Increasing access to nutritious local complementary foods: A whole-of-systems approach

What we know: Inadequate complementary feeding practices in low- and middle-income countries (LMICs) are a major contributor to persistent child malnutrition, adversely affecting growth and cognitive development. Despite various initiatives, barriers (ranging from limited local production and distribution to weak policy and regulatory frameworks) continue to impede access to and use of safe, nutritious complementary foods.

What this adds: We propose a comprehensive, whole-of-systems approach that addresses these barriers by increasing local production, stimulating demand, and establishing supportive policies. By showcasing successful interventions and integrated approaches, we provide actionable insights and a roadmap for stakeholders to scale up solutions and improve complementary feeding practices in LMICs.

Globally, nearly 181 million children live in severe child food poverty, surviving on two or fewer food groups a day (UNICEF, 2024). This dietary inadequacy means that children lack the essential micro- and macro-nutrients that they need. This contributes to persistent malnutrition, impeding children’s growth and development. Malnutrition undermines a child’s future economic prospects while perpetuating cycles of poverty. Increasing consumption of locally produced and fortified, commercially available complementary foods (CACFs) can contribute to reducing food poverty in young children (Micronutrient Forum, 2024).

A recent study highlighted that locally produced CACFs often meet appropriate nutrition criteria and are typically more affordable than imported options. In Thailand, of the 54 CACFs that met all nutritional composition requirements, 35 were produced locally, with 32 products across 12 Thai companies. The average price of these complementary foods was lower than the average price of imported products meeting the same nutrition criteria (ATNI, 2023). Yet, unhealthy, energy-dense and nutrient-poor snacks, foods, and beverages proliferate and are aggressively marketed. They are often more desirable to caregivers than nutritious foods (Zehner et al, 2019).

Systemic barriers prevent local and regional producers from scaling up CACF production and improving access to nutritious foods. Addressing these challenges requires a ‘whole-of-systems approach’, engaging not only producers, but also governments, suppliers, distributors, researchers, technical agencies, and investors. This collective effort is crucial to strengthen the food system and reshape the food environment for complementary foods, ensuring that nutritious options are accessible, affordable, and aspirational.

In this article we highlight key challenges and action areas that can play a transformative role in scaling up nutritious solutions at the national, regional, and global levels.

Enterprises of all sizes in LMICs (especially small- and medium-sized enterprises) face considerable hurdles in scaling up their production of nutritious CACFs. Large multinational corporations generally have access to extensive financial resources and established supply chains. By contrast, local producers often struggle with limited access to affordable financing. High interest rates, limited collateral, and underdeveloped financial sectors in LMICs prevent local producers from securing the necessary investments to upgrade technologies, procure quality ingredients, and improve infrastructure to meet food safety and nutritional standards (Bove et al, 2023). This puts them at a distinct competitive disadvantage.

This challenge is further compounded by a lack of access to technical expertise. Larger companies often have in-house expertise in critical areas, such as product formulation and food safety. This disparity makes it challenging for local producers to meet national or international guidelines and to be competitive in the market (Micronutrient Forum, 2024).

Pervasive supply chain inefficiencies which exist across LMICs hinder the availability of CACFs, particularly in remote and underserved areas. In urban areas within Burkina Faso, Chad, Mali, Mauritania, Niger, and Senegal, and despite locally produced CACFs being 2-4 times less expensive than imported options, imported products dominate urban markets. In rural areas in these countries, irregular supply chains affect both locally produced and imported CACFs. This leads to significantly higher prices (sometimes double those in urban markets), further limiting access for low-income households (UNICEF et al, 2020).

Inconsistent or weak enforcement of food safety and quality standards provides further opportunity for unhealthy CACF options to dominate local markets. These products are typically high in sugar and salt and engineered to be hyper-palatable and aspirational. They are also aggressively marketed. These foods risk displacing more nutritious options due to their widespread availability and affordability (Zehner et al, 2019). A recent assessment of CACFs marketed across seven Southeast Asian countries found that a large proportion was of poor nutritional quality and/or carried misleading labels (ATNI, 2023). This underscores the need for stronger regulatory environments.

