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Laddoo Project

Project Leader Ramsey Ford Organisation Design Impact Designed By Jaskeerat Bedi, Anisha Shankar Project Location Pune, Maharashtra, India Project Website www.d-impact.org/urban-nutrition-program-improving-health-for-malnourished-children/ Name of nominating Icsid Member organisation Kaleidoscope

Please describe the project and the challenge it intended to address

Each year an estimated 45,000 children die from malnutrition in the State of Maharashtra, India. The Laddoo Project was developed as a home-grown solution designed to address this issue. A traditional "laddoo" is a small, ball-shaped snack, often eaten during festivals. The Ladoo Project has developed as a high-nutrition variant of this familiar snack that is inexpensive and provides a vital combination of protein and iron—essential nutrients for healthy, growing children. As the laddoo is a familiar food throughout India and easily made with local ingredients, it is well accepted by parents and children alike.
This healthy laddoo variant was developed by Design Impact’s (DI) professional design fellows, Anisha Shankar and Jaskeerat Bedi, who worked with the Deep Griha Society (DGS), an Indian non-profit in Pune, Maharashtra over the course of 16 months. Having witnessed high malnutrition rates among children in DGS’ day care centers, DI and DGS set out to develop an inexpensive solution appropriate to the local context.
Laddoo distribution began in May of 2012 at the DGS day care centers where 300 children between ages two and five years received a healthy laddoo three times a week. Baseline height and weight measurements were taken of 100 randomly selected children. After a six month period over 50% of the malnourished children had moved into the World Health Organization (WHO) height and weight based nutritional ‘safe zone.’ The project has been sustained by local funders and parents, and DGS continues to provide healthy laddoos to all children enrolled in their day care centers.
These peanut and sesame based laddoos are the result of significant research, design, prototyping, testing and development and come packed with the fats, protein and iron essential to the diet of young children. Each laddoo costs only three rupees (US$0.05) to manufacture and distribute. The healthy laddoo has proven successful as an effective nutritional supplement which can be easily manufactured and distributed within local communities, and has potential for addressing wide-spread malnutrition in India.

What are the objectives of the project and are the outcomes same as those originally intended?

The Laddoo Project’s objective of ‘reducing malnutrition among Indian children through the development and distribution of a nutritious food supplement’ has remained consistent throughout the duration of the project. This initiative was implemented over a six-month period during which the laddoos were distributed to 300 children in DGS’ day care program. At the end of the six months, almost 50% of the children assessed as ‘severely malnourished’ at the beginning of the program had moved into the World Health Organization height-and-weight-for-age nutritional ‘safe zone.’ This program has now been established within the DGS organizational structure, supported by both parents and outside funders.
While reducing malnutrition has obvious direct benefits to children, it is also critical to recognize that improving early childhood nutrition is directly tied to improved cognitive development and long term occupational and educational success. While the Ladoo Project does not measure these long term impacts, they are vital to the objectives of the project.
Using this small scale pilot as a successful case study, we are looking for partners to expand the Laddoo Project to benefit even more children in India. Our first step is to instigate a larger and more formal research effort which will study the nutritional effect of laddoo consumption among 10,000 children over a three year period. This second-phase of the Laddoo Project will test whether the large scale manufacture and distribution of laddoos is a sustainable and effective method for reducing widespread child malnutrition.

How was the community engaged through the life cycle of the project?

Every phase of the Laddoo Project was developed in consultation with various stakeholders from the local community, or ‘community of interest.’ The DI model of ‘embedded design’ partners professional designers (fellows) with community based organizations and develops initiatives based on best practices of community development principles. All aspects of the project’s development, including research, design, testing, and implementation took place within the local community with DGS children, parents and teachers providing feedback.
DI fellow Anisha Shankar spent her first month observing DGS’ day care program and the programs of other local day care centers. The rampant malnutrition in these centers led Anisha to contact and work with a pediatric nutrition research group at the local Jehangir Hospital. The nutrition research group assisted Anisha in formulating and customizing the nutritional composition of the laddoos in order to meet the nutritional needs of the DGS children. Armed with this research, Anisha worked closely with DGS staff and community members to design a laddoo that was easy to make, packed with the right nutrients, and inexpensive. Finally, Anisha had the most important stakeholders, DGS children, taste and rate the various laddoo recipes.
DI Fellow Jaskeerat Bedi trained DGS staff to accurately measure the children’s height and weight and enter the information into the WHO’s AnthroPlus Software database used to track the children’s growth. With the nutritional benefits of the laddoo realized, Jaskeerat also conducted interviews and education sessions with parents to understand the demand for continued laddoo distribution and to educate them on the benefits of the program. She also co-developed a workshop for three other non-profits on making laddoos and running a laddoo program within their own day care centers.
As the Laddoo Project begins to scale to other regions of India it is important for us to continue to engage the various communities/societies of interest that could benefit from participating in this initiative.

Include the society of interest and describe any other relevant stakeholders and partners that were involved or consulted.

