2019 was a significant year for Fortify Health. It was our first full year of operations in India, and therefore, a year of important growth. 2019 was not just a year of achieving, but also a year of intensive learning, refining and retrying. As with any startup, the learnings we take from our troughs provide us with the wisdom to reach our peaks.
Here are 7 of our most important moments and subsequent learnings of 2019:
1. We signed contracts with four mills to start fortification
In 2019, we signed four contracts with three mills in Maharashtra and one in West Bengal. The projected output of fortified flour across the four mills, once fortification is launched and scaled-up in all four of them, will be approximately 105.4 metric tonnes (MT) per day.
Learnings: Through the process of building partnerships with mills, we have learned that in-person visits to new mills are much more successful than cold calling new mills. We’ve also learned that delays to contract signing and installation of equipment are an inevitable part of onboarding mills, usually owing to external factors relating to the miller, and we now know to factor these in to our timeline predictions. We are now hiring accordingly to ensure that we have sufficient capacity in-house to work around these delays and to conduct regular technical and follow-up consultations in-person with millers.
2. We started fortifying flour in our first mill
In June 2019, we installed a microdoser in our first partner mill (Mill 001), based in Mumbai. In the same month, Mill 001 was supplying fortified flour to consumers, and fortifying 0.4 MT per day of wheat flour. By the end of 2019, Mill 001 confirmed they will scale up fortification to their other brands and packages in Mill 001, after a successful trial with the initial amount of 0.4 MT per day, which is 40% of their current daily production.*
Learnings: As a team of non-millers,beginning fortification in our first mill gave us the opportunity to better understand how to effectively incorporate fortification practices into existing mill operations of this size and how to improve the precision of dosing premix into flour. We also learned how we can transfer knowledge of our work in one mill to our work with other new mills, and also how we can’t in various cases, given the setup of mills is incredibly varied. We also quickly learned the necessity of working with a technical consultant, who has significant technical understanding of mill equipment and fortification machinery.
3. We nurtured our first government partnerships
At the beginning of 2019, our relationship with government was minimal, since we were a brand new organisation and, therefore, had no established track-record of fortification. Thanks to the consistent diligence of Fortify Health’s partnerships and programmes team, we built some strong initial relationships with government partners in Maharashtra over the course of 2019; through this, we have made some initial progress towards partnering with local government departments in trial projects that will allow safety net programs to have continued access to fortified flour. In 2020, we will work towards the implementation of these trial projects.
Learnings: With frequent political change in state governments, officers are regularly shifted to new departments. This means organisations working with a particular officer may have to start from scratch in establishing partnerships with respective replacement officers, and may involve re-submitting proposals to departments to get permissions for projects. It is helpful to understand this and have experience with it, so that morale does not lessen in such cases and we become more confident with government partnership building.
4. We hired for four new roles 2019 was the year of maintaining and expanding the dream team. We recruited for four essential roles, three of which were made possible by the reassured runway provided by our 2019 GiveWell grant:
Country Director, Dr Urmi Bhattacharya
Monitoring and Evaluation Officer, Akanksha Manwatkar
Operations Officer, Abhishek Kumar
Programme Officer, Kapil Parve (position offered in December 2019, position started in January 2020)
Learnings: We learned that hiring is both the most time consuming, and the most important task to get right. It is the team that creates the organisational culture: a strong sense of community and respect is the engine to an organisation’s long-term success. We learned it is, therefore, worth putting significant time into planning, execution and ongoing maintenance of our recruitment process.
Team Fortify Health, November 2019
Brendan on a mill visit, February 2019
5. We said a semi-goodbye to Fortify Health’s Co-founder, Brendan Eappen
The Fortify Health team bode well wishes to Brendan, who started at Harvard Medical School in August 2019. Brendan stepped down from his full-time position as Co-founder and Managing Director of Fortify Health, and now works with us for a couple of hours each week on long-term strategy and M&E guidance. While we miss Brendan’s spontaneous bursts into song and infectious optimism, we are glad that he is still very much involved in Fortify Health’s wider strategic decisions and remains in regular touch with the team. We want to thank Brendan for everything he has done to shape the future of Fortify Health.
Learnings: Once a Fortify Health teamie, always a Fortify Health teamie.
6. We received a $1 million GiveWell incubation grant
The most momentous moment of Fortify Health’s 2019 was the confirmation of our $1 million grant through GiveWell’s Incubation Programme. The Incubation Grant will allow us to continue and grow our operations in Maharashtra and West Bengal for at least two more years: by December 2020, we aim to be fortifying 214.8 MT wheat flour per day across 12 mills of varying production capacities. We also aim to be working with local government divisions to produce and distribute fortified wheat flour to ashram schools in Maharashtra, where children are consistently malnourished.
Learnings: When working alongside a highly considerate and analytical donor, budget about four months for the funding process: the process entails an initial funding conversation, a full analysis with several back and forth conversations, confirmation of grant, and finally, receipt of funds.
7. We refined our monitoring and evaluation strategy and received our first mill data
In 2019 we concretised our plans for how Fortify Health would monitor the fortification process in mills. Monitoring and evaluation (M&E) of fortification in our partner mills includes: a) monthly visits to mills to observe mill practice, b) collecting data on production of fortified flour from mills, c) coordinating quantitative testing of fortified flour for iron in labs, d) facilitating iron spot tests in the mill, e) potential use of in-house testing equipment, called iCheck, and f) working towards obtaining consumption data for fortified flour. We’ve also been collaborating closely with Laura Rowe, Deputy Director at Food Fortification Initiative, to refine and operationalise our M&E strategy. We’d like to thank Laura for all the support she has given Fortify Health from day one, and for continuing to share her expertise and thoughtfulness with us.
Learnings: A significant takeaway from our M&E efforts in 2019 was how challenging it can be to obtain mill data from mills. It can, at times, be a test of time and patience. We learned that it is important to obtain the same information from various sources, so as to triangulate results. Our regular consultations with Laura Rowe have significantly increased our capacity to overcome challenges as they arise.
Here’s to continued growth and continued learning in 2020!
* 0.4 tonnes of fortified flour can be considered at around 3150 people’s average daily consumption. [Calculation: (0.4 MT / day)*(1,000,000 g / MT)/(127g/person/day) = equivalent to 3150 people's average daily consumption. The 2011-2012 National Sample Survey data we have on household consumption for Maharashtra indicates a statewide per capita consumption of 127g / person / day, although our cost effectiveness analysis uses slightly less favourable estimates. It is important to note that this is a somewhat imprecise estimate of how much flour is eaten on average in Maharashtra compared to production of fortified flour, and that our intervention may not affect all of a given beneficiary's flour, and in that case our fortified flour may be eaten by more people but at a lesser amount to per capita daily consumption.]