVATE SECTOR PERSPECTIVE

In November 2007 WHO launched the Landscape Analysis of countries’ readiness to accelerate action in nutrition. The ultimate aim of the Landscape Analysis is to scale up nutri-tion action in the high-burden countries and accelerate support to achieve Millennium Development Goals. WHO asked GAIN to participate in the Ghana Landscape Analysis because of its ability to introduce a private sector perspective; this was considered a major strength and added an element that WHO recognised had been missing from the landscape process.

GAIN works to mobilize the transfer of ‘Best Practice’ across sectors.

ENSURING BEST PRACTICE MONITORING AND EVALUATION

To evaluate projects against GAIN program goals requires that two perspectives be taken into consideration: the potential to generate positive public health outcomes and the potential to create successful large-scale business opportunities. For both commercial and public health evaluations, GAIN draws on the

expertise of partners with a proven track record for evaluat-ing business viability or public health outcomes in developing countries.

The International Food Policy Research Institute (IFPRI) is assisting GAIN with the design of the public health aspect of the Performance Measurement Framework and related tools.

Accenture Development Partnerships (ADP) assists GAIN with business performance evaluation of IYCN projects. ADP is a not-for-profit group within Accenture (the global management consulting company) which provides services to non-profit enti-ties working in international development.

Discussions are underway with the Bangladesh Rural Advance-ment Committee (BRAC) and the South African Medical Research Council (MRC) to provide local knowledge and expertise in the Asian and African regions and assist GAIN with the monitoring and evaluation of IYCN projects to ensure they reflect regional needs and standards.

POOLED FUNDING WITH INVESTMENT BANKS AND VEN-TURE PHILANTHROPISTS

In March 2008, GAIN and International Finance Corporation (IFC) set up a joint portfolio called the IFC-GAIN Nutrition Trust. In June, a similar agreement was signed between GAIN and Acumen to set up the GAIN-Acumen Nutrition Portfolio (GAP) Fund. Both the Nutrition Trust and GAP offer financial and tech-nical support to companies interested in developing new prod-ucts, distribution channels and marketing approaches aimed at improving the nutrition of infants in low-income families. Nutrition Trust and GAP investments aim to achieve both nutri-tion and business objectives on a sustained basis.

The International Finance Corporation (IFC), a member of the World Bank Group, is the largest multilateral source of loan and equity financing for private sector projects in the developing world. IFC aims to reduce poverty and improve lives by fostering sustainable economic growth in developing countries by financing private sector investment, mobilizing capital in the international financial markets, and providing advisory services to businesses and governments.

Acumen Fund is a non-profit global venture capital fund that uses entrepreneurial approaches to solve the problems of global poverty. Their investments help build financially sustainable and scalable organizations that deliver affordable, critical goods and services – like health, water, housing and energy – through innovative, market-oriented approaches.

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Africa1%

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56%

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South East Asia

Eastern Europe

Multi-region

South Asia

Latin America

Expressions of Interest by RegionExpressed as percentage of the total

14%

IYCN GOING FORWARD

GAIN issued an invitation for Expressions of Interest for project concepts in December 2007.

The response was overwhelming - a total of 72 were received. 56 percent were from Africa, indicating the interest of African businesses in addressing the problems faced by the most vulnerable groups in their communities.

A review panel of eight senior experts in nutrition and business development assessed responses. Parallel to this screening, GAIN hired a specialist in the International Code

of Marketing of Breastmilk Substitutes to screen all applicants for Code compliance or other business practices that might be considered harmful. Those invited to move to the next stage of the process were sent a business plan package consisting of a detailed business plan template, the Complementary Food and Food Supplement Formulation Guidelines and the International Code of Marketing of Breastmilk Substitutes. Following the Business Plan Review process, five projects were selected for presentation to GAIN’s Board; following approval and negotiation of the grant agreements all are expected to launch in 2009.

The problem of growth faltering and stunting demands the scale-up of products that will provide adequate macronutrients as well as the right balance of micronutrients. Future investments will be increasingly focused on products that will have an impact in this regard.

