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Location

India

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Sector

Health

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Type of Investment

Grant

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Project Stage
Completed
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Length of Investment

2017+

Investment Overview

A £1.3m grant to J-PAL South Asia to support a randomised controlled trial in Tamil Nadu, India, to test whether the distribution of free fortified rice through the Public Distribution System is a cost-effective way to treat anaemia at scale.

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The Development Challenge

Anaemia is the most common form of malnutrition, affecting approximately 1.6 billion people worldwide. In Tamil Nadu, anaemia affects 60% of children between six months and five years of age, and more than half of pregnant women. Despite research showing that dietary iron and other micronutrients can help to alleviate the problem, in practice they are often ineffective as their usage relies on recipients actively using them.

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The Innovation

The innovation tested in this study was the distribution of fortified rice via the already existing Public Distribution System (PDS) that delivers free rice to all households in the Indian state of Tamil Nadu. Whereas other programmes require people to remember to take iron pills, or to go out of their way to buy fortified food, this intervention involved no behavioural change from consumers.

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Our Investment

GIF’s investment supported a randomised controlled trial to test whether the distribution of fortified rice through the PDS is a cost-effective way to treat anaemia at scale. The J-PAL team also wished to collect information, carry out implementation and advocacy activities, and produce guidance to facilitate the potential scale-up of the intervention by the Government of Tamil Nadu (GoTN).

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Investment Objective

To address anaemia and micronutrient deficiencies in the Indian state of Tamil Nadu by providing iron and micronutrient fortified rice through the Public Distribution System and conducting a rigorous randomised controlled trial to evaluate the impact of this approach.

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Why we invested

The RCT addressed an important public health challenge in India and beyond with significant benefits on the health of women and children and general productivity.

The RCT and complementary activities set out to test the effectiveness of rice fortification close to actual programme conditions on a large scale.


The study was designed in close collaboration with, and with strong support from, the GoTN which contributed human and financial resources to the study.


The intervention had the potential to be highly cost-effective and scalable – the PDS covers 72 million people in Tamil Nadu alone.


This project was high on the agenda for J-PAL South Asia at IFMR – it was their first partnership with a state government and the first RCT co-funded by the GoTN under the joint MoU.


This intervention supported a number of the UN Sustainable Development Goals including: Goal 1 (No Poverty) and 2 (End Hunger).

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Reducing Anemia in numbers

110

Villages each in control and treatment arms of study

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Reducing Anemia Completion Brief

The innovation being tested in this study was the distribution of fortified rice via the already existing Public Distribution System (PDS) that delivers free rice to all households in the Indian state of Tamil Nadu for an increased intake of iron and micronutrients to tackle the endemic issue of anaemia. Whereas other programmes require people to remember to take iron pills, or to go out of their way to buy fortified food, this intervention involved no behaviour change from consumers.

Use of GIF Funds

GIF provided $540,000 funding to cover:

  • The work of research and implementation personnel
    • The two arms of the RCT:

    • Treatment arm of 110 villages that were to receive fortified rice

  • Control arm of 110 villages that were to receive normal (unfortified) rice

  • Data collection and analysis costs

  • Cost for a Project Implementing Agency (third-party agency), responsible for quality control and supervision

  • Policy dissemination costs

  • Equipment, supplies, travel, and other project costs.

Objectives

This project aimed to address anaemia and micro-nutrient deficiencies in the Indian state of Tamil Nadu. The intervention involved replacing conventional rice provided free of charge through the PDS with fortified rice made from rice flour enriched with iron, zinc, vitamin A, folic acid, and B vitamins blended with parboiled rice.

Impact to Date

Unfortunately this investment was closed in late 2020 following a number of challenges that prevented the distribution of the fortified rice from being successfully launched. These included a change in the standards set by the Food Safety and Standards Authority of India (FSSAI) in 2018, a setback in testing nutrient levels (2019), and travel restrictions during the Covid-19 pandemic (2020).