Even when nutritious CACFs are available, low consumer demand (driven by limited awareness, misinformation, and lack of trust in locally produced foods) hinders market growth. Many caregivers are unaware of the long-term benefits of nutritious CACFs or prefer less nutritious options that are often cheaper. Without consumer demand, private sector investment in the production of nutritious CACFs remains low, perpetuating the cycle of inadequate supply.

Over the past decade, several actors have supported small and medium-sized enterprises to produce and market nutritious complementary foods. Organisations like the Base-of-Pyramid Innovation Centre (BoP Inc), the Global Alliance for Improved Nutrition (GAIN), Gret, and TechnoServe have all been working towards this aim. These initiatives have yielded valuable insights on key considerations for scaling up production. These include the necessity of culturally appropriate CACFs, improving market access, and the technical support required by local producers. However, progress has been hindered by the absence of standardised metrics on production, sales, and consumption of complementary foods. Isolated efforts focusing on single enterprises have not reached the scale necessary to influence market dynamics or improve child diets at the population level.

To tackle the challenges in scaling up CACF production, we advocate for a whole-of-systems approach, focusing on six key action areas:

Investment and financing

Overcoming financial barriers requires innovative financing mechanisms targeted at local CACF producers. Agencies like Aceli, iGravity, and Incofin are examples of organisations that have developed impact investment opportunities for nutrition. The Nutritious Foods Financing Facility (N3F), a partnership between GAIN and Incofin Investment Management, offers affordable loans and technical assistance to local enterprises in Sub-Saharan Africa. The aim is to expand the production and sale of locally produced nutritious and safe foods destined for domestic markets.

Blended finance models (combining public and private financing to de-risk investments) and microfinance programmes (offering small-scale loans to entrepreneurs in LMICs) are also potential solutions to alleviate the financial burden on smaller producers (Bove et al, 2023).

Capacity building

Capacity building is crucial for empowering local CACF producers. Training programmes focused on food processing, quality control, and supply chain management have proven effective in improving product quality and market access. In Sub-Saharan Africa, small and medium-sized enterprises received training in food processing techniques, quality control, and business management for nutritious, fortified foods (USAID et al, 2023). This support not only improved product quality but also helped local producers comply with food safety regulations and opened up new market opportunities.

For over 30 years, Gret has supported local enterprises in Madagascar and the Sahel region to develop and market fortified complementary foods tailored to local nutritional needs, tastes, and purchasing power (Caclin et al, 2021). With technical assistance and innovative business models, Nutri’zaza, a Madagascan social enterprise, now sells over 42,000 fortified meals every day. This generates a turnover of more than USD 1 million, a significant figure given the local context.

Supply chain efficiency

Improving supply chain logistics and distribution systems is critical to improve access to CACF, particularly in rural and remote regions. As an example, the Ghana Nutrition Improvement Project developed a complementary feeding supplement called KOKO Plus. The supply chain was optimised by localising ingredient sourcing and production, and by distributing through local networks and kiosks near health facilities (Nutrition Connect, 2019). Recently, the project has implemented a new digital distribution management system to establish monthly tracking of distribution coverage and product proximity. The involvement of local entrepreneurs, including women in rural areas, facilitated the traceability of KOKO Plus from ingredient sourcing to final sales.

In Kenya, the World Food Programme (WFP) partnered with the government to provide critical food and nutrition assistance to hard-to-reach communities (WFP, 2018). By leveraging their supply chain expertise and facilitating market access, WFP supported the distribution of fortified complementary foods to refugee camps such as Dadaab and Kakuma. This partnership also helped reduce operational costs, allowing producers to offer CACFs in local markets at more affordable prices.

Policy and regulatory environment

Establishing a supportive policy and regulatory environment is critical for promoting the production and consumption of nutritious CACF. For example, Rwanda's national food fortification programme established mandatory fortification standards for staple foods and complementary foods (UN Food Systems Summit, 2021). The government’s commitment to monitoring and enforcement has created a business environment where local producers are incentivised to invest in fortified foods, ensuring consistent nutrient quality and safety.

In Madagascar, the Alliance Nationale pour la Fortification Alimentaire (ANFA) is responsible for the formulation and implementation of a national food fortification strategy. ANFA is supporting the private sector in the production of fortified foods by advocating for the de-taxation of premixes. ANFA is also facilitating linkages between national and international partners to enhance fortification efforts. With the support of Gret, ANFA developed and adopted a national guideline on infant flours in 2020. It also implemented a certification process for complementary food producers and a technical certification committee to oversee compliance (Caclin et al, 2021). To date, four Madagascan products have received a certificate of conformity to the Madagascan national guidelines for fortified infant flour.

