5) Description of health product/service offering: PSI is working to reduce the incidence of iron deficiency anemia among infants in Haiti through the marketing and distribution of Sprinkles, a supplement that increases iron absorption and addresses other micronutrient deficiencies.

Proper iron intake is more important during infancy (6-24 months) than any other stage of life. Yet Haitian infants 6-24 months are traditionally weaned on a low nutrition, starch based porridge, without the diversity of iron rich foods needed to prevent anemia.

In the Americas, Haiti has the highest infant mortality rate, to which malnutrition is a primary contributor. Sixty-six percent of Haitian children under age five suffer from iron deficiency anemia, which results in poor cognitive and delayed motor development and decreased resistance to illness and disease.

Companies have developed products such as Gerber rice, wheat, and corn, as well as infant cereals fortified with iron, but it is difficult for dietary sources alone to provide the iron an infant needs. For decades, parents were encouraged to give infants iron drops to treat and prevent anemia, however, compliance was low due to bad taste, teeth staining, and difficulties administering the proper dosage.

PSI began distributing Sprinkles in Haiti in 2005 as an alternative to iron drops. Sprinkles are composed of encapsulated iron granules that mask the metallic taste of the iron and other micronutrients (Vit A, C, D, zinc, folic) that enhance iron absorption and address other deficiencies. Sprinkles are easy for parents to prepare for their children, as they are simply mixed into an infant’s weaning porridge. Sprinkles do not affect the color, taste, or smell of food.

6) Description of innovation: The Sprinkles product represents a breakthrough method of delivering micronutrients to young children in developing countries because it eliminates barriers to compliance observed with traditional iron supplements.

For decades, the use of ferrous sulfate drops (three times per day) had been the standard therapy for iron deficiency anemia in infants. Adherence to this treatment regimen was poor because of the drops’ side effects (metallic taste, teeth staining and abdominal discomfort) and the challenges parents faced in administering treatment accurately, particularly among illiterate populations.

Sprinkles is a tasteless powder supplement packaged in a single dose sachet. Sprinkles are composed of encapsulated iron granules to mask the metallic taste, plus other micronutrients (vitamins A, C, D, zinc and folic acid) that enhance iron absorption and address other deficiencies. Sprinkles can be custom-formulated to deliver alternate combinations of needed micronutrients, including vitamin D to combat Rickets. Parents can easily mix Sprinkles into their child’s porridge, requiring less literacy among parents.

7) Operational model: In 2005, PSI introduced Sprinkles into the Haitian market under the brand name Babyfer. Distribution of the product was accompanied by a large public media campaign to increase awareness of problems associated with iron deficiency anemia and inform potential consumers of the benefits associated with the product.

PSI initially anticipated that the product would reach 423,831 children ages 6 to 24 months. The program has already exceeded expectations with sales between October 2005 and April 2006 reaching 697,230. While Sprinkles is not yet available throughout Haiti, distribution has focused on the regions that suffer most from malnutrition (rural areas in the North and Southeast).

The key elements of the Babyfer marketing and distribution program in Haiti include:

• Pricing: PSI/Haiti conducted market and consumer research to determine a price point that is affordable to the target population, while also achieving cost recovery and promoting product sustainability. • Promotion: To officially introduce the product, PSI/Haiti began with a ceremony organized in the Port au Prince hotel in the presence of local authorities and a number of other medical, pharmaceutical, NGO, and media guests. Additionally, a mobile cinema caravan travels around the country to promote Babyfer. • Physical Distribution: Babyfer is distributed in Haiti through wholesale commercial and pharmaceutical distributors, health centers (private and public), markets, pharmacies, NGOs, missions, and women’s groups. • Publicity: PSI/Haiti communicates the effectiveness of Babyfer to target populations through television, billboards, and radio. The principle goal of the communications campaign is to increase awareness of the dangers associated with iron deficiency anemia, educate parents about the effectiveness of Babyfer and encourage its use for infants.

