Market-Based Food Safety Interventions in South-Asia Himadri Pal, Prof. Delia Grace, Dr. Judy Bettridge layout INTRODUCTION OBJECTIVE & METHODS RESULTS FURTHER RESEARCH FOOD BORNE DISEASES- SE ASIA https://www.mapchart.net/world.html Introduction The south Asian region has the 2nd highest FBD burden and diarrhoea causing microbes lead as hazards. These countries suffer a combines loss of approx. 110 million annually on a global level. Foodborne Disease Burden Epidemiology Reference Group (FERG) in 2007 by WHO In depth studies in countries and regions Includes Enteric and parasitic diseases plus Chemicals and toxins 3 FACT CHECK South East Asia 2nd highest FBD Burden per population 1 Diarrhoeal disease agents lead as hazards (mainly EPEC, norovirus, non-typhoidal S. enterica, ETEC and Campylobacter spp., Salmonella typhi)1 Unsafe Foods in LMICs loss of productivity, medical treatment cost 110 billion USD annually2 The Food Safety Burden (unit: DALYs per 100k) FBD Burden South-East Asia Region [PERCENTAGE] Rest of the world South East Asia Region SEAR B SEAR D 4349 685 711 Other Contributors There has been a need for interventions tailored for the target groups, adaptive enough to be scaled and frugally effective beyond the pilot. Interventions in INFORMAL MARKETS, & FOOD SAFETY Introduction FS Hazards tend to converge in traditional/informal markets (how?). Then there are many other variables which impact these markets & their functioning such as ……. Example poor infra and conflicts in Nigeria- Market present but not in use. The need of targeted interventions, can be flexible enough for scaling and effective for a long time at a low cost. There are many such interventions coming up, and these have been some in the past. One such project is on dairy value chain by IlRI in assam which I will be discussing today. 4 FOOD HAZARDS INFORMAL MARKETS LMIC CONSUMERS Legal & Political Conflicts Regulatory failure Lack of proper infrastructure and utilities Mismatch - investment priorities & actual health risks Context varies w.r.t. beliefs & practices challenging transfer Complex food systems with layers Milk & it’s safety India’s Milk Production: 127MT annually3 48% milk consumed within households, not traded 36% milk traded through informal sector 2018, National milk sample analysis4: 4.8% non-microbiological safety concerns. “Since, in most cases, liquid milk is boiled and then consumed, public health risk due to microbiological contamination is minimal.” Yet there exists a big risk from microbiological contamination of milk & dairy products. Boiled milk may also be prone to chemical hazards, bacteriological toxins and post-boiling contamination. The dairy value-chain (INDIA) Introduction Assam 97% of dairy sector is unorganized – neighbourhood & door-to-door deliveries. One of the poorest states in India. Multiple separatist and militant movements. Average temperature - mostly tropical (24-32°C). Antimicrobial residue 8% of milk samples tested positive (across dairy farms of Assam & Haryana states)5 88% samples tested positive in Assam.6 Location of Assam - Before I move to Assam, we should talk about how the Dairy Value chain is in India. India is the largest producer of milk in the world and most of it is consumed at home, or used in the informal chain. - A SURVEY IN 2018 BY THE GOVT OF iNDIa, reported approximately 5% samples having safety concerns of non microbiological quality. The survey did not evaluate microbial safety as it is assumed that milk will be boiled. However, there still exist a large probability of microbial concerns in milk. - Then there are also concerns of chemical hazards such as antimicrobial residues, adultrants and bacterial toxins. Even boiled milk is highly susceptible to post boiling contamination. Coming to the north-eastern state of Assam, where the ILRI project was targeted, the state struggles with several situations in terms of an organized food sector. Poor, Separatist & Militant movements, Tropical temperature. Previous studies on antimicrobial residue conducted in 2018 and 2021, reported a high positivity of such residues. 5 The DAIRY VALUE-CHAIN (ASSAM) Introduction The value chain often has 2 branches. The dairy farmer may himself be a trader selling directly to end consumers, or he may sell to middlemen. These middlemen (locally called paigari) collect milk from the farmer’s residence or a central collection point (which is often within a walking distance) and carry it to the city or big markets to be sold to the end consumer. Although the use of paigari reduces the profit for farmers, they have to use them because of work overload and lack of labour support. Now coming to the end consumer, consumers are sold this milk within 2-3 hours of milking in plastic bags or sometimes their own containers. The milk is not subjected to any cold temperature. The price of selling ranges between 55-60 INR per litre as of 2022. 6 DAIRY CHAIN PROJECT (ILRI), ASSAM (2009-2013)6,7 Introduction ILRI in 2009 conducted a dairy chain project aiming at livestock and milk safety. The project involved formative research which identified training needs of farmers and traders. Manuals for training were developed and pre-tested, and were then implemented through a participatory approach. The impact or compliance with taught good practices was regularly monitored at local and regional levels. This was combined with a policy initiative and impact was evaluated. The project was successful on some critical parameters (insert red boxes), especially on increasing milk production and hence income, which often acts as a strong motivator for food handling vendors. The project was scaled to 16 districts of Assam state and is now a part of a bigger World bank funded consortium of projects, called the APART project. MY PERSONAL NOTES: CONSISTENCY of staff or PI is such an important point in the intervention success. Example, Dr. Ram in the APART project. 