Dr Rajan Sankar, Director of Nutrition at Tata Trusts

RS: I am Dr Sankar, I am a physician by training, and I was in clinical practice for 3 decades before I got into basic nutrition work; and what pulled me into the nutrition work was as a part of clinician and medical doctor in the army, I was posted in Sikkim and that is the time that I realised the devastation of iodine deficiency causes. And I spent 5 years of my active life there working on iodine deficiency. Then one led to the other, and then I got into clinical epidemiology and then into nutrition.

Q1. Can you tell us about Tata Trusts and the priority areas of work? 0’50

RS: Tata Trusts is an amalgamation of a number of trusts and that’s one of the oldest in the country; the legacy spreads over 130 years. The big area of focus are education, health and nutrition, livelihood, agriculture, water and sanitation; and then, these are done through different platforms. A platform for innovation, a platform that is mainly grant-making, and a platform to support institution creation as you might be aware that many of the institutions in the country at some stage were created with big endowments from the Tata Trusts. So we work across the country, and for nutrition particularly, we have memorandum of understanding with 5 state governments: Andhra Pradesh, Rajasthan, Tripura, Maharashtra, Uttar Pradesh, and Madhya Pradesh.

Q2. What are the strategic priority areas for Tata Trusts in nutrition? 2’03

RS: Some of the keys areas in nutrition are firstly to work within the government system because that give you the scale and as a country we have several right policies and fantastic programmes but many of them are not working very well or are not working optimally. So the idea of us to work with this system is to catalyse action so you can reach the scale very quickly. That is mainly working with the Integrated Child Development Services (ICDS) and the National Health Mission. The second focus is in the area of food fortification. Food fortification as a strategy has helped many developed countries and many Western countries to virtually eliminate several nutritional disorders. Whereas it is something as a strategy grossly under-utilized in the developing countries, and particularly in India. So with this in mind, we thought that we should fill the gap and prioritize on staple food fortification, the food that is commonly eaten, whether it is salt, milk, edible oil, rice, wheat flower, these are consumed by most people, most of the day, and nearly about the same quantities for different groups. So, to add the missing vitamins and minerals, they can serve as an excellent vehicle. So food fortification is one high priority area. The third area of priority is severe acute malnutrition (SAM) because children with SAM have many fold higher chance of dying when they get an infection and therefore that is one area that we said we would focus on.

Q3. How else is Tata Trusts strengthening and supporting nutrition programming? 4’08

RS: Another area is on monitoring, and particularly, around data. So for data it is 2-fold – one is bring all the available nutrition and related data and make a data portal that is accessible to those programme managers, for researchers, and general public, and the other one is to get process data of how well the programmes are being implemented. So we are trying to get real-time monitoring of many of these programmes done so that would help supervising, monitoring, and therefore improve the service delivery. We are also investing in interests of using innovations in product development as well as the programme delivery.

Q4. How are you integrating nutrition into programmes in other sectors? 5’06

RS: That’s a very interesting thing because we realised that it is just not only the direct nutrition interventions. As you mentioned, we also have a number of other related investments, so we try to use them all in the same geography, so we try to layer one over the other. For example, in Andhra Pradesh, our main intervention in ICDS is going to be through what we have learned with our education programmes on early child education and early child development. That’s the main entry point. We also are using the livelihood programme that we are doing in Andhra Pradesh to be in the same geography, and water and sanitation is another area which would be done in the same 3 districts. So we are making at times to see that all our investments are layered one over the other in the same geography, so that they will have a synergistic action, and fasten the reduction of malnutrition.

Q5. Does Tata partner with other organisations? 6’22

RS: So, we work with many development partners, with other big foundations; like we have joint platforms created with the Bill & Melinda Gates Foundation in India, we work with the Children’s Investment Fund Foundation from UK, the 3 of us jointly have created a multi-donor trust fund with the World Bank for one of the biggest programmes now in India called the ISSNIP-ICDS System Strengthening and Nutrition Improvement Programme, which is being implemented in 8 states and 132 districts. As I mentioned earlier, we work with several state governments, and we also work with a number of community-based organisations, with local NGOs, and with the academia. So, I don’t find it a problem or in any way it is not only big players, they all have their own merits and we do need partners of different sizes and different skill sets.

Q6. What is the impact on nutrition of the new CSR Law in India, which requires companies to donate 2% of profits to CSR? 7’52

RS: In the last few years ever since the CSR Law was enacted in India, it is slowly increasing. Initially it was taking time for companies to understand how to implement it but I think there are several organisations that are being created several platforms have come up to assist companies and in the last 2 years, year after year, the kind of work and the quality of work that they do, the areas where the CSR spending is going is all improving for the better. Nutrition is not a major focus there; for them, even today, it is curative medicine, health, and now, because of this highly visible Swachh Bharat (‘Clean India’) campaign, water and sanitation are important areas. So we are trying our best to project nutrition as a fundamental, foundational block for human development and confident that people are seeing when ? aid and it is moving. In respect to the monitoring of how the CSR money is going, now there are few platforms that put together, compile, and it is easily visible; and with this visibility that is being created, I am sure it will improve over the years.

Q7. How can we encourage industry and the private sector to care about nutrition? 9’27

RS: With nutrition, it’s difficult because we start the narrative saying it’s complex; and there has been so much problem statements around nutrition, people don’t have time. Unless you give with the problem the kind of an action statement or what action can we take, people lose. So we’ve got the nutrition community as a whole, we are trying to do it with our partners, package it, and give it to people. Tell a company if they want to reach a million adolescent girls, what is it that is required?  If you have one million dollars, what it is that you get for that in terms of nutrition benefits to mothers and children. So we’ve got to package it and start talking the language that they understand. The same way that we have been stating the problem to governments to do may not work with the industry.