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FOOD FORTIFICATION

“ The poorest and most vulnerable were hit hardest last year by the high food price crisis and they will continue to bear the brunt of the burden in the global economic decline. We will count on GAIN

again to keep all food and nutrition issues high on the global agenda. The partnership with GAIN is fundamental to WFP’s ability to truly address the nutritional needs of the people we serve. I am

grateful for your unwavering commitment and support. ” – Josette Sheeran, WFP, Executive Director (Correspondence with GAIN 2009)

“ Without fast action, this crisis will steal the potential of a generation. In India, alone, 1.5 million more children are already at risk of malnutrition because of the crisis. Globally, we have estimated

that this crisis could push 100 million people into poverty – 30 million in Africa alone - reversing the gains made in poverty reduction over the last seven years. ” – Robert Zoellick, World Bank,

Group President (Speech to Rome World Food Security Summit, June 2008)

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In 2007 and 2008 large-scale fortification projects were underway in 18 countries in Africa, Asia and Latin America and were bringing fortified staple foods and condiments

to people in need. Products fortified include wheat flour, vegetable oil, maize meal, sugar, soy sauce and fish sauce. To support project implementation requires that GAIN stay abreast of global issues that influence the climate in which its projects operate. The food price crisis was the most serious

issue in 2007 and 2008.

IMPACT OF THE FOOD PRICE CRISIS ON GAIN’S PORTFOLIO

OF NATIONAL FORTIFICATION PROJECTS

Food prices were destabilized in this period by extreme variations in global commodity markets. To assess the impact of price rises on its program GAIN examined the case of five countries where it supported large-scale food fortification projects: Bangladesh, Egypt, Mali, Pakistan and South Africa.

The crisis had an impact on consumers, the food industry and governments. As prices rise poor consumers tend to eliminate expensive protein and nutrition rich foods from their diets and substitute cheaper starchy staple foods. They spend an increasing percentage of their income on diets of decreasing variety and nutritional value. For industry, commodity price volatility leads to increased risk and insecurity. Some businesses have difficulty acquiring raw materials; others hoard supplies; still others purchase at the top of the market and are forced to sell at a loss. Governments are not immune either. They are pressured by consumers to bring prices down but the measures required to achieve that end may reduce the markets for local food producers.

GAIN projects fared differently against these competing pressures.

The Bangladesh Oil Fortification Project suffered delays. Refineries bought stock when prices were high and struggled to stay afloat in the face of government price controls. They became more reluctant to pay for premix and to support mandatory fortification. The project has been redesigned to cover some premix costs and is now expected to be launched in 2009.

In Mali, higher prices have proved to be the final straw for cotton seed oil, making it no longer competitive with other edible oils. This evolution had the potential to reduce the health impact of oil fortification in Mali but the decreased production of fortified cottonseed oil was partly offset by imports of fortified palm oil from GAIN’s oil fortification project in Côte d’Ivoire.

Maize meal fortification has been mandatory in South Africa since early 2007 and has not itself been affected by the food price crisis; maize meal consumption, however, is reported to have declined.

In both Egypt and Pakistan fortification has been used as a tool to address the crisis.

In Egypt, the Ministry of Social Solidarity used GAIN funds to enhance its subsidized Baladi bread program. This targeted initiative has the potential to reach a large number of people in need and provides opportunities to gear up for more widespread fortification. The down side is that the fortification program may become dependent on the government’s willingness to continue to subsidize bread.

In Pakistan the Utility Stores Corporation (USC) cooperated with the Ministry of Health’s fortification program on a pilot initiative that has the potential to be scaled up to cover all flour sold in the national network of 5000 USC stores. This could have a significant public health impact. However mills operating in the commercial market are showing less willingness to fortify.

As a result of its analysis GAIN is looking at:

Improved planning for contingencies when assessing food •vehicles for fortification;

Models that can move from subsidized to unsubsidized •large-scale fortification projects;

The• Global Premix Procurement Facility as a tool to assist industry in financing premix.

“ The mantra to fight malnutrition has to be fortification, fortification, fortification. I completely endorse that and I believe that it is even more important today than it was yesterday to fortify our foods.” Renuka Chowdhury, Ministry of Women and Child Development, India.

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GAIN PREMIX FACILITY

With global concerns over food additives, fortification programs have been under growing pressure to ensure that vitamin and mineral fortificants meet the highest quality standards. While WHO and the UN Food and Agriculture Organization (FAO), with support from GAIN, have published quality guidelines, many fortification programs and food producers in the developing world are not readily able to verify the quality of the micronutrient premix (a commercially prepared blend of vitamins and minerals used to fortify staple foods) they procure globally. They are unable to travel long distances to directly inspect the manufacturing facilities and they often do not have adequate testing facilities for the full range of vitamins and minerals. A globally recognized quality certification process for premix is badly needed.

