M&E Plan

 

Logic Model

Assumptions:

• Children will continuously eat enough of our therapeutic food to improve their nutrition levels

 

Social Return on Investment (SROI)

Health spending encompasses 9% of Sierra Leone’s national budget, and mothers and children under 5 receive free healthcare. Additionally, Sierra Leone has one of the higher GDPs of underdeveloped countries, but is lower in terms of health, education, and standard of living. If our product sold at just 500 units/day in the beginning, this would impact approximately 167 children under the age of 5. [2] With that being said, SROI does not include saving the government money. Our product aims to improve the micronutrient levels in children and limit the number of chronically malnourished kids. Malnutrition causes issues with a child’s cognitive development, so if we can impact around 150 children’s nutrition levels, those 150 children will have more of an ability to learn and succeed in school and eventually contribute to the economy. Well nourished children are also less susceptible to disease because their immune system are more healthy, so our product could impact savings to health services in Sierra Leone. Because families are not responsible for paying for their child’s healthcare when they are under the age of 5, they are not necessarily saving money they would spend on healthcare. Our product will be at least five times cheaper than other therapeutic foods, like Bennimix, but because they are not responsible for paying for healthcare until after their child is over 5, it cannot be used to truly quantify the success of our product. It is difficult to give a value of our SROI ratio, but it is something we will continue to research and try to quantify.

References:

1. https://dhsprogram.com/pubs/pdf/FR297/FR297.pdf
2. https://www.afro.who.int/sites/default/files/2017-08/Sierra%20Leone%20Health%20Sector%20%20Performance%20Report%202016.pdf

1. Funding Sources

Design Phase:

A) ASPEN Nestlé Health Science Enteral Nutrition Research Grant  https://www.nutritioncare.org/Research/ARRF/Nestlé_Health_Science_Enteral_Nutrition_Research_Grant/

The ASPEN Rhoda’s Research Foundation this year introduced a new grant opportunity, the Nestlé Health Science Enteral Nutrition Research Grant.  The focus of this grant is to address nutrient intake in the critically ill. This would fit as an option for our malnutrition product because it supports projects trying to address clinical problems due to nutrition.  The budget of the grant is up to $50,000 for a year of research, and this money would help us advance our product development by funding ingredients, supplements, cooking supplies, shelf life testing, and more.

B) ICATCH GRANT https://www.aap.org/en-us/about-the-aap/Sections/Section-on-International-Child-Health/Pages/ICATCH-Grants.aspx

The ICATCH grant is a possible source of funding for our malnutrition product because they support projects that are developing a product that improves the lives of children in low-income countries. The grant is for a total of $6,000 over the course of 3 years and can be used for the development and implementation of the product into the country. This year specifically, the applications focusing on infant health are being prioritized over adolescents. This money will go towards acquiring necessary supplies such as micronutrient supplements, ingredients for our product, and cooking supplies.

Dissemination Phase:

A) Venturewell DEBUT grant https://venturewell.org/debut/

The National Institute of Biomedical Imaging and Bioengineering (NIBIB) and VentureWell are funding the DEBUT (Design by Biomedical Undergraduate Teams) challenge, which is a grant application for undergraduate students working on innovative solutions to unmet health and clinical problems.  This fits into our project since we are developing solutions to address malnutrition in children in developing countries. Teams of students submit proposals to this challenge and can be awarded up to $20,000 in prizes for strong applicants.  This money would help in the dissemination part of our project by recognizing design achievements, and then helping fund marketing and economic feasibility to advance the products.

B) The Izumi foundation http://izumi.org/funding-grants/recent-grants-awarded/ 

The Izumi foundation is a great opportunity to receive funding for our venture project. The foundation is dedicated to supporting projects that create lasting solutions to critical problems in developing countries, such as malnutrition. In the past, projects have been funded for anywhere from $50,000 to $200,000. We will write a proposal for funding that will be used to train and pay the initial workers for our venture. This would be a funding source that we would apply for in the future after we have finalized our products and determined that the product would be popular in Sierra Leone.