The project’s initial target group consisted of 300 children in the DGS day care centers in Pune. These children are predominately from low-income families living in the informal communities of Pune. In addition to the children, efforts were made to engage and educate DGS parents on the benefits of the laddoo program and general child nutrition. The project is currently established and ongoing in the DGS day care centers. DI is working to establish partnerships and scale-up this initiative to other locations throughout India.
The Laddoo Project was developed in a partnership between the Pune-based community organization Deep Griha Society (DGS) and the US based non-profit Design Impact (DI). DGS leadership, including Executive Director Dr. Neela Onawale and Lead Medical Officer Dr. Prakash Onawale, worked closely with DI on the program design. DGS staff were essential in the program development and implementation, providing insight and support to manufacture, test, distribute and measure the impact of the program. DI provided two full-time, onsite professional designers for a total of 16 months to help design and manage the project. These two design fellows, Anisha Shankar and Jaskeerat Bedi, served as organizers and project leaders within DGS’ structure.
Beyond the core development team at DI and DGS, DI fellows collaborated on initial nutrition research efforts and a pilot program evaluation with doctors from the nearby Jehangir Hospital in Pune. In addition, Pune based design firm “Elephant Design” was consulted to create visually appealing and cost effective packaging for the laddoos. Naandi, a non-profit based in Hyderabad, offered insight and support on scaling the production and distribution of the laddoos. Further partnerships are currently being developed in the effort to scale this program.
Funding was obtained from diverse sources including an Indiegogo campaign run by Design Impact ($13,000), corporate donations from the US based design firm Kaleidoscope ($15,000), a grant from the Episcopal Diocese of Southern Ohio ($7,000), and an adventure funding campaign by India-based organization Unventured ($3,000). In addition to these funding sources, laddoo distribution is also supported by direct payments from the parents of the children in DGS’s day care program.

How has this project benefited the community of interest?

The Laddoo project has already demonstrated significant benefit to the DGS communities in Pune as demonstrated by the data collected during this initiative. The DI and DGS team completed pre-pilot height, weight and hemoglobin measurements on over a 100 children (ages three to five years). After eating a laddoo thrice a week for six months, each child’s anthropometric measurements were re-taken. On average, these children moved from -2.2 standard deviations (based on WHO standards) to -1.8 standard deviations in terms of height—with 54% moving from severely malnourished into the WHO nutritional ‘safe zone.’ Likewise, children moved from an average of -2.5 standard deviations to -1.7 standard deviations in terms of weight in the same period—with 42% moving from severely malnourished to the WHO nutritional ‘safe zone.’ In addition to this test group, laddoos were distributed to 200 additional children in DGS’ day care program for the past year.
The Laddoo Project’s impact is not limited to the direct nutritional benefit of the laddoos. As mentioned above, childhood malnourishment can impede behavioral and cognitive development, educability, and reproductive health— thereby undermining future work productivity. The positive impact of the laddoo project will continue to unfold over the entire lives of these children. Additionally, the project has also increased greater general awareness among parents about malnutrition and the importance of nutrients such as protein and iron in a child’s diet. Community-based awareness raising is a critical component of the Laddoo Project’s attempt to decrease malnutrition among Indian children. Earlier this year, DI fellow Jaskeerat Bedi met with DGS parents to demonstrate laddoo making while giving them the opportunity to taste the snack.
The Laddoo Project has demonstrated immense potential as an inexpensive and uncomplicated tool to address India’s daunting child nutrition crisis. If supported by adequate funding, this initiative could be scaled to benefit thousands of children throughout India.

What metrics are used to track the impact of the project?

The laddoos were designed with significant input from local nutritionists, and nutritional analysis was completed on the laddoos to understand fat, protein, and nutrient content. (Peanut Laddoo nutritional values per 100gm: energy 405 kcal, protein 9.4g, fat 16.7g, sugar 5.8g, iron 3.03mg). As described above, these laddoos were distributed to all 300 children in DGS’ day care system, and specific measurements of height and weight were taken for a group of 100 randomly selected children. The project’s impact is tracked using the WHO’s AnthroPlus Software, which records the children’s height and weight over designated periods of time. The study controlled for growth due to aging when analyzing the project impact. The measurements are compared with World Health Organization standards, and are communicated in the form of standard deviations. As stated above, the pilot enabled approximately 50% of the children in the study to move from a ‘severely malnourished’ state into the WHO defined nutritional ‘safe zone’ in just six months.

How will winning the Prize raise awareness of the project and further its impact?

Based on the findings and lessons learned from our small but successful pilot project, we are looking to grow the Laddoo Project in order to combat malnutrition at a greater scale across India. Winning the Icsid World Design Impact Prize would greatly expedite this process by validating the importance of the Laddoo Project. Our next step is to implement a medium scale trial that provides laddoos to 10,000 children in India. This trial will allow us to test large scale laddoo manufacture and distribution, establish a sustainable model of growth, and validate our impact through a randomized trial. This three-year trial requires the development of significant on –the-ground partnerships in India, as well as partnerships with economists and medical professionals to help design and validate the project. The cost of this three-year trial is approximately $750,000 USD. Winning the World Design Impact Prize would build potential stakeholder’s confidence in this project, and increase the likelihood of securing the necessary funding.

Briefly describe the challenges the project currently faces

Scaling up the Laddoo Project from a 300 child pilot to a 10,000 child study poses several administrative, personnel and cultural challenges. We anticipate that developing and managing a global team with various fields of expertise, working in multiple geographic locations to develop, implement and measure program impact will no doubt be a daunting task. In addition to developing a strategy for manufacturing and distributing laddoos in low income communities, this team also needs to develop a keen understanding of the end-user; about his/her life, local environment, and political realities. This is a critical factor for long-term and large-scale sustainability. This factor is also related to a second challenge, which is also related to our strategy of ‘embedding’ the Laddoo Project within each community. While the laddoo was developed and implemented in Pune, Maharashtra, the scaled pilot may take place in another region of India and may be spread out across multiple communities. Therefore, developing a team which can ensure that each phase of this initiative is consistent and acceptable to a new location’s values and beliefs will be critical to the success of the project.

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