Micronutrient premix is the largest recurrent input cost for large-scale mass food fortification programs. A number of barriers exist for countries in procuring premix: access to suppliers; prices for premix that are not always competitive; access to upfront capital for large purchases; governance challenges in the purchasing process; and lack of quality assurance and monitoring of delivered products.

To address these barriers, GAIN is establishing a Global Premix Procurement Facility, specifically to help partners in the developing world manage premix procurement. GAIN has a strong comparative advantage in designing, managing and operating such a facility. It is currently establishing large new markets for the premix industry through its national fortification programs, and will continue to do so with the addition of new programs for infant and young child nutrition and salt iodization. GAIN’s programs have a strong relationship with food producers who will need guidance and support in sustaining the benefits achieved under the projects. GAIN can leverage its technical knowledge of and operational experience with fortification programs to support the GAIN Premix Facility and its recipients, thereby reducing administrative and operational inefficiencies.

UNIVERSAL SALT IODIZATION

After more than two decades of work, universal salt iodization (USI) programs now reach approximately 70 percent of people in developing countries; recently, however, programs have stalled and in some cases salt coverage has even declined. Innovation is required to reach higher levels of coverage and to assure that achievements are sustained.

The GAIN-UNICEF Universal Salt Iodization Partnership Project responds to this requirement for new models. A five year partnership between GAIN and UNICEF, it builds on the complementary skills of the two organizations. GAIN will focus on two of the four program components, supply and monitoring and evaluation, whereas UNICEF will focus on the advocacy and demand components. The GAIN program model will place great emphasis on stimulating business to produce, market and distribute adequately iodized salt while the public sector focuses on the policy and regulatory environment.

The project will assist 13 countries with a high burden of malnutrition in strengthening salt iodization efforts, increasing coverage, implementing monitoring systems and assuring program sustainability. Complementary to existing programs, it focuses on market-based approaches to support the salt industry and encourage consumer demand. Country programs are developed through a review of existing information about USI at the country level, a series of missions, and in country consultations which involve GAIN regional staff, UNICEF country offices and all key national stakeholders. The first country strategies are underway.

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INVESTMENTS AND PARTNERSHIPS: THE GAIN

BUSINESS ALLIANCE“ Established in 2002,the Global Alliance for Improved Nutrition works with the food industry

to develop food fortification schemes, and uses existing food marketing channels to deliver better nutrition. The fortification programs are locally developed, sustainable, and inexpensive.

They achieve high population coverage with no need for behavioural change. This is a most encouraging way forward .” – Dr Margaret Chan, WHO, Director-General

(Keynote address Pacific Health Summit Seattle, June 2008)

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Originally conceived as a mechanism to create awareness within the business community of its responsibility to engage in the nutrition debate, the

GAIN Business Alliance has evolved into a global network that reduces malnutrition through fostering innovative partnerships, investments and new ideas.

At the heart of the Business Alliance is the determination to scale up innovative business models that are able to deliver quality fortified food and complementary foods to the base of the pyramid. Market solutions may not always reach the poorest of the poor but they can reach ever larger numbers of poor consumers who suffer from malnutrition. The Business Alliance is a learning platform where companies showcase their experiences and share the challenges of doing business at the base of the pyramid. Dialogue has recently moved beyond business models to investment instruments and innovative financing mechanisms.

The annual Business Alliance Global Forum is the flagship event that strengthens the links among network members. Regional events reach deeper into communities of national and regional decision makers from governments and civil society to allow companies to define sustainable local partnership strategies.

The Global Forum in Brussels was the highlight of the period with speakers from the European Commission and the European Parliament. Business leaders were joined by leading thinkers such as Bjorn Lomborg from the Copenhagen Consensus who demonstrated clearly the business case for food fortification. The Forum was co-organized with the World Bank Institute (WBI); it attracted over 100 business leaders from across the food supply chain, together with experts from the European Union, other international agencies, academia and government. The Forum’s theme of growing GAIN – growing understanding of malnutrition, growing the market for business to invest in nutritious products, growing cross-sector partnerships and resources targeting innovative and sustainable solutions – provided a focus for the discussions.

In a welcome letter sent to participants, President Bill Clinton said “the great challenge of this century is to move the world along the path of positive interdependence ... and ensuring adequate nutrition for all people, regardless of geography, is a crucial part of that.”

