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November 2018

Milk fortification in India: The journey so far

Edward W. Bresnyan's picture
 NDDB
In India alone, 185 million people don’t get enough nutrients. This hidden hunger is especially pervasive among children. as more than 70 percent of India’s children under five are deficient in Vitamin D, and 57 percent of all children in the country lack adequate levels of Vitamin A. Credit: NDDB
Globally, more than two billion people are deficient in key micronutrients, which are essential to their good health.
 
In India alone, 185 million people don’t get enough nutrients.
 
This hidden hunger is especially pervasive among children. More than 70 percent of India’s children under five are deficient in Vitamin D, and 57 percent of all children in the country lack adequate levels of Vitamin A. 
 
These deficiencies have contributed to high levels of stunting, wasting and underweight children.
 UNICEF 
Global micronutrient deficiency (as a percentage of the population). Two billion people in the world lack key micronutrients such as Vitamin A or iron. South Asia has the most critical malnutrition levels. Source: UNICEF 


Micronutrient availability can make or break a balanced diet
 
If accessible and affordable, nutritional supplements taken in the form of capsules or tablets can mitigate the symptoms of hidden hunger. But they can become toxic if consumed in large amounts.  
 
Unlike supplements, food fortification is a simple, preventive and low-cost approach to curb micronutrient deficiencies.
 
But except for mandatory iodine fortification of salt, India lags in adopting food fortification as a scalable public health intervention.  
 
This is a missed opportunity as a glass of fortified milk (320g) can provide approximately 34 percent of the recommended daily allowance of Vitamin A and 47 percent of Vitamin D.
 
In 2016, the Food Safety and Standards Authority of India released standards for the fortification of five staple food items: rice, wheat, salt, oil, and milk. Further to that, regulations are now in place to fortify milk variants such as low fat, skimmed, and whole milk with Vitamin A and D.   
 
But despite its significant health benefits, and while established for more than three decades by companies such as Mother Dairy, a subsidiary of the National Dairy Development Board (NDDB), milk fortification is not yet common practice across the Indian milk industry.
 
To fill that gap, NDDB partnered in 2017 with the South Asia Food and Nutrition Security Initiative (SAFANSI), the World Bank, and The India Nutrition Initiative, Tata Trusts to explore the possibilities of large-scale milk fortification in India.
 
Over the last twelve months, this collaboration has enabled ten milk federations, dairy producer companies, and milk unions across the country to pilot milk fortification for their consumers. Fifteen others have initiated the process.

Act now for a brighter future for the Afghan people

Hartwig Schafer's picture
Also available in: دری | پښتو
Today, over 8.5 million students attend school–over 40% of them girls
Photo Credit: Rumi Consultancy/ World Bank

In 2001, only one million Afghan children attended school–none of them girls. Today, over 8.5 million students attend school–over 40% of them girls.

Amina, a 9th grade student, is one of over 3 million girls that now attend school through the contributions of the Afghan people and support from the international community.

"I have seen many improvements at my school. We are learning more now through better teaching methods and materials,” she said. Amina is one of the millions of Afghans whose lives have improved and has great hopes for the future.

As the first country that I visited after becoming the World Bank’s Vice President for the South Asia Region in July 2018, Afghanistan impressed me with its resilient people and achievements in spite of challenges, notably in education, health, and infrastructure.

The country has immense potential. Located in the center of a fast-growing region blessed with a young population and abundant natural resources, Afghanistan can achieve rapid growth and huge improvements in living standards through sound planning and tight implementation.

Game-changing technology empowers India’s women farmers

Paramveer Singh's picture
 World Bank
Since it started a decade ago, JEEVIKA, a World Bank program that supports Bihar’s rural communities, has mobilized more than nine million women into self-help and producers groups. Joining forces has helped lower costs and boost agricultural production. Credit: World Bank

It’s a dusty September morning, and Kiran Devi is finishing her chores at lightning speed.

 “Wouldn’t it be nice to keep 5,000 women waiting, especially when it’s a celebration,” she says with a touch of gushing pride and makes her way to the annual general meeting of the women-owned Aaranyak Agri producer company.

Located in Purnea district in Bihar—one of India’s poorest states—the company is made up of small local women small farmers and producers and lies in the most fertile corn regions in eastern India.

But until recently, small farmers did not fully reap the benefits of this productive land.

Local traders and intermediaries dominated the unregulated market. Archaic and unfair trading practices like manual weighing, unscientific quality testing, and irregular payments made it difficult for small farmers to get the best value for their produce.

 “The trader would come, put some grains under his teeth and pronounce the quality and pricing. For every quintal of maize [corn], 5-10 kilos additional grains were taken, sometimes through faulty scales and sometimes simply by brazenly asking for it,” says Lal Devi, one member of the company. “We had the choice between getting less or getting nothing.”
 