8) Human resources: PSI staff working on the Sprinkles initiative have extensive experience developing and implementing marketing campaigns for a variety of health products and services in the developing world. Key staff include:

Samuel Nganga, PSI’s Country Representative in Haiti, overseeing all marketing and behavior change communication activities in the country.

Jamie Ciesla, PSI’s Technical Advisor for maternal and child health initiatives in Haiti. Brad Lucas, PSI’s global expert for the Sprinkles product.

9) Key operational partnerships: PSI/Haiti collaborates with a variety of partners to market and distribute Babyfer in Haiti. The team consists of 40 commercial wholesalers, 20 pharmaceutical wholesalers and a dozen NGOs that work to aggressively promote and sell Babyfer. Key partners include CARE, Citimed, Save the Children, the Red Cross, and World Vision, among others.

10) Financial Sustainability

          • Fees charged to clients?: Yes

          • How do you assure affordability?: PSI has found that selling products rather than distributing them for free establishes greater value for a good. PSI/Haiti conducted research to determine consumers’ ability and willingness to pay for Sprinkles in Haiti, pricing the product so that it is affordable to low- income populations. The price also enables some cost recovery to promote project sustainability.

By selling products rather than giving them away, PSI also motivates the commercial sector to distribute and sell the product. This means that product becomes available across thousands of pharmacies and other retail outlets already in existence across the country.

          • Earned incomes as a percentage of operating costs: 0

          • Other funding sources: This project is partially funded by the Micronutrient Initiative (MI), headquartered in Canada. Funding supplements income from product sales used to maintain promotion and distribution activities.

          • Strategy for long-term sustainability: Financial sustainability in the long-term will partially depend on market evolution. If product demand increases, PSI may increase prices to achieve greater cost recovery. As product awareness increases, PSI predicts that profit incentives for commercial distributors will broaden distribution and gradually reduce PSI’s distribution costs. PSI also anticipates that promotion costs will decrease over time as product knowledge and awareness increase.

11) Current and Future Impact

          • Total number of clients: 697,230

          • Clients in the past year: 697,230

          • Percentage of low-income clients: 100

          • Impact: Since October of 2005, PSI/Haiti has sold 697,230 units of Babyfer in Haiti, providing 10,388 years of protection.

The project targets low-income mothers of young children. PSI has conducted extensive research to ensure the product is priced so that it is affordable to them.

By working with other NGOs, women’s groups and commercial distributors, PSI also ensures that the product is available to populations living throughout the country.

          • Overall "market": The potential demand for Sprinkles is extensive, as nearly half of children in developing countries are affected by iron deficiency anemia. The affordability of Sprinkles and potential to further reduce costs with in-country production could yield a global market for the product.

12) Scaling up strategy

          • Stage of the initiative: Scaling Up stage.

          • Expansion plan: The Babyfer initiative was launched in Haiti in October 2005 and is currently in the scaling up stage. PSI/Haiti plans to expand the project to distribute Babyfer in all nine regions of Haiti. PSI/Haiti plans to conduct Babyfer and nutrition/anemia training sessions every month in each region with health care staff and women’s groups, as well as sponsor two Babyfer outreach events per month.

13) Policy change: Malnutrition is the second leading cause of death among children aged 0 to 24 months in Haiti. Support for programs aimed at educating parents about the dangers of malnutrition and iron deficiency anemia is greatly needed.

14) Origin of the initiative: Sprinkles were developed by pediatrician Stanley Zlotkin, head of Gastroenterology and Nutrition at the Hospital for Sick Children in Toronto, Canada. HJ Heinz Company has an agreement with Ped Med Ltd. (Stanley Zlotkin’s organization) to manufacture and produce Sprinkles on a cost-recovery basis. Relatively low technology is required to manufacture Sprinkles, making local manufacturing a possibility in developing countries. HJ Heinz is developing a “technology transfer kit” to encourage such local production.

Contact Information:
Patricia  McGrath
Development Director
Population Services International
(NGO)
1120 19th St., NW Suite 600 Washington, DC 20036
Haiti
Tel: 202-785-0072
Fax: 202-572-4678
Email: pmcgrath@psi.org
Website: www.psi.org