CINI's Nutrimix works as nutrition for the very poor

Subir Roy, Kolkata

It was in the early 1970s that Dr Samir Chaudhuri, then a young pediatrician, chose to work in the villages and slums of West Bengal. He soon found that he needed to go much beyond the confines of his specialisation to improve the health of the pregnant mothers and children who came to him as patients. Medical attention in itself was not the only answer. Malnutrition was the real problem. The first step, he realised, lay in awareness and a balanced diet.

In 1974 Dr Chaudhuri set up the Child In Need Institute (CINI) in Joka on the outskirts of Kolkata to train health workers and reach out to poor families. They needed to be told the importance of eating nutritious meals. It was sound advice but families eking out an existence in slums could hardly afford such meals.  

What they really needed was a low-cost nutritional food through a high-calorie, protein-based organic mix. CINI began providing such a mix and out of that initiative 41 years ago has been born Nutrimix. It now touches the lives of nearly 100,000 children daily in West Bengal and Jharkhand.

Nutrimix has also morphed into CINCOMM, a social enterprise with immense potential. It is now available in six products, including a health drink. Nutrimix is all set to enter the Public Distribution System (PDS) and the commercial market with a slew of new products, including nutritious noodles and breakfast cereals.

“We want to enter the bottom of the pyramid market and target the poor, just like the multinationals do, so that they get nutritious food products,” says Dr Chaudhuri. “There is no reason to subsidise these products and hopefully there will be marginal profits.”

CINI works on the assumption that malnutrition is not always the result of the lack of food. Mothers and infants, especially girls, are not given the priority they should be given. Traditionally women eat last. Diet may be imbalanced due to lack of understanding of nutrition as much as the lack of food. CINI therefore focuses its nutrition project on informing and educating women especially those who are pregnant and lactating, to make the best of what is available.

CINI is one of the oldest and most well-known voluntary organisations in India working on mother and childcare and fighting India’s endemic malnutrition. It works mostly in West Bengal and Jharkhand and has, till now, impacted the lives of five million people.

In the initial years Dr Chaudhuri collaborated with Sister Pauline Prince, an Australian Loreto nun and nutritionist, and Rev. Fr. J. Hendrichs, S.J. In 1998 CINI was recognised as a National Mother NGO under the Reproductive and Child Health programme of the Government of India. The same year it was recognised as a training institute by the National Institute of Health and Family Planning.

It also has a disaster management global footprint and is supported by global organisations like Save the Children, UNICEF, Care and World Bank. With around 1,300 staffers and an annual budget of Rs 29.3 crore (2013-14), it is also intensively into the training of development workers.

Two aspects of CINI stand out. One, it works closely with the government but political change in West Bengal has not affected it. Two, Dr Chaudhuri, who got his degree at the All India Institute of Medical Sciences (AIIMS), has had a research mindset from day one. Hence, the evolution of CINI is based on learning from structured research by Dr Chaudhuri which has a reputational standing of its own in academics.

 

LOCALLY AVAILABLE INGREDIENTS

Dr Chaudhuri recalls that, in the early ’70s most of the nutritional products available in the market were unaffordable for the poor, costing almost a week’s earnings of a daily wage labourer. Hence, he began searching for a low-cost food supplement which could be made out of locally available ingredients in the kitchen of a poor family. 

In keeping with CINI’s aim of using locally available material, Nutrimix initially consisted of rice and green gram (pulses) for a protein-rich, near-balanced food. In the beginning, milk powder was added but this was later discontinued as that reduced shelf life. Today, Nutrimix consists of wheat, green gram, iodine and iron to address the main deficiencies of protein, iodine, iron (causing anaemia) and Vitamin A.  

A packet of Nutrimix has 400 gm of roasted wheat and 100 gm of green gram. It has 70 gm of protein and yields 1,700 kilocalories of energy.

A key person who gave the first stamp of professional approval to Nutrimix after analysing it was Prof. Sunit Mukherjee, then heading the department of food technology at Jadavpur University. Over the decades he has continued to play a key role in checking quality and in the evolution of the product, laying down its production path and, where necessary, designing machinery and working with fabricators.