7 Identification of Training Needs Drafting of Training Manuals Pre-Test & Field-Test of Manuals Implementation of 5-day Participatory Training Monitoring at 2 levels (monthly & quarterly) Policy Initiative & Impact Evaluation Knowledge, Attitude & Practice Significant improvement in knowledge on milk hazards Improvement in some practices on hygienic milking Milk Quality Antimicrobial residue- High positivity(89%) E. coli- Almost all samples tested positive before & after training (96.5-100%) Aflatoxins reported in 4.5% milk samples tested Reported Milk Production 14% higher milk production among trained farmers than untrained farmers Government Support Intervention extended to 16 districts in Assam State with support from Govt liaisons, ILRI & World Bank Intervention ongoing aimed at dairy & pork value chains Prevailing traditional beliefs documented Water adulteration reduced significantly from 2009 to 2012 Methods In 2022, we conducted FGDs among ILRI Project trained and untrained dairy farmers. A FGD tool containing key questions and probes was developed and used. All FGDs were conducted in local language, at time & location suitable to dairy farmers, in the presence of ex-dairy farmers’ association head. Sessions lasted 30-45 minutes and were voice recorded. The transcribed data was coded and analysed through thematic Data Analysis No. of FGDs Trained Dairy Farmers (n=6) Untrained Dairy Farmers (n=4) Total No. of participants 33 21 Objective & Methods Objective & METHODS Objective To study the food safety knowledge, perception & needs among ILRI project trained & untrained farmers in Assam. Location of FGDs in Greater Guwahati Area In 2022, we conducted a study in the greater Guwahati area, to understand the farmers’ recollection of the ILRI project, their knowledge on milk safety and needs for making their milk safer. FGDs were conducted among trained and untrained farmers and, a total of 54 participants were recruited. The FGDs were conducted in hindi at convenient locations and times. Data was translated to English and was evaluated. 8 Results- Demographics RESULTS- Demographics Talking about the demographics of participants, only a small portion of the participants were women and the same goes for youth below the age of 25. The participants belonged to both components of the dairy value chain, i.e. traders only and traders as well as vendors. 9 Results Food SAFETY & HYGIENE KNOWLEDGE “We do purification only by sieving. We have no electronic process. If we get that, it that would be better. Sieving would not remove the disease. Maybe someday a customer comes and complains that my child fell sick because of only sieving and we may face a problem.” (Trained Farmers, FGD 1) Perception of consumer needs We covered 4 aspects of food safety and hygiene knowledge. Firstly we asked farmers about their perception of consumer needs. The top priority was hygienic milk & good quality. We also probed about relationships, and farmers who sold directly to end-consumers valued relationships, while those who sold to middlemen considered quality as a bigger selling factor. Food safety, or hygienic practices was not a response when being asked about how to make your product attractive. Though some of the responses may indirectly impact these factors. 10 What could you do to improve the attractiveness of your products? The most popular responses across both groups were: Improve cattle health Increase milk production Find a solution for space constraints. Respondents also discussed high feed prices and lack of utilities such as water. What do you think are the factors which customers care about when they choose where to buy? Trained & untrained farmers expressed similar views. Top priority: hygienic milk of good quality. Farmers with middlemen as customers gave more importance to quality over customer relations. Results Food SAFETY & HYGIENE KNOWLEDGE “We also feed this milk to our children, even though doctor says no. The doctor is right, and hence we don’t give milk to children when they have a cold. In the winter season we don’t have curd to avoid getting a cold” (Trained Farmers, FGD 4) “In Japan, they never boil milk. They consume raw milk after ‘pasteurization’.” (Untrained Farmers, FGD 1) When we asked people possible impacts of poor hygienic practices, and impact on milk was mostly reported as an after-thought. Illness though spoilt milk was not heard of, however, some respondents mentioned actions to protect children. 