2. Income Statement after 2 years

In order to create an income statement for our products we evaluated the cost of goods sold (COGS), overhead costs, profit, and revenue. At this point, we are still somewhat unsure of exactly how our product will be manufactured because we have a few different recipes and are unsure of what equipment we will need. One possibility is that we rent our own manufacturing space, and another is that we rent space or facilities in a restaurant that is already operating in Sierra Leone. We performed the income statement for

For COGS, we made a few assumptions. First, the population of Makeni is around 125,000. https://www.statistics.sl/images/StatisticsSL/Documents/final-results_-2015_population_and_housing_census.pdf Based on census data, we estimated that the population includes around 5,000 children below the age of 2 https://sierraleone.unfpa.org/sites/default/files/pub-pdf/Population%20structure%20Report_1.pdf. If 75% of these children consume our product 3x per day, we need to make around 11,250 units per day. In early stages, we will assume that we are only making around 500 units per day. The quantities are slightly inaccurate because they are they quantities we need in order to make around 1/2 cup of our pudding which is slightly more than the actual serving size of the unit. So, these costs are actually overestimates. With that being said, we did not include general kitchen utensils and equipment (tables, trays, other packaging materials) that may be necessary. The information for COGS is shown below (assuming 500 units per day).

Overhead costs that we will definitely need to consider are electricity and rent. It will also be useful to have a supervisor that can oversee how our product is selling and how children and families like our product.

With this information, we were able to calculate our projections every six months. We assumed that we would produce 500 units/day for the whole two years, but ideally, we will have the resources to produce more as time goes on. For example, if we produced/sold 1,000 units per day in Year 2, we would have a greater profit in Year 2.

Acumen Business Model Canvas

References:

1. https://acumen.org
2. https://www.guidestar.org/profile/13-4166228
3. https://www.plusacumen.org/about
4. https://www.bloomberg.com/research/stocks/private/snapshot.asp?privcapId=12735717
5. https://thegiin.org/acumen-fund

Guy Kawasaki had a very memorable talk on the art of the start and gave information on thing we could truly integrate into our food products. First, Kawasaki stressed the importance of making meaning with whatever product we create. Anything truly worth doing should increase the quality of life, right a wrong, or prevent the end of something good. While the goal of our project was kind of decided for us, it’s something we have considered in every decision we have made. Our goal is to create is to provide a food that treats micronutrient deficiencies and makes a change in the malnourished children, the product will also provide job opportunities for women in production and distribution. The success of our food would lead to the high nutrition levels in children in Sierra Leone which contribute to a better immune system, a lower chance of catching diseases, and lower mortality. Next, Kawasaki explained that everyone working on a project should be “infected” with your product. His word choice really resonated with me, and it’s what I remember most from his talk. Hopefully, the people we work with in Sierra Leone will really like our product and help us make decisions for its success. If we have people working on our product that really love it and think it can succeed, it will. Third, Kawasaki’s approach to making a business model was very similar to what we discussed last week in class. His philosophy in creating the business model was to think ‘how do I get my money out of my customers’ pockets?’ We are not working on this project to make money, but we can use this thinking when trying to get customers to switch to our bouillon cube from the Maggi cube. Then, after explaining business models, Kawasaki explained his idea of weaving a MAT. MAT represents weaving through the milestones, assumptions, and tasks of a design. In the past few weeks, we have really thought about the assumptions we have about our customer, and while these are things that we cannot completely confirm before fieldwork, these assumptions have been leading the direction of our product since the beginning. For example, we are assuming that our customer, like many people in Sierra Leone is living on less than $1 per day, so our product needs to be extremely cheap to produce. Lastly, Kawasaki gave advice on pitch presentations that I found interesting. He believes that a successful pitch should have 10 slides, last 20 minutes, and have no smaller than 30 point font. We cannot exactly translate this to our final presentation, but if we truly know our material and focus on getting the point across, we can see the same results that Kawasaki was emphasizing. We can also use this format when we (hopefully) present at conferences or for other groups.

