1. International Food Aid Conference: Nutrition Panel Dipika Matthias Project Director, PATH May 2012 Ultra Rice: Improving the Nutritional Value of Rice

2. Slide 2 Topics PATH Ultra Rice Technology Reaching Scale Product refinement Operational integration Engagement of the private sector Looking Ahead

3. Slide 3 PATH: An International Non-Profit Organization To improve global health by advancing technologies, strengthening systems, and encouraging healthy behaviors. Innovation ensures health equity

4. Slide 4 Layers of Innovation for Global Health Technological innovation Designing products, services, and/or methods which are culturally appropriate. System innovation Accommodating the technology within the agricultural, health, or other delivery system. Process innovation Harnessing the energy of the private sector to ensure sustainability => Public-Private Partnerships.

5. Slide 5 PATH: Global Reach PATH has 31 offices in 22 countries with programs in 70 countries

6. Slide 6 Working to improve micronutrient health in rice consuming communities Working to improve micronutrient health in rice consuming communities ©PATH/Satvir Malhotra PATH’s Ultra Rice  Technology

7. Slide 7 Developed by Bon Dente International and transferred to PATH in 1997. Manufactured rice grain made from rice flour, micronutrients, and stabilizing ingredients. Extruded through pasta-making equipment, formed into the shape of traditional rice. Mixed with locally milled rice, typically at a 1:100 ratio. Can retain nutrients through typical preparation practices (soaking, rinsing). Over 30 studies to date form the evidence base for Ultra Rice technology. Technological Innovation © PATH/Shirley Jankowski © John Lok/The Seattle Times

8. Slide 8 Wholesalers/ Rice Aggregators Small Retail, Open Markets Consumers Fortified Rice (Ultra Rice blended w/ traditional rice)Ultra Rice grains only Rice Distribution Channels Blend at point-of-use Blend in mills Blend in warehouse Public Sector/Food Aid Programs (School Feeding, Dry Rations, etc.) Ultra Rice Grain Manufacturer Rice Millers Super/ Hypermarts Large Retailer

9. Slide 9 Ultra Rice Pilots in India: 250,000 children

10. Slide 10 Ultra Rice Pilots in Brazil: 76,000 children

11. Slide 11 Rice Distribution Channels Wholesalers/ Rice Aggregators Small Retail, Open Markets Consumers Fortified Rice (Ultra Rice blended w/ traditional rice)Ultra Rice grains only Blend at point-of-use Blend in mills Blend in warehouse Public Sector/Food Aid Programs (School Feeding, Dry Rations, etc.) Ultra Rice Grain Manufacturer Rice Millers Super/ Hypermarts Large Retailer

12. Slide 12 Technology Attributes AttributesCurrent GrainOpportunity for Improvement Nutrient Content Iron (FePP), Thiamin, Folic acid, Zinc Add Vitamin A May also enhance uptake of iron Cost Incremental cost of $15-$20 to fortify one MT of rice Use more bioavailable iron to reduce quantity needed Find substitute for expensive binders Target is <$10 to fortify one MT of rice Performance Minerals fully retained Lose up to 40% of vitamins under rigorous preparation conditions Enhance grain strength through heat or other means to reduce losses Appearance Manufactured on cold extrusion equipment, slightly opaque Enhance translucency to reduce probability that grains will be picked-out before cooking Manufactured on double-screw hot extrusion equipment; expensive and not prevalent Optimize manufacturing on single screw hot extruders, which are more prevalent in the developing world

13. Slide 13 Reaching Scale: Technology Refinement Iron substitute/ enhancer Vitamin A/ Iron Heat in manufacturing process* Reduce Cost Enhance Appearance Expand Nutrients OptimizationR&D Nutritional value/ access Maximize impact Improve Performance Deliver Vitamin A and enhance uptake of iron Use less iron and enhance bioavailability Substitute heat for costly binders Potentially improve retention of vitamins Improve translucency Manufacturing flexibility *Single screw hot extruders and/or adding steam to a cold manufacturing process