11 Do you think if you or your cowshed are not clean, it may affect the milk you sell? If so, how? Most groups raised concern towards human & cow health & used the term ‘mastitis’. Many respondents also mentioned an impact on milk, although as a second response. Have you ever heard of anyone falling ill by consuming milk or sweets? None of the respondents reported anyone falling ill by drinking milk or having heard of anything similar. Respondents reported selling milk the same day as milking and criticized the vendors in Guwahati city on selling milk the next day as they believed this may lead to spoilage. Results ACTIONABLE ATTITUDE- FOOD SAFETY Traditional Beliefs around cow manure Not considered harmful Not being used as fuel due to lack of space for drying Sometimes sold to plantations, but mostly discarded in drains or on hillsides => poor hygiene We also asked farmers on the feedback they received for their milk. While receiving feedback was very common, the cause for bad milk was rarely reported to be in their control. On extensive probing about dirty utensils, some groups agreed that this may be a cause of spoilage at times. As an action towards negative feedback, farmers reported checking cows for diseases. Cow manure was observed to be often ignored by farmers and it’s removal was not a priority in most of the farms. There was also a belief about the manure being harmless. Though there were alternative uses for it discussed, it was not considered to be a priority. 12 Do you get feedback from consumers on milk quality? If so, give examples. The cause for bad milk (thinner & smelly) was reported to be: If someone comes back and complains of milk quality, what do you do? Checking cattle for disease was the most popular action reported. All groups confirmed receiving feedback. On being probed about container condition and environmental temperature, farmers agreed to both these being possible causes. cow health, either due to sickness, medicines or calving. change in feed quality & quantity which impacts fat content Time of the day Results PERCEPTION- CAMPAIGNS & INTERVENTIONS Awareness about schemes for safe food was very low. Respondents remembered ILRI training but not w.r.t. milk safety. Farmers who supplied milk to middlemen did not find any use for the certificates or displaying them. Inaccessibility to schemes for vaccines was reported as a constraint as they were mainly centered in the city. Respondents were aware of a banner on agriculture and seeds. When asked who should be paying for food safety improvement, the government was considered as more responsible than any other organization. Examples of other countries and systems, such as Nepal were highlighted by the farmers. In one group, NGOs were considered as an option based on their perception of reliability (‘can keep up promises’) and speedy provision of funds. One group of untrained farmers preferred society (DCS) funding over government citing more ownership and monitoring. 13 Are you aware of any help scheme in terms of making food safer? Have you ever seen any slogans or banners around it or anyone from the government publicizing safe food? The most common response was Government investment as in other dairy-focused states (Haryana, Punjab). The dairy system of Nepal, and subsidy provided to cow farmers was also highlighted. The respondents recalled ILRI training, and the topics recalled were cow care, feed, but milk safety or hygiene were not mentioned. To make food safer it comes at a cost? How do you think food safety improvement could be paid for. Who should pay? Respondents mentioned inaccessibility to vaccine camps as they lived far from the veterinary center. The certificate & displaying it was not perceived beneficial. Results PERCEPTION- government SERVICES A challenge was reported by the farmers in terms of basic utilities such as water and waste disposal. The low income farmers had to also purchase water in months of shortage, or had to feed dirty drain water to the cows. Waste was also observed lying on hill sides and in houses, as they did not have any means to dispose it off. Drains fiolled with cow manure were also observed. On being asked if any government inspections happened, only vet visits were reported across all FGDs. However, those also seemed bleak as they visitred only when called, and sometimes they were too late for the cow to survive. How are existing utilities/amenities in the area you sell? Water: In rural villages (most of them), water supply is from the mountains or local tanks. Hence they face shortage during some months and have to purchase water for themselves and the cattle. Drain water is also often used to feed the cattle in these areas. Waste Disposal: None of the respondents reported presence of any waste disposal system. Cow manure was usually discarded, burnt, sold or turned into biogas. The farmers in Anil Nagar area reported presence of shared toilet and they lived on rented land. Electricity: Often reported available in the greater Guwahati area. Have you ever seen any government inspection happen at the your point of sale? Government inspection was majorly confused with government veterinary doctor visits. All FGD respondents reported doctors visiting only when there is a need and sometimes not soon enough for the cow to survive. They also reported doctor visits for vaccination and insemination of cows. No other inspection was reported. 