Business Model Canvas

Ten non-obvious assumptions about our target customers (or organizations) that we need to validate:

1. Families are consuming too much rice because they cannot afford other types of food.
2. Mothers and children have not had success with or access to other micronutrient treatments, which is why the children are still malnourished.
3. Mothers feed children under 1 year old 3 times per day and feed a 1-2 year old 4 times per day, so our food product will have ¼ – ⅓ of the required daily nutrients.
4. Mothers are willing to spend 10-15 cents (around 1,000 Leones) on food for their children under 2 years old.
5. Mothers are largely influenced by other mothers and women in the household and are less influenced by men/husbands.
6. They value the opinion of other women in the family and usually go to mother support groups for advice. This could impact the marketing of our product. Would they listen to other mothers over a community health worker?
7. This is a product mothers would purchase in a market setting for their children.
8. Mothers would be willing to listen to the value of our product and could be convinced to try it.
9. The food would require packaging and descriptions that are easy for the customer to follow.
10. Mothers would be willing to report to CHWs or people at World Hope about the behavior and health of their child after trying/ continuing to eat our foods.

Ten hypotheses about our project that we need to test during fieldwork:

1. First, young children would be willing to eat our pudding and bouillon product based on its taste and texture.
2. Our product will be able to improve the health of the child. This is not something we will be able to really examine during fieldwork, but it is something we will have to consider
3. The child will not have any adverse reactions to our vitamins.
   1. When people consume over the recommended daily amounts of vitamin intake, there are some potential side effects. One worry is that malnourished children that suddenly have access to many different micronutrients will experience these side effects even at low levels, but statistically, this should not be an issue.
4. Similar to the first list, we hope mothers will be willing to report information about our product’s effect on their children’s health and behavior.
5. We will be able to find our ingredients at low enough costs and in large enough quantities to manufacture enough of our product at our price point. (This is information we have discussed with employees at World Hope International, but we will need to confirm it on the ground.)
6. Either employees or CHWs would be willing to help mothers and children use and learn the benefits of our product.
7. Women will be willing and able to manufacture and sell our product in the marketplace.
8. Children are not getting other micronutrients throughout the day. We are assuming children don’t get nutrients from any of the other foods they are eating, so our nutrient content will be optimized so it can be fed to children at each meal.
9. Women will require adequate training in order to make and sell our product.
10. Any ingredients that cannot be found in markets, like supplements, could be imported and used in our manufacturing process.
11. Families would be willing to try a new bouillon cube in place of Maggi cubes.

What I bring to the team and how my own strengths and weaknesses have changed over the course of the class:

I think I help to bring an open mindedness to our team. I may think my ideas are great and practical, but so could everyone else, and I’m well aware of that. With that being said, I’m not afraid to stand up for the ideas I have or the direction I think we should go. I have been exposed to different leadership roles throughout high school and college that have prepared me for the organization and work of this course. This semester, I’ve been lucky to have learned what it’s like to work on a real, functioning team of members that pull their own weight. I’ve always been someone who is kind of loud and takes charge, and in the past, I’ve had to pull a lot of weight when others slacked. This semester has been great because every team member is responsible and proactive about research and design concepts, which has helped me become a better listener in a group setting. I think I still have room to grow as a team member, but I really like our group’s dynamic.

Last week, we had our first presentation. We focused on our recipe design process and why we have made certain decisions throughout the semester and got pretty good feedback. In general, I think we should structure our next presentation a little differently. I think we expected different questions and had different back-up slides that we prepared for questions we were expecting. Because we have just finished each of our recipes, we haven’t been able to build a cost or business model, and that’s what a lot of the judges asked about. In order to improve our next presentation, we need to calculate an approximate cost of our products based on the numbers we received from Allieu and Jawara. We also need to identify a marketing plan for the products, and it will differ for each of them. Many of the judges were concerned about how Maggi cubes are different from our bouillon cube and whether people in Sierra Leone would use our product. Lastly, in terms of content, we also need to begin to work on a business model of who will create the product and where they will create it. We won’t know a lot of this information yet, but it’s worth working on until then. In terms of the presentation itself, we hope to better organized our transitions to better use our time. A seven minute presentation is very short, so we need to use our time wisely. I also really liked how some groups organized their last slides to have links to other topics or slides. Finally, I think our group needed to better organize our questions and who answered them.