Kanchan Rani Devi bringing her corn to Sameli
Kanchan Rani Devi bringing her corn to Sameli. Credit: World Bank

Such practices stirred local women farmers into action, and they formed the Aaranyak Agri Producer Company Limited (AAPC) to access markets directly and improve their bargaining power.  

The company established a farmer-centric model and received funding and technical assistance through JEEViKA (livelihoods in Hindi), a World Bank program that supports the Government of Bihar and has achieved life-changing results for Bihar’s rural communities.

Since it started a decade ago, JEEVIKA has mobilized more than nine million women into self-help and producers groups. Joining forces helped lower costs and boost production. Together, the groups saved $120 million and leveraged more than $800 million in bank loans.

Further, digital technologies have been introduced as an innovative way to improve the production, marketing, and sale of small-farmers’ produce.

For example, women farmers receive regular periodic updates on their mobile phones to learn best practices to grow corn as well as weather information to inform farming decisions.

During harvest season, farmers receive daily pricing information from major nearby markets to help them stay abreast of the latest variations in prices.

Toward a livable Dhaka

Ede Ijjasz-Vasquez's picture
Toward a Liveable Dhaka


The Dhaka Metropolitan Area is the economic and political center of Bangladesh and has been the country’s engine of economic growth and job creation. Dhaka’s role as a commercial hub has led to rapid population growth, with the population increasing 10 times in 40 years to about 18 million in 2015. This has contributed to Bangladesh having one of the fastest rates of urbanization in South Asia.

Today, more than one-third of Bangladesh’s urban population lives in Dhaka, one of the world’s most densely populated cities with 440 persons per hectare – denser than Mumbai (310), Hong Kong, and Karachi (both 270).

Dhaka is also one of the least livable cities in the world. It is ranked 137 on livability out of 140 cities, the lowest for any South Asian city surveyed. The low livability in Dhaka disproportionately affects vulnerable populations, such as the poor, women, and the elderly.

Brazil’s small farmers offer lessons to India

Priti Kumar's picture
Angela, on the far left and dressed in red, is a small-holder farmer and entrepreneur in Brazil. She started a banana business that expanded to packed lunches for truckers, college students, and travelers. Credit Priti Kumar/World Bank

“Once, it was a rodeo day here and my son asked for money to go. But I didn’t have the money and told him to sell our farm’s bananas on the road instead. So, he took 50 bunches of bananas and sold them all in a few hours. Soon I started a banana business. The sales enabled me to expand my business to packed lunches for truckers. Over time, with the help of my family, the road administration, and my own investments, I started receiving invitations to make meals for college students and travelers.”

Angela, small-holder farmer and entrepreneur, São Paolo, Brazil.

 
Angela told us her story one afternoon as we ate the delicious lunch she had prepared for us at her rather humble roadside eatery in rural São Paulo, Brazil.

Her story was not only touching but also summed up the importance of entrepreneurial foresight and the power that collaboration holds in opening new doors for poor farming communities.
 
India and Brazil have much in common. Both have smallholder farmers - called family farmers in Brazil - (although these farmers make up a much smaller proportion of Brazil’s overall farming community and have a different landholding structure).

Yet Brazil, like many other Latin American countries, has been able to promote commercial agriculture and raise farmers’ incomes by creating collectives, comprised mainly of family farmers.
 
Even though family farmers represent a small slice of Brazil’s cooperatives, the impact of their collectives is considerable.

Often referred to as the “breadbasket of the world”, half of Brazil’s food comes from its 1,500 plus agricultural co-operatives, which employ more than 360,000 people.

The productivity of Brazil’s agriculture is evident.

With only 15% of Brazil’s population living in rural areas, more than 20% of its GDP comes from the agriculture sector.

 In India, on the other hand, 66% of the people live in rural areas while just 15% of GDP comes from agriculture.
 
Brazil’s success in making agriculture more market-oriented and raising farmer incomes holds many lessons for India.

For many years now, India has recorded a surplus in most critical agricultural commodities. 

Yet, farmers’ incomes continue to be subdued.

To help farmers earn more from the land and move onto a higher trajectory of growth, India has gradually shifted its policy focus to linking farmers to markets, as well as enabling them to diversify their production and add value to their produce.
 
So how do Brazil’s farmer collectives work?

An update on Bhutan’s economy

Tenzin Lhaden's picture
Accelerating the reform momentum after the 2018 elections is key to consolidating and furthering Bhutan’s development
Accelerating the reform momentum after the 2018 elections is key to consolidating and furthering Bhutan’s development. Credit: World Bank

Bhutan is one of the smallest, but fastest-growing economies in the world.
 
Its annual average economic growth of 7.6 percent between 2007 and 2017 far exceeds the average global growth rate of 3.2 percent.
 
This high growth has contributed to reducing poverty: Extreme poverty was mostly eradicated and dwindled from 8 percent in 2007 to 1.5 percent in 2017, based on the international poverty line of $1.90 a day (at purchasing power parity).
 