14. Slide 14 Reaching Scale: Technology Refinement Iron substitute/ enhancer Vitamin A/ Iron Heat in manufacturing process* Reduce Cost Enhance Appearance Expand Nutrients Improve Performance *Single screw hot extruders and/or adding steam to a cold manufacturing process Partners Abbott Corporation: nutritional scientists (pro-bono contribution) Kansas State University: (single screw hot extruders) Northern Crops Institute at North Dakota State University: (cold extrusion plus steam) USDA Food and Agricultural Service

15. Slide 15 Partners Institut de Recherche pour le Développement (IRD) WFP School Meals Programme 5 00,000 primary schoolchildren in the Ministry of Education/WFP school meals program. McGovern-Dole Program covers funding for food commodities (rice, canned fish, legumes, etc.) and operational costs. Reaching Scale: Test Improved Technology World Food Programme (WFP) Cambodia Biological Impact Assessment 16 schools in Kampong Speu province in Cambodia

16. Slide 16 4 schools: No school meal (control) 4 schools: Standard meal (double control) 4 schools: UR new version (vitamin A and enhanced iron) Baseline: Deworming + assessment for anthropometry, micronutrient status, parasite infestation and cognition End-point assessment: Anthropometry, micronutrient status, parasite infestation, and cognition No school meal Standard school meal UR new in school meal Absence and Morbidity Study Design = 500 per arm = 2000 children 4 schools: UR current version (no vitamin A) UR current in school meal 5 mo assessment: Anthropometry, micronutrient status and cognition No school meal Standard school meal UR current in school meal UR new in school meal

17. Slide 17 Expanding the Evidence Base Incremental impact of new Ultra Rice grain over the current formulation. Further evidence for scale-up. First biological impact assessment of fortified rice in SE Asia. First assessment of fortified rice on cognition and anthropometry (weight, height, muscle mass).

18. Slide 18 Innovation within Delivery System Wholesalers/ Rice Aggregators Small Retail, Open Markets Consumers Fortified Rice (Ultra Rice blended w/ traditional rice)Ultra Rice grains only Blend at point-of-use Blend in mills Blend in warehouse Public Sector/Food Aid Programs (School Feeding, Dry Rations, etc.) Ultra Rice Grain Manufacturer Rice Millers Super/ Hypermarts Large Retailer

19. Slide 19 Blending in Warehouse: Burundi USDA Food Aid Nutritional Enhancement Program Indian equipment manufacturer: Toshniwal PATH developed prototype

20. Slide 20 Blending in Warehouse: Burundi Training warehouse staff Blending operation and quality control (5 people) Maintenance & trouble-shooting (2 people) Total training: over 40 man hours (4 days) Quality & traceability Recording of homogeneity( %), date of blending, batch number, date of manufacturing, date of dispatch. Results Average UR blend = 1.04% (target 1%) Coefficient of variation = 15.9% (< 20% sufficient) No change in homogeneity during transport to schools PATH blending machine => target price $300

21. Slide 21 Blending at Rice Mills: WFP Cambodia Donated rice and Ultra Rice stored in WFP’s warehouses. All commodities shipped to rice mills to be blended. Validation studies already conducted on batch and continuous blenders. Used brown rice in lieu of Ultra Rice to assess blend efficiency and effectiveness. Results: coefficient of variation between 10-20%, under two minutes to achieve homogenous blend in batch blend process. Fortified rice bagged, delivered back to WFP warehouses, and stored until dispatched to the schools.

22. Slide 22 Process Innovation: PUSH PULL Harnessing the private sector

23. Slide 23 Looking Forward Additional biological and operational evidence: Approved commodities list of WFP and USDA National policy change Programmatic policy change Further scenarios of integration need to be piloted in order to facilitate uptake once approved. PATH can offer technical assistance and tools to the global development community.

24. Slide 24 Summary Innovation goes well beyond the technology. Innovation within food aid can spillover into local market development (and vice versa). Fortified rice is ready for scale-up by the global development community.

25. Slide 25 Thank You