Our group definitely will need IRB approval for when we feed our product to children. The product will be fortified with nutrients and ingredients that are designed to help the child, but too many vitamins and minerals can hurt people.  Side effects of too much vitamin A are vision problems and clumsiness. Side effects of iron, iodine, and zinc overdose are upset stomach, nausea, and vomiting. We need to ensure that our product will not do this to children, especially if used correctly. We also need to be sure that it truly works to treat malnutrition. In a developing country like Sierra Leone, it may be difficult for us to get accurate reporting of how children are doing after they eat our products. Groups in other countries who have undertaken similar projects haven’t been able to report much quantitative data about the health of children after eating products that treat micronutrient deficiencies. Instead, mothers report their children’s health, weight, and appearance to people who work as community health workers or in clinics. Many times, the main issue is that mothers stop feeding their children the product or stop reporting the data. In order to get IRB approval, it is important for us to present the nutrient content of our recipes, how they are supposed to be consumed, how we will explain their nutrient composition, and how families can report any issues with the product.

In order to create a design that is uniquely my own and effective, it’s first important to consider the user needs. If there is a need for any type of product, it means that something is missing from the market. There are many ways to go about determining these needs. In my entrepreneurship class, we went through the process for potato peelers. We tested a few different peelers, identified what we liked and didn’t like about them, and used that feedback to identify the needs of a potato peeler. Professor Heiss explained a similar process for an ice cream scooper. The biggest question I have had in the past few weeks speaks to this as well. We have found and researched many different micronutrient treatments, like Bennimix. At first, we thought Bennimix was so ingrained into the culture of Sierra Leone; they call almost all porridges Bennimix, similar to how we call tissues, Kleenex. In reality, Bennimix does not reach as many people as they would like, and they have a surplus of product that they are unable to sell. This may depend on price, access, taste, or really any different reason, but we’re kind of unsure at this point. Our first recipe was a porridge that could served by mixing with boiling water, but we needed to differentiate that porridge from Bennimix. To ensure that we create a product that is uniquely our own, we can’t copy something that’s already out there. We can identify a gap in the market and work from there.

We are continuing to work on our recipe. Like Professor Heiss explained, our design process has been full of reworking and reinventing recipes. We started by identifying what micronutrient treatments were already out there and tried to create our first recipes based on them. By reworking our product and being unafraid in our design choices, we are ensuring that we will choose a design that meets all the needs of our customer- something that is affordable, meets all the nutrient requirements, tastes good, is marketable, and is culturally accepted. We have continuously checked on the validity of our recipes with contacts in Sierra Leone and nutritionists. For example, we described our pudding recipe to our contact at World Hope International, and while he thought the recipe was great and could be integrated in Sierra Leone, he urged us to use sweet potatoes because they are so widely used and highly nutritious in vitamin A. It’s important for us to ask good questions and accept critique in order to improve our product.

On Tuesday, Dr. Sarah Stanlick’s conversation about working with people working in Sierra Leone made me think. She stressed that we would need the ability to listen, be humble, and be culturally aware for the success with our project. It’s important for us to realize that no matter how much research we have done, we don’t know everything about the culture and habits of people in Sierra Leone, so it’s okay to ask questions. We also discussed our engagement with communities with Khanjan on Monday of this week. At this point, it’s difficult to know exactly what we will be doing during fieldwork, but we’re hoping to have a product that people can maybe try.

Our food will mostly be made from ingredients that can be found in nature, like plantains, wheat, sweet potatoes, and more. One interesting biomimicry application is ANSA- the Autonomous Nutrient Supply Alternative. While this project doesn’t exactly relate to ours, it’s an interesting concept. The team members realized that food insecurity is a prominent issue in developing countries, so they tried to solve problems of lack of space, water, low-quality soil, limited food accessibility, and high cost of nutritious foods all in one product. They used cyanobacteria as their model and tried to mimic  its ability to produce its own food by designing a multi compartmental growing space with solar powered LED lights for crops. One of the team members explained, “In nature there is no waste. Waste becomes nutrients for other organisms to thrive … We’re trying to propel the (food) system into a closed-loop cycle.” ANSA does so by providing healthy and organic food to populations with limited resources and a high demand for food by changing the way they grow crops. This translates to our project because we also want to minimize waste in the packaging of our material and in the manufacturing process for both cost and environmental purposes.