GAIN had laid the groundwork for the successful Forum by its active participation in the Laboratory on the Base of Pyramid organized by Corporate Social Responsibility (CSR) Europe. The Laboratory, led by Danone with participation from Unilever, Suez, Vodafone and other companies, produced a white paper on business activities that deliver social benefits in emerging markets through re-engineering existing business models. Through its involvement in the Laboratory, GAIN will continue to broker dialogue between nutrition companies and the European Commission.

LEARNING FROM GAIN’S PROJECTSOver the past year GAIN has gathered more experience in implementing its Performance Measurement Framework and is generating new knowledge to improve programs both at local and international levels. Direct technical assistance has been provided to country teams in Ghana, Côte d’Ivoire, Jordan, Bangladesh and Uganda to refine monitoring plans, develop data collection tools, conduct rigorous baseline and follow-up surveys and to interpret information emanating from information systems. Emerging data are not only useful for mid-course corrections for individual country projects but the application of standardized indicators is increasingly allowing GAIN to compare results across country projects to identify systematic issues and performance bottle-necks. Examples from this past year’s survey reports include new information on the age and income groups most affected by iron deficiency anemia in Ghana and Côte d’Ivoire. The data will allow better targeting of future efforts as well as new knowledge on the performance of social marketing and communication activities.

19

As a complement to its food and nutrition-related indicators, GAIN is refining its metrics in the area of partnerships. Specifically, GAIN collaborated with the Partnering Initiative (a global program of the International Business Leaders Forum) to develop a new methodology for measuring the strength of alliances and partnerships. The methodology features an on-line survey tool and will be further field-tested this coming year. Business performance indicators are also currently being developed as part of GAIN’s new Infant and Young Child Nutrition Program and will aid with the assessment of sustainability.

Finally, this year GAIN introduced a research program to fill knowledge gaps that may either hinder the effectiveness of investments or GAIN’s ability to accurately track progress. Among other studies, trials are being funded to determine the effectiveness and safety of micronutrient powders distributed in a malaria-endemic region of Kenya (carried out by the United States Centers for Disease Control and Prevention). The Performance Measurement and Research Program and IYCN are working closely together on this study in Kenya and elsewhere. Another study will evaluate serum zinc as a performance indicator for fortification programs (carried out by the International Zinc Consultative Group). Results obtained from these studies will be disseminated through conferences, peer-reviewed journals and the GAIN website.

MEASURING GAIN’S IMPACTThe reach and coverage of GAIN’s programs

Through its programs, GAIN aims to reach 1 billion people, including 500 million women and children.

While the current project portfolio reached nearly 188 million people at the end of June 2008 it is on track to reach more than 600 million people. The new GAIN-UNICEF Salt Partnership, which will operate in 13 countries with a high burden of

malnutrition, is expected to reach 700 million. We are therefore confident that we will reach our target of 1 billion people when projects approved by 2010 are operating at full scale.

Reducing years lost because of death or illness caused by malnutrition

Our primary target is to reduce the number of years lost in a population because of death and illness caused by malnutrition. This is a measure known as ‘Disability Adjusted Life Year’ or DALY.

GAIN aims to add one healthy year to a person’s life at the cost of less than US$ 15. Estimates of current costs are US$ 13 to US$ 27 but costs will come down as our programs expand and as we add iodine and folic acid to our calculations of DALYs.

Cost per target individual reached

GAIN is on track to reduce the cost of its fortification efforts to US$ 0.13 per person covered, demonstrating once again the cost effectiveness of fortification as a public health measure.

Leveraging additional investments in nutrition

GAIN has exceeded its targets with respect to donor contributions but has fallen behind with respect to contributions from the private sector. However, as we finalise new grants in support of infant and young child nutrition, build the portfolio of iodization projects and initiate a new call for proposals for food fortification we expect to see the private sector contribution grow rapidly.