In the first decade of its life Nutrimix was made in CINI clinics by the mothers who brought their children there by roasting rice, wheat and dal in cast iron kadais, the same way muri (puffed rice) is made, and grinding the mix at the local chakki for grinding atta. This cottage industry operation was good for 200-300 kg of Nutrimix a year. It was distributed to women with malnourished children who were brought to the clinic. This phase can be described as one of conceptualisation, creating awareness and free distribution.

Having got a good thing going, CINI decided to make its product even more local and take it into the homes of the poor through its health workers. They showed mothers how Nutrimix could be prepared at home, using the much smaller home kadai and the sil-batti used to grind spices, and the many ways in which it could be used.

CINI’s health workers also showed mothers how nutritional content could be improved by adding things like green leafy vegetables and cooking oil to fortify the product with iron and vitamin content, crucial for growing children. This second decade could be called the phase of community-centric manual production and distribution.

CINI’s surveys consistently show that the nutritional status of malnourished children improved after two months of eating foods prepared with Nutrimix.  For instance, in areas covered by the Murshidabad field unit, weight increased in 265 children out of 394 and the nutritional grade of 79 children changed after two months. All the members of the SHG knew how to use Nutrimix.

A qualitative and quantitative jump came with the arrival of the World Bank, enabling CINI in 2010-11 to set up a mechanised Nutrimix plant at its headquarters off Diamond Harbour Road near Kolkata.

The other critical input came from the nearby Indian Institute of Management (IIM), Kolkata, two of whose faculty members, Sougata Ray and Kalyan Mandal, and an action researcher, Anjan Ghosh, came in during 2012 to conceptualise and roll out a social business venture around Nutrimix and also develop its supply chain. They participated for two reasons — Dr Chaudhuri’s conviction that Nutrimix could be a social movement and the fact that the idea also matched their research interest in the transition of purely social effort into hybrid organisations.

The three scientists, so to speak — in basic sciences and management — all located near Kolkata, are members of the governing body of CINI.

Dr Chaudhuri was keen to involve the community in producing Nutrimix. So CINI began creating community production units which would buy ingredients needed for the mix locally and deliver locally while creating local employment. There was thus a product (Nutrimix) and a process “Community+” to empower a community.

This model conforms to guidelines laid down by the Supreme Court on the functioning of the midday meal and the government’s Integrated Child Development Scheme (ICDS).

CINI promotes community ownership. Nutrimix as a product has local avatars. At a production unit we visited in the Sundarbans, we found Nutrimix had acquired the name Pushti.

The first community unit was set up in Jharkhali in the Sundarbans when World Vision India came in to support it. It was a kind of challenge. “If you can do it there you can do it anywhere,” says Bishan Mukherjee, CEO of CINCOMM. Four more units have come up in Birbhum district of West Bengal. The success of the model can be seen from the fact that there are now government orders for two more community units in Birbhum and one in Jharkhand. Further expansion will take place in Bihar, Odisha and Tripura.

 

A SOCIAL BUSINESS

The biggest change that has taken place for Nutrimix is the creation of CINI Community Initiative or CINCOMM. It got going in 2013 as a sister company of CINI, as a non-profit Section 8 company under the Companies Act, which as a social business enterprise is seeking to take Nutrimix on a new path of growth and expansion. 

“We wanted to provide a free hand to CINCOMM to expand, using business and management principles and to tap into the growing demand for low-cost nutritious foods for the ICDS and the Sabla programme of the department of women and child development in various states to reduce malnutrition,” explains Dr Chaudhuri.

CINCOMM in its first year (2013-14) of proper functioning recorded a turnover of `1 crore and in the second year (2014-15) `1.7-1.8 crore. In the current year (2015-16) CINCOMM has the potential to get orders of `30 crore but finding working capital to execute orders of such magnitude would be an issue. Payment from government, the key buyer, takes a lot of time to come. So, despite having a good order book, CINCOMM is currently negotiating with the government so that some of the orders go to the community-run units. A community unit can produce three tonnes per month and five such units can take care of the needs of a block.  

The community units, as part of the Community+ initiative, are a boon to the local women who run them by forming Self-Help Groups (SHGs), enabling more than 100 rural women to become entrepreneurs. They procure the cereals locally, sometimes from their farmer spouses. The benefit of eliminating the middleman goes to the farmer, that is, stays in the family which also gets the price security implicit in having an in-house buyer for their grain. Also, when community plants meet local needs transportation costs are slashed. The aim is to work the mother plant only to meet shortages and take the number of community units to 15.  