Q8. When was food fortification embraced at a high level in India? 10’34

RS: In the last one year, food fortification as a strategy to prevent and control vitamin and mineral deficiencies really picked up a lot of momentum. This happened after a global conference on food fortification that was held in Tanzania in 2014. A big delegation from government of India went - I was also there - at the conference and when they came back, the officials who went, they convened a group and I made a presentation to them as to where we stand with the food fortification in India. Then the ministry of Women and Child Development constituted a small expert committee to look at it and their expert committee recommended that it should be a priority and action should be taken and necessary amendments to existing food law need to be done. Then the next step was that the Women and Child Development ministry constituted a ministerial group, so a group of secretaries and then a ministerial group, and based on their recommendation, the ministry of health and the Food Safety and Standards Authority have come up with a draft regulation for staple food fortification.

Q9. What has been the role of Tata Trusts in food fortification? 12’01

RS: Has Tata Trusts been able to provide a number of technical support to them when it was required? Now, for the Tata group as a whole, as you know, one of the most successful food fortification initiatives in India is the salt iodization. As per available recent data set that was collected in 2015, 92% of the households across the country get salt with some iodine; and then 80% of them, they have adequate iodine that is adding iodine level that is as per the standard. Tata salt from Tata Chemicals was one of the first to be iodized and distributed when the salt iodization which was a controlled-license industry was de-licensed, Tata Chemicals was the one which put out iodized salt of a large quantity. They have been leading, and then when the National Institute of Nutrition came up with a suitable technology to add both iodine and iron in the salt, they took on the lead by starting making it. Subsequently, as anaemia is such a major problem and iron deficiency is a problem, the government of India has been focusing and asking many food aid programmes to use double-fortified salt so Tata Trusts has focused on it and been providing support. We also brought another way of making double-fortified salt, other than what NIN has propounded, that is the University of Toronto has come up with a new method, or a new technology of making double-fortified salt. We have brought the technology and we are trying to provide it free to many producers, anyone who is ready to use that. We have this idea of double-fortified salt but it can be made by different technologies, our idea is to support producers scale up, as well as work with the premix manufacturers to see that the prices drop down.

Q10. How can we engage non-food companies in nutrition? 14’31

RS: I think malnutrition is such an important societal problem so we must involve all key sectors of society to be part of finding a solution to it. That way, I think businesses are an important pillar of any society and we must involve them to do. You mentioned correctly that companies that are in food and beverage business have a direct role to play, but it is important to use the private sector as a whole because they must take this as part of the challenge and bring whatever they can. Any private sector to my mind can play a role, in the sense that if you have a media house it can play a positive role in spreading the right message, an advertising company can come up, you know, with pro bono help, on how to communicate correctly, logistic companies can help with logistics, there are so many ways; IT companies can play a lot, information and technology companies as a whole can play, but more than that if they take this as an important societal problem and then they can use that for their corporate social responsibility, they can widen; there are multiple ways by which we can but, more than that, they should, as a stakeholder group, the private sector should come to the table in the problem solving. It is difficult to be prescriptive, except for food companies; others can play a big role if they are brought to the table to be part of the design and problem solving.

Q11. What are you doing to bring businesses together to contribute to the nutrition agenda? What is the role of the food and beverage industry? 16’42

RS: One of the things that we have in the agenda is to bring about a business alliance that has kept the private sector on board, as I said, the private sector as a whole for problem solving. The second thing is to look at Food and Beverage companies, because they have currently a big role, and their role will increase with this rapid urbanization and more people getting into cash economy and more and more population dependent on markets for their food needs. What we have learned from the Western world or rapidly urbanizing developing countries is that, as urbanization occurs, more and more people move towards low-cost but not necessarily healthy food that is readily available. So as this processed food is going to replace what people have been traditionally eating, it is important that we work with the companies to see the best that they can do keeping nutrition of the population in mind. It is going to be a big task but we have a lot we have learned from what has happened in the Western world and what is happening in a number of developing countries. It will be a bit of coercion, a question of co-creation, and a lot have to be regulated and controlled – the role of government. So it is good that all these keys players - the government, the civil society, the private sector, food industry - sit together and agree on how to move forward on this. As you know, in India, it is no more than the future. We have this double burden of under-nutrition and over-nutrition seen simultaneously, in the same geography, even in the same household. So we have the problem already, and we need the private sector as a part of the table. So the business alliance will have a big chapter, with the Food and Beverage companies, along with the Food regulators from the government and the civil society crews to really take stock of this and find solutions.

Q12. What advice would you give to a company that is interested in focusing its CSR work on nutrition? 19’19

RS: I will strongly recommend that they identify a good civil society partner or an NGO to work with the communities to increase to the community participation in this wide range of public-funded programmes. Once thing that we find is that there is a lot of policies and programmes in our country; they are not implemented very well. And the one way to improve that is to increase the community ownership of these programmes, and by increasing community demand, I am confident that that will result in an improved programme delivery by the public systems. The public systems are structured in a way that they can reach the most vulnerable and the reach that they can have is really a match. The CSR who, rather than creating parallel systems, if they would use their resources to improve community participation in public funded programmes, I think that will be an easy quick win.