20

Food Fortification Programs

Infant & Young Child Nutrition Programs

Communication & Advocacy Programs

Corporate Administrative Services

Investments & Partnerships Programs

Performance Measurement & Research Programs

Financial Year 2007-2008 Expenditures by Program

39%

27%

10%

5%4%

15%

2005/62006/7

2007/8

US$ 20,000

US$ 25,000

US$ 10,000

US$ 5,000

US$ 15,000

TOTAL EXPENDITURES BY FINANCIAL YEAR

TOTA

L EX

PEND

ITUR

ES

figures in thousands; estimated figure for 2007/8

20200505/6/62020060 /7/7

202007/8

UUS$ 20,000

US$ 25,000

UUUUUUUUUUUUUUUUSSSSSSSSSSSSSSSSSSSSSS$$$$$$$$$ 10,000

UUUUS$ 5,000

USSS$$$$$$$$$$$ 111115,000

TOTAL EXPENDITURES BY FINANCIAL YEAR

TOTA

L EX

PEND

ITUR

ES

figures in thousands; estimated figure for 2007/8

GAIN keeps close track of its income and expenditure and applies strict policies to ensure transparency and accountability to its supporters and partners. Deloitte,

GAIN’s auditor, has consistently given GAIN’s accounts a clean bill of health. The Income Statement and Balance Sheet extracted from the audit report are presented in the following pages; we invite you to read the complete auditor’s report and financial statements which can be found at www.gainhealth.org.

As in previous years, financial and technical support to food fortification took the largest proportion of GAIN resources at over 39 per cent. The Infant and Young Child Nutrition Program has grown significantly – from 1 percent of expenditure in 2006-2007 to more than 27 percent in 2007-2008. Expenditure on Corporate Administrative Services reduced slightly as a percentage of overall expenditure with other programs maintained close to the same levels of expenditure.


21


© G

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22

BALANCE SHEET AS AT 30 JUNE 2008

2008 2007

ASSETS US$ US$

CURRENT ASSETS

Cash at bank 36,804,815 41,230,415

Advances to UNDP and UNOPS - 111,223

Other receivables 576,965 791,071

Prepaid expenses 72,392 147,553

Total current assets 37,454,172 42,280,262

Fixed assets, net 386,069 211,836

TOTAL ASSETS 37,840,241 42,492,098

LIABILITIES

CURRENT LIABILITIES

Bank overdraft - 1,349,818

Accounts payable 331,173 313,124

Other creditors 67,816 35,997

Accrued expenses 614,891 426,140

Grants payable 9,515,933 3,541,144

Project supervision fee 108,277 228,896

Total current liabilities 10,638,090 5,895,119

LONG TERM LIABILITIES

Grants payable after one year 3,325,642 4,377,894

CAPITAL AND RESERVES

Foundation capital 36,187 36,187

Surplus** 23,840,322 32,182,898

Total capital and reserves 23,876,509 32,219,085

TOTAL LIABILITIES 37,840,241 42,492,098

23

INCOME STATEMENT FOR YEAR ENDED 30 JUNE 2008

2008 2007

INCOME US$ US$

Donations received 12,706,071 42,781,128

Bank interest 1,700,752 1,828,900

TOTAL INCOME 14,406,823 44,610,028

EXPENDITURE

Project related costs:

Project grant expenditures 12,856,036 5,232,368

Project supervision fees 25,000 25,000

12,881,036 5,257,368

General administration expenses:

Staff related expenses 4,491,224 3,662,221

Office rental 288,624 199,741

Secretariat operational expenses 801,822 641,267

Professional, technical and legal fees* 2,404,193 2,101,949

Travel and meeting expenses 1,998,100 1,318,577

Depreciation 135,541 100,568

Other miscellaneous 357,973 17,658

Bank charges 39,661 40,087

Exchange difference, net (648,775) 41,939

9,868,363 8,124,008

TOTAL EXPENDITURE 22,749,399 13,381,376

Surplus of income over expenditure (8,342,576) 31,228,652

Surplus, beginning of the year 32,182,898 954,246

SURPLUS, END YEAR ** 23,840,322 32,182,898

*These funds and staff costs are utilized to provide technical assistance to projects.

**These funds are already committed to multi-year grant agreements for food fortification,the program on infant and young child nutrition, and project supervision contracts.24

© G

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/Mik

los

Feje

s

25

CHAIR, GAIN

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

VICE CHAIR, GAIN

Jaime Sepulveda, Director, Integrated Health Solutions Development Program, Bill & Melinda Gates Foundation, USA

Dora Nkem Akunyili, Director-General, National Agency for Food, Drugs, Administration and Control, Nigeria

Chunming Chen, Senior Advisor, Chinese Center for Disease Control, Director, International Life Science Institute, China