In Southeast Asia, the COMMIT consortium compiled a Compendium of International Standards and Guidelines on CACFs to support national composition and labelling efforts in the region (UNICEF EAPRO, 2023). This work informed the development of a regional Nutrition and Promotion Profiling Model for CACFs, by the World Health Organization Southeast Asia Regional Office. Both frameworks guide the development of new and stronger country regulations and identify good practices that can be leveraged through increased investment and capacity building.

Consumer demand creation

Building consumer demand is essential for the growth of the CACF market. Public sector education campaigns which promote the benefits of nutritious complementary foods are effective in raising awareness. In Bangladesh, Alive & Thrive demonstrated that the combination of interpersonal communication, community-based education initiatives, and mass-media campaigns significantly improved complementary feeding practices. This included the increased consumption of iron-rich or iron-fortified foods (Menon et al, 2016). To counterbalance aggressive marketing of unhealthy foods, creating synergy between public sector promotion of nutritious complementary foods and appropriate marketing of safe and nutritious CACFs is crucial. Some social marketing examples, mainly focusing on complementary food supplements, such as micronutrient powders, have successfully amplified public health promotion.

Public-private partnerships

Multi-stakeholder partnerships are a powerful tool for addressing challenges in CACF production and distribution. The Scaling Up Nutrition Movement’s Business Network works across 27 LMICs, empowering national enterprises through business training and mentorship to strengthen nutritional impact and scale-up. The Business Network supported Baby Grubz, a small/medium-sized CACF enterprise in Nigeria. Baby Grubz won a financial award in the Global Scaling Up Nutrition Pitch Competition for an inclusive business model providing peer-to-peer mentoring on the benefits of nutritious foods and breastfeeding. In West and Central Africa, the recently launched First Food Initiative, by UNICEF, provides yet another example of how to coordinate efforts across countries and regions. It leverages the strengths of all food system actors to create a more conducive environment for scaling up the production of CACFs in LMICs. These collaborative platforms facilitate the sharing of resources, knowledge, and best practices, amplifying the impact of individual efforts and driving systemic change in the food environment.

In Burkina Faso, Gret, and Hystra supported Sodepal (a local food producer) in developing a high-quality and affordable local infant flour (Super Leo). The product is delivered more broadly through a partnership with Fortis, a distributor specialising in mass-market food products. This partnership ensures that Super Leo reaches approximately 75% of the outlets in the capital, Ouagadougou. The partnership applies a holistic approach to improving access to CACFs, covering market diagnostics, product development, and consumer engagement. 

CACFs have the potential to play a critical role in filling the nutritional gaps in children’s diets, helping them to achieve optimal health and development. A comprehensive whole-of-systems approach is required to tackle financial constraints, low levels of capacity, supply chain inefficiencies, policy and regulatory gaps, and low demand. These all hinder the widespread adoption of locally produced CACFs.

Going forward, national actors must unite in a collective and systemic effort. Governments should lead by establishing clear, consistent regulatory frameworks that create a level playing field for local producers. This will enable them to compete with multinational companies. Investors must prioritise financing for local producers, while technical agencies should invest in capacity-building programmes that equip these producers with the necessary skills to produce high-quality CACFs. Furthermore, synergistic public-private sector campaigns are essential to raise awareness amongst caregivers about the importance of adequate complementary feeding. This will drive consumer demand for CACFs. Finally, there is the need to capture, share, and learn from country experiences.

The upcoming Scaling Up Nutrition Global Gathering in November 2024 and the Nutrition for Growth Summit in March 2025 present timely opportunities to galvanise action and make concrete commitments to increasing investments in CACFs. The time for action is now. Through collective action, we can build resilient food systems that nourish the next generation.

For more information, please contact Marti van Liere at marti.vanliere@micronutrientforum.org

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Menon P, Nguyen P, Saha K et al (2016) Combining intensive counselling by frontline workers with a nationwide mass media campaign has large differential impacts on complementary feeding practices but not on child growth: Results of a cluster-randomized program evaluation in Bangladesh. The Journal of Nutrition, 146, 10, 2075-2084

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