Access to basic services such as health, education and asset ownership has also improved significantly.
 
The country has a total of 32 hospitals and 208 basic health units, with each district hospital including almost always three doctors.
 
The current national literacy rate is 71 percent and the youth literacy rate is 93 percent.
 
The recent statistics on lending, inflation, exchange rates and international reserves (Sources: RMA, NSB) confirm that Bhutan maintained robust growth and macroeconomic stability in the first half of 2018.  

Gross foreign reserves have been increasing since 2012 when the country experienced an Indian rupee shortage.
 
Reserves exceeded $1.1 billion, equivalent to 11 months of imports of goods and services, which makes the country more resilient to potential shocks.
 
The nominal exchange rate has been depreciating since early 2018 (with ngultrum reaching Nu. 73 against the US dollar in early November).

Poor sanitation is stunting children in Pakistan

Ghazala Mansuri's picture
A nutrition assistant measures 1 year old Gullalay’s mid-upper arm circumference (MUAC) at UNICEF supported nutrition center in Civil Dispensary Kaskoruna, Mardan District, Khyber-Pakhtunkhwa province, Pakistan.
With a stunting rate of 38 percent, Pakistan is still among the group of countries with the highest rates of stunting globally and the pace of decline remains slow and uneven. In Sindh, for example, things have worsened over time, with one in two children now stunted. Credit: UNICEF


More than one in every three children born in Pakistan today is stunted.

Child stunting, measured as low height for age, is associated with numerous health, cognition and productivity risks with potential intergenerational impacts.

With a stunting rate of 38 percent (Demographic & Health Survey 2018), Pakistan is still among the group of countries with the highest rates of stunting globally and the pace of decline remains slow and uneven.

In Sindh, for example, things have worsened over time, with one in two children now stunted!

The policy response to this enormous health crisis has been almost entirely centered on interventions at the household level—reducing open defecation (OD), improving household behaviors like child feeding and care practices and food intake.  

A recent World Bank report, which I co-authored, suggests that a major shift is this policy focus is required for significant progress on child stunting.

The report begins by showing that over the past 15 years Pakistan has made enormous progress in reducing extreme poverty, with the poverty rate falling from 64 percent to just under 25 percent in 2016.

This has improved dietary diversity, even among the poorest, and increased household investment in a range of assets, including toilets within the home.

This has, in turn, led to a major drop in OD, from 29 percent to just 13 percent. Curative care has also expanded, with the mainstreaming of basic health units and the lady health worker program.
 

Protecting Bhutan’s cultural heritage

Dechen Tshering's picture
Cultural heritage is an extremely important aspect of Bhutan and is one of the four pillars of Gross National Happiness, the guiding philosophy of Bhutan’s development


Culture defines the sovereignty and identity of Bhutan and its people.

And the intricate beauty and uniqueness of its traditional architecture are known around the world.

As such, cultural heritage preservation is one of the four pillars of Gross National Happiness, the guiding philosophy of Bhutan’s development, and is embedded in all its national development policies.

In this context, the Royal Government of Bhutan has made it a priority to sustain both tangible and intangible aspects of its culture with dedicated offices under the Department of Culture of Ministry of Home and Cultural Affairs (MOHCA), which work closely with local governments.

This work is critical as Bhutan’s monuments are vulnerable.

The 2009 and 2011 earthquakes damaged hundreds of historic monasteries and fortresses known as dzongs, including the Lhuntse and Trashigang Dzongs (2009) and the Paro Tadzong (2011).

Also, fires triggered some of the worst disasters in Bhutan’s cultural history.

The famous Paro Taktshang, nicknamed the Tiger’s Nest and the Wangduephodrang Dzong were burnt down in 2008 and 2012 respectively.

One of the distinctive characteristics of the Dzongs of Bhutan is their strategic location.

Making higher education accessible to Afghan women

Muzhgan Aslami's picture
Also available in: دری | پښتو
Afghan students attending their class in Kabul University
Students attending class at Kabul Medical University. Photo Credit: Rumi Consultancy/ World Bank

As a women’s rights activist who has dedicated the past six years of her life to empowering women, ensuring that women can access education is crucial to me.
 
This is what motivates me in my work with the Higher Education Development Program (HEDP) at the Ministry of Higher Education (MoHE), the principal body responsible for providing and regulating higher education in Afghanistan.  
 
When I joined the MoHE as a Gender Specialist in 2016, I mainly focused on making sure female students did not face the same challenges I personally encountered as a student at Kabul University.

Some of the issues my friends and I remember was traveling long distances to the university, the lack of facilities for female students on campus, and the few opportunities to go abroad for postgraduate studies. Factors which, together, led to low female enrollment rates.

Today, with support from the Afghanistan Reconstruction Trust Fund (ARTF), many of the challenges I witnessed have been resolved with the initiation of the second National Higher Education Strategic Plan, 2015–2019, under the HEDP.