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

Christopher Elias, President, PATH, USA

Pierre Henchoz, Former Partner, Lombard Odier Darier Hentsch & Co, Switzerland

Saad Houry, Deputy Executive Director, UNICEF, USA

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

Olivier Kayser, Senior Advisor, Ashoka, United Kingdom

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

Franck Riboud, Président Directeur Général, Groupe Danone, France

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

Paulus Verschuren, Senior Director, Partnership Development, Unilever R&D, Netherlands

EX OFFICIO:

Julian Schweitzer, Director, Health Nutrition and Population Unit, Human Development Network, World Bank, USA

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

GAIN BOARD OF DIRECTORS

26

Marc Van Ameringen, Executive Director

Edward Atkinson, Chief Financial Officer

Barbara Macdonald, Senior Manager, Performance Measurement and Research

Bérangère Magarinos, Senior Manager, Investments and Partnerships

Regina Moench-Pfanner, Senior Manager, Food Fortification

Vanessa Ng, General Counsel

Dominic Schofield, Manager, Infant and Young Child Nutrition

Craig Courtney, Manager, Investments and Partnerships

Philippe Guinot, Manager, Premix Fund, Food Fortification

Lorenzo Rossi, Manager, Salt Iodization, Food Fortification

Rajan Sankar, Senior Manager and Regional Representative, South Asia

Larry Umunna, Manager and Regional Representative, Africa

Bing Liu, Manager and Regional Representative, South East Asia

GAIN MANAGEMENT

27

GAIN PROJECT MAP

National Food FortificationGAIN’s National Food Fortification Program supports 18 projects in countries with high levels of vitamin and mineral deficiencies. The projects, managed by coalitions of governments, businesses, international organizations and civil society partners, fortify foods and condiments with vitamins and minerals. When at full scale, GAIN’s national food fortification projects will improve the lives of more than 600 million people.

Salt IodizationGAIN’s Salt Iodization Program, in partnership with UNICEF, supports projects in 13 countries with the lowest coverage of iodized salt and the greatest burden of iodine deficiency. The partnership aims to reach more than 700 million people not yet covered by worldwide salt iodization programs, including 20 million new born infants.

Infant and Young Child NutritionThe Infant and Young Child Nutrition Program, which aims to improve the nutrition of 10 million children under two years old worldwide, supports projects in eight countries. The projects increase access to high-quality and affordable nutritious complementary food products. The program also supports the development of national nutrition policies that

prioritize maternal and young child health.

2.

6.

15.22.

4. 10.

17.

18.

7.

9.26.

1.

3.

27.

13.

21.

12.

20.

19.

23.

28.

24.

8.

14.

11.5.

16.

25.


SALT IODIZATION

NATIONAL FOOD FORTIFICATION

(Grants in Côte d'Ivoire, Ghana and the Philippines as well as an additional grant in Bangladesh have been approved by the GAIN Board and grant agreements are being negotiated.)

GAIN Projects Worldwide as of May 2009

1.Bangladesh

1 Number of individuals project reached as of June 2008

* Fortified food not yet on the market

2.Bolivia

13.Kazakhstan

15.Mali

16.Morocco

27.Vietnam

28.Zambia

18.Nigeria

19.Pakistan

23.South Africa

24.Uganda

26.Uzbekistan

3.China

4.Côte d’Ivoire

5.Dominican Republic

9.Georgia

10.Ghana

7.Egypt

GRANT AWARDEDUS$ 0.40 million

FOOD VEHICLEWheat flourFORTIFICANTIron, zinc,folic acid (B9), thiamin (B1), riboflavin (B2), niacin (B3), cobalamin (B12)Reach*

FOOD VEHICLEVegetable oilFORTIFICANTvitamin AReach1

5.2 million


FOOD VEHICLEVegetable oilFORTIFICANTvitamin A and DReach1

22.8 million


FOOD VEHICLEWheat flourFORTIFICANTIron, folic acid (B9), thiamin (B1), riboflavin (B2), niacin (B3) Reach1

10.1 million

FOOD VEHICLEVegetable oilFORTIFICANTvitamin AReach*

FOOD VEHICLESugarFORTIFICANTvitamin A Reach*


FOOD VEHICLEWheat flourFORTIFICANTIron, zinc, vitamin A,thiamin (B1), riboflavin (B2),and niacin (B3),pyridoxine (B6), cobalamin (B12)Reach*