The Life Principle of being locally tuned and responsive relates to our malnutrition project. It is very important that our food product is made with local materials and local resources and that it follows local regulations and customs. Our future food and its packaging will be sourced and produced by resources in Sierra Leone. This will make for a more efficient supply chain and minimization of energy consumption. We hope to locally source every ingredient, but there is the possibility that we will need to outsource the supplemental vitamins for our product. Sierra Leone has the Pharmacy Board, a comparable organization to the FDA. Our product would need to be evaluated to ensure that it is safe for human consumption.

Our product will be as organic and natural as possible. While this is an important concept to our project, it is also important that we do not sacrifice nutrition, cost, and ease of use for solely technical and biological nutrients as described in the Cradle to Cradle Design Concept. We were originally thinking of a dried porridge material distributed in single-use packaging. We wanted to create an environmentally-friendly, easy-to-use packaging, but now we are considering other options for both packaging and the recipe. We have been looking into packaging materials that would allow us to instantly heat the porridge or instantly add water. These could potentially be reusable dishes or packages that would minimize our impact on the environment.

Different cultures and countries have cool customs that could be completely alien to people only visiting. For example, when I visited Spain, I had heard about siestas and the different eating times, but I did not realize how different it would really be. I went from eating a very early dinner at home (around 5pm) to eating at 10 o’clock at night. Every meal was pushed later into the day, where people would eat lunch around the time of their siesta (around 2pm) so they weren’t hungry before dinner. This is another concept that is completely unrelated to our project, but it indicates how things that are completely normal in one culture can be a foreign concept to another. We have tried to keep this in mind when designing out product. The cultural implications and whether or not people would actually like or want to use our product have helped us make all of our decisions.

There are many stakeholders in our project, and some are hard to identify without knowing exactly what our product is. The first major stakeholder of our product is the customer, including children between 6 and 24 months, their mothers, and other women with influence in the family. Our product is designed to address micronutrient deficiencies of children in this age group, but children between 6 months and 1 year require different nutrient values than a child between 1 year and 2. In order for them to want to buy this product, it must address the main 4 micronutrients: iron, zinc, vitamin A, iodine. The food needs to taste good, have a normal texture, and potentially look good in order for mother’s to buy this product and keep buying it. It also needs to be affordable. Other women and influencers in the family are important because they sometimes help mothers make decisions for the children and are the people that pass down any food taboos that mothers may believe in.

Our product will be produced and manufactured in Sierra Leone, so we will need both suppliers for ingredient of our product and laborers to manufacture and sell it. We will need to acquire our ingredients from markets and farmers in Sierra Leone. For that reason, it is very difficult to identify cost of our products. The manufacturing of our food and packaging will ideally both be done in Sierra Leone, so there must be clear instructions for how to produce our product and how to solve any problems they may face. Women will be selling our product in markets where bargaining and haggling is common. We will need to sell our product for a set price to cover our ingredients, labor, and overhead costs. Both of these groups need to be paid, and these costs will need to be budgeted out of our production cost.

Other groups in Sierra Leone like community health workers and employees at World Hope International will most likely be impacted by our project. I imagine that they will help families gain access to this product and help us stay in contact with our manufacturers and distributors.

Lastly, our team, including Professor Herz, Professor Pinter, and Khanjan are all stakeholders in the project. Our team of students (Rachel Caffrey, Matt Feryo, and Sudi Shankar) are the ones designing the product and making choices that impact its nutrition content and safety. We hope to be able to publish our findings and impact of the product, but any potential issues that could arise would lead back to us. If any changes were needed in the recipe, those questions would be directed toward us as well.

We have reached out to many different external sources for advice on our project and research thus far. Our first contact in the Fall of 2018 was Allieu Samuel Bangura, Director of Health and Nutrition at World Hope International. We explained that we were considering two different types of products, and he agreed that a supplement product like a porridge would have a better lasting impact in Sierra Leone because it is something that is already part of their culture. We have had trouble connecting with Mr. Bangura because of the time difference and conflicting schedules, so we may need to reach out to other people living in Sierra Leone for information on food prices and what consumers may like.