The foundation of the arrangement lies in a tripartite agreement — the government as buyer, the SHG as seller and CINCOMM as guarantor of quality and delivery schedules.

The SHGs form a pyramid structure. About 10 of them make a sangh, and a similar number of sanghs form a maha sangh which corresponds to an administrative block in a district and forms a cooperative to receive government orders. CINCOMM works with the National Rural Livelihoods Mission (NRLM) in creating jobs at the community plants and with the ICDS for the distribution of Nutrimix.

Capital to start a community unit is not an issue for a maha sangh or cluster. With every member contributing a couple of hundred rupees or so they can easily raise around `5 lakh, with an equal amount coming from a bank. Virtually the entire output (9:10 ratio) is purchased by the government for distribution to anganwadis to feed children.

One-tenth is bought by gram panchayats from the SHGs. The latter pay the same price as the government and so SHGs, whose production (raw material) costs are lower than the mother plant’s, make a higher margin.

The basic product plus micronutrients plus flavours costs the government Rs 80 per kg and the current cost works out to `72-76 per kg.

As demand for the entire output is assured, CINCOMM is not dependent on grants as CINI was earlier. The surplus generated by CINCOMM supports two entities: parent CINI and Dr Subhas Mukherjee Memorial Reproductive Biology Research Laboratory, out of which Dr Mukherjee works. (A bit of history: Sunit Mukherjee is sibling to Subhas Mukherjee who created India’s first test tube baby in 1987.)

Nutrimix now comes as six basic products — wheat, rice and multi-grain based and their sugar added versions. Of these six there are six other variations, depending on the added micronutrients. The latter take care of vitamin deficiencies which is different from plain lack of adequate calorific intake. You can have it almost whichever way you like — as barfi, pakora, pancake, porridge or plain sattu. Or as a health drink with flavours like orange and lime.

The last is important. It came out of the need to give children something to eat when they came in early after the anganwadi centre timings were extended. For as little as 20 gm per drink, you can reach out to several times the number of children you could earlier. Nutrimix is sold as a powder, be it for the health drink or for malnutrition projects. In some cases Nutrimix is made into porridge and other recipes and fed to children at sneho sibirs (care centres). Nutrimix for malnutrition constituted 25 per cent of last year’s total production and the health drink accounted for the remaining 75 per cent.

In keeping with changing tastes and incomes, Nutrimix has also been changing. It is projected as a ready-to-eat nutritious food at a time when there is demand for ready-to-eat stuff. In keeping with popular sensitivity towards taste, Prof. Mukherjee says variations of the product have been devised by adding salt, sugar and flour, as also flavours like orange and lime, all natural.

Two new products are being developed. One is an extruded product, like kurkure, which is about the same in content as Nutrimix but made with an extruder which works at high pressure and temperature. Developing new products sometimes needs developing new machinery. For example, while grinders are easily available, roasters have to be designed and put together by working with fabricators.

The other new product being developed is noodles which will be Nutrimix plus wheat flour. Noodles, which are popular among both children and busy working people, will be a vehicle with which to enter the commercial market.     

There is a growing demand for low-cost nutritious foods to reduce malnutrition in the various schemes of the central government for women and children, corresponding state government schemes and NGOs working in the area. In fact, demand is increasing. CINCOMM’s aim is to enter the Public Distribution System (PDS) and cater to the public demand for nutritious foods. “There is no reason to subsidise these products and hopefully there will be marginal profits,” says Dr Chaudhuri.    

There is scope for packaging and branding CINCOMM products in a mainstream commercial way and R&D work is going on in Prof. Mukherjee’s lab to come up with not just kurkure but also breakfast cereals and health drinks to meet the needs of the middle class. “This will hopefully generate profits to start innovative projects at CINI or invest in other product ranges,” says Dr Chaudhuri  

 

(CINCOMM can be contacted at: [email protected]; c/o Child In Need Institute (CINI), Daulatpur, PO Pailan Via Joka, 24-Parganas (S)- 700104, West Bengal)