14 How are existing utilities/amenities in the area you sell? Government inspection was majorly confused with government veterinary doctor visits. Water: In rural villages, water supply is from the mountains or local tanks. Inconsistency of supply makes them purchase water for themselves and the cattle. Drain water is often used to feed the cattle. Have you ever seen any government inspection happen at the your point of sale? Electricity: Consistent supply in the greater Guwahati area. Waste Disposal: Lack of waste disposal system and cow manure is usually discarded anywhere. All FGD respondents reported vets visiting only when there is a need and sometimes not soon enough for the cow to survive. Other visit reasons were for vaccination and insemination of cows. No other inspection was reported. Results The need of the hour “If we have a DCS we can get a storage unit for milk like a cold storage. We will have 100-150 farmers and everyone can use the facility. A DCS can request government for support as well.” Trained Farmers, FGD 6 “It is so difficult for us, that it is impossible to do this business anymore. They say worship cows, but they (govt.) do not support us.” Trained Farmers, FGD 5 “The government should preserve dairy farmers or they will face huge losses. Today if you offer to buy anyone’s cowshed, they will be highly willing to sell. This is our last stage of attempt.” Trained Farmers, FGD 5 The final question we asked, was for the one thing the farmers would get most helped by, and the results have been mentioned here. They struggle with several aspects of storage, medical facilities, labour and municipal support. They mostly wanted trainings on gatting higher returns and having prior intimation for any activities. 15 What should be the focus of a company willing to help you in the maximum possible way? Several help areas were identified, including: Land provision Municipal support for carcass removal Availability of sufficient labour farmer loans Trainings on topics such as ‘making a profitable business’ were preferred. Organizers should intimate 2 days in advance to enable people to set-up replacements for work in their absence. Cold Storage Facilities Availability of veterinarian Feed subsidy Further research- SCALE UP SCALE-UP The ILRI project is being scaled up to 16 districts across Assam (as a part of APART Project) with activities as follows: Risk Assessment study across value-chain stages. Training tailored for 4 value chains: Milk Producers, Milk Traders, Sweet Makers and Cottage Processors and Consumers Capacity building of regional testing labs & local farmers/vendors This initiative will also be replicated for the Pork-value chain in the said districts. FURTHER RESEARCH Poster Session - P3-113 - TODAY Title: A conceptual framework for food safety interventions: Insights from low- and middle- income countries As of now, the ILRI project is being combined with a world bank funded project, APART and has 4 major activities. Recently, a MoU was also signed by the govt and …… At a later stage, we aim to identify the factors contributing towards scalability of this project by the means of an in-depth evaluation of the project. We have developed a conceptual framework for highlighting concepts critical to market based interventions. The framework has 3 main guiding principals and follows a socio-ecological model. The other concepts are in poster and details here. 16 KEY TAKEAWAYS 17 Food Safety Knowledge The dairy farmers in Assam have a poor understanding of food safety principles, however, the trained farmers show a higher understanding than the untrained farmers. While they strictly follow a set of hygienic practices, the main motivation is to prevent visible spoilage in the milk and not to ensure milk safety. Dairy farmers face several challenges such as lack of labour, space, veterinary services, water & suitable storage facilities. These challenges impact their focus on quality as well as reaching their maximum income potential Food Safety Compliance & Authorities No awareness of govt. registration and licensing as needed by petty businesses, was observed among farmers. Enabling Environment Anger towards the government was sensed among the farmers. They seek government support & funding over any third party or organization. Thank You! ACKNOWLEDGEMENTS Prof. Delia Grace, Dr. Judy Bettridge References 1. World Health Organization. (2015). WHO estimates of the global burden of foodborne diseases: foodborne disease burden epidemiology reference group 2007-2015. World Health Organization. 2. Jaffee, S., Henson, S., Unnevehr, L., Grace, D., & Cassou, E. (2018). The safe food imperative: Accelerating progress in low-and middle-income countries. World Bank Publications. 3. Landes, M., Cessna, J., Kuberka, L., & Jones, K. (2017). India's Dairy Sector: Structure, Performance, and Prospects. Washington, DC, USA: United States Department of Agriculture. 4. National Milk Safety and Quality Survey Executive Summary - FSSAI, 18 Oct. 2019, fssai.gov.in/upload/uploadfiles/files/Report_Milk_Survey_NMQS_Final_18_10_2019.pdf. . 5. Kumar, N., Sharma, G., Leahy, E., Shome, B. R., Bandyopadhyay, S., Deka, R. P., ... & Lindahl, J. F. (2021). Understanding antibiotic usage on small-scale dairy farms in the Indian states of Assam and Haryana using a mixed-methods approach—Outcomes and challenges. Antibiotics, 10(9), 1124. 6. Lindahl, J. F., Deka, R. P., Melin, D., Berg, A., Lundén, H., Lapar, M. L., ... & Grace, D. (2018). An inclusive and participatory approach to changing policies and practices for improved milk safety in Assam, northeast India. Global food security, 17, 9-13. 7. Lindahl, J. F., Deka, R. P., Asse, R., Lapar, L., & Grace, D. (2018). Hygiene knowledge, attitudes and practices among dairy value chain actors in Assam, north-east India and the impact of a training intervention. Infection Ecology & Epidemiology, 8(1), 1555444. image4.png image3.png image5.png image6.png image7.png image8.png image9.png image16.jpeg image10.jpeg image11.jpeg image12.jpeg image13.png image14.jpeg image15.jpeg image16.png image17.png image180.png image19.png image20.png image21.png image22.png image23.svg image18.png image14.png image15.png image24.png image25.png image26.png image27.png image28.png image29.jpeg image30.jpeg image31.gif image32.png image33.png image34.jpeg image2.png