Nutritionists and sensory specialists can give us insight on the eating habits of children whether they do or don’t live in Sierra Leone. The types of foods a baby can or can’t eat and will or won’t like is universal. By explaining our recipes and ideas to nutritionists here, and providing our calculations for nutrition content, we will be able to gauge whether or not our product would solve micronutrient issues. A sensory specialist has insight on taste and texture preferences, characteristics that are very important to our product. By communicating with a sensory specialist, we will have a better idea of whether or not a child in our age group would consume our product.

Most importantly, I think we need to be open and honest throughout our entire research process. There definitely isn’t one right answer of what our product should be, and we can only decide what’s best by considering all of our sources and research. At this point in our project, we have a pretty solidified bouillon cube recipe and a working porridge recipe. We have gotten advice from some of our sources, but it doesn’t make much sense for us to reach out to nutritionists and sensory specialists until we are a little further along in our recipe building.

My team and I are trying to tackle malnutrition in 6-24 months old children in Sierra Leone where one-fourth of children die before their fifth birthday and maternal mortality is the highest in the world. Before we even considered what kind of food we were going to make, the first question was why. Why is malnutrition still such an insurmountable problem despite efforts made from all over the world and despite the availability of nutritious foods in Sierra Leone? The basis of the issue is that children are not getting access to nutritious foods, and when they do, it’s only temporary. Over 70% of the population lives on less than $1 a day so food must be cheap. Rice is a staple in Sierra Leone and is typically consumed at every meal, but it does not have any nutritional value. Cultural taboos hinder what can and cannot be eaten. Many families choose not to eat meat, eggs, or bananas for various reasons. These taboos are passed down by mothers and other women in the family, and they are currently the ones being heard. When a mother has a question about medicine or nutrition, she typically goes to another woman in the household for advice, not a community health worker. Because of this influence, mothers are often not exclusively breastfeeding until six months, or they aren’t feeding their children properly, causing malnutrition and developmental issues. We are working to make a food that is nutritious, cheap, and easy to use to fix these problems. Ease of use is kind of a difficult thing to tackle. Most people in Sierra Leone do speak English, but there are things about our future product that are difficult to explain in words, especially on packaging, which is why we need clear, concise images on our packaging to prevent confusion on how to use our product. This graphic packaging will have directions for use, ingredient amounts, and limited words that are easy to follow to alleviate any potential confusion.

Unfortunately, many of these issues cannot be applied to the US. Many people in Sierra Leone live on less than $1 per day, and the average American household spends $20 just on food in one day. Food insecurity and hunger are definitely problems that still need to be fixed, but children do not go malnourished at any rate close to those in Sierra Leone. Like food anywhere, our product needs to taste good, have a normal texture, and have easy, attractive packaging. This includes a packaging with clear images of portions or any recipes our product will have. One thing in our favor, is that people of Sierra Leone tend to be drawn to packaging that looks American- they see it as high quality.

Sierra Leone presents different challenges than the US because people have such little money to spend. First, making a product that has enough micronutrients and still costs only a few cents to make will be difficult. It will be hard to purchase materials and foods while still being able to pay for labor costs. Next, Sierra Leone severely lacks physicians and it is difficult to connect with community health workers, especially from remote areas. This is difficult for us because these would potentially be the people helping us connect with mothers and families to communicate with them and ask them to try our product. Finally, Khanjan has explained that many people in Sierra Leone expect compensation if they are ever asked to attend training sessions or similar meetings. We will definitely have to interview mothers and families, and hope this doesn’t prove to be an issue for us.

With that being said, there are resources in Sierra Leone that will help us. We are expecting World Hope International to be a great resource and guide for us during fieldwork. We are also already in contact with one of the program directors, Allieu Bangura for advice on our recipes and life in Sierra Leone. Many families shop in a marketplace, which is where we would sell our product. We will be able to visit these markets and learn how they work during fieldwork to see how our product would be sold to families. Lastly, with products like Bennimix and other micronutrient treatments, babies are used to eating porridge-like foods which is great in our case. We had always assumed that children eat foods with a porridge consistency because they’re soft and easy to eat, but it’s not just that. A nutritionist informed us that porridge is a great product for children in our age group because it aids in sensory development and teaches kids to chew and swallow food like they’re supposed to.