FOOD VEHICLEWheat flourFORTIFICANTIron, folic acid (B9)Reach1

4.6 million


FOOD VEHICLEMaize mealFORTIFICANTIron, folic acid (B9),zinc, vitamin A,thiamin (B1), riboflavin (B2),niacin (B3),pyridoxine (B6) Reach1

30.1 million

FOOD VEHICLEWheat flourReach1

20.4 million



20.5 million


FOOD VEHICLEWheat flourFORTIFICANTIron, zinc, vitamin A,thiamin (B1), riboflavin (B2),niacin (B3),pyridoxine (B6), cobalamin (B12)Reach*

FOOD VEHICLEWheat flourFORTIFICANTIron, zinc,folic acid (B9),thiamin (B1), riboflavin (B2),niacin (B3),Reach1

5.8 million


6.Ecuador

8.Ethiopia

11.India

12.Indonesia

20.Philippines

22.Senegal

14.Kenya

17.Niger




FOOD VEHICLEMilkFORTIFICANTIron, zinc, vitamins A and DReach*


FOOD VEHICLEWheat flourFORTIFICANTIron, folic acid (B9), thiamin (B1), riboflavin (B2), niacin (B3), cobalamin (B12)Reach*

FOOD VEHICLESoy sauceFORTIFICANTIronReach1

62.8 million



10.4 million


FOOD VEHICLEWheat flourFORTIFICANTIron, folic acid (B9) Reach1

6.3 million

FOOD VEHICLESugarFORTIFICANTvitamin AReach*



4.6 million



0.4 million



3.4 million


3.1 million


FOOD VEHICLEWheat flourFORTIFICANTIron, zinc, vitamin A,folic acid (B9), thiamin (B1), riboflavin (B2), niacin (B3), cobalamin (B12)Reach1

16.3 million


FOOD VEHICLEFish sauceFORTIFICANTIronReach1

0.3 million

FOOD VEHICLEMaize mealFORTIFICANTIron, zinc, vitamin A,folic acid (B9),thiamin (B1), riboflavin (B2),niacin (B3),pyridoxine (B6), cobalamin (B12)Reach1

5.2 million


25.Ukraine

21.Russia

28

2.

6.

15.22.

4. 10.

17.

18.

7.

9.26.

1.

3.

27.

13.

21.

12.

20.

19.

23.

28.

24.

8.

14.

11.5.

16.

25.


SALT IODIZATION




1.Bangladesh



2.Bolivia

13.Kazakhstan

15.Mali

16.Morocco

27.Vietnam

28.Zambia

18.Nigeria

19.Pakistan

23.South Africa

24.Uganda

26.Uzbekistan

3.China

4.Côte d’Ivoire


9.Georgia

10.Ghana

7.Egypt




5.2 million



22.8 million



10.1 million






4.6 million



30.1 million


20.4 million



20.5 million




5.8 million


6.Ecuador

8.Ethiopia

11.India

12.Indonesia

20.Philippines

22.Senegal

14.Kenya

17.Niger








62.8 million



10.4 million



6.3 million




4.6 million



0.4 million



3.4 million


3.1 million



16.3 million



0.3 million


5.2 million


25.Ukraine

21.Russia

2.

6.

15.22.

4. 10.

17.

18.

7.

9.26.

1.

3.

27.

13.

21.

12.

20.

19.

23.

28.

24.

8.

14.

11.5.

16.

25.


SALT IODIZATION




1.Bangladesh



2.Bolivia

13.Kazakhstan

15.Mali

16.Morocco

27.Vietnam

28.Zambia

18.Nigeria

19.Pakistan

23.South Africa

24.Uganda

26.Uzbekistan

3.China

4.Côte d’Ivoire


9.Georgia

10.Ghana

7.Egypt




5.2 million



22.8 million



10.1 million






4.6 million



30.1 million


20.4 million



20.5 million




5.8 million


6.Ecuador

8.Ethiopia

11.India

12.Indonesia

20.Philippines

22.Senegal

14.Kenya

17.Niger








62.8 million



10.4 million



6.3 million




4.6 million



0.4 million



3.4 million


3.1 million



16.3 million



0.3 million


5.2 million


25.Ukraine

21.Russia

GENEVA, SWITZERLANDRue de Vermont 37-39

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Delivering improved nutrition to make people, communities and economies stronger, healthier and more productive.

www.gainhealth.org

2007-2008 Annual Report

Documents

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fights malnutrition

developing world

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