Equipping Millers to End Malnutrition

Felix Brooks-church has dedicated his adult life to ending micronutrient malnutrition. He co-founded and leads Sanku, a Tanzania-based social enterprise that has been named one of Fast Company’s Most Innovative Companies, a GiveWell Standout Charity, and won the Zayed Sustainability and Lipman Family prizes. A former graphic designer and product developer, Felix recognized that malnutrition is depriving current and future generations while living in Southeast Asia working in education. A true problem solver, Felix invented a new fortification technology and a sustainable business model for deploying it in the world's hardest to reach areas. Felix led all aspects of product development and engineering for Sanku’s award-winning Dosifier (incl. 2019 Time Magazine Invention of the Year). Sanku is providing the basic human right of nutrition to 2M/day people across East Africa and is on track to reach 100M people by 2025. Felix attended Oberlin College and is a Mulago Fellow.

Worldwide, 16,000 children die every day and 2B suffer from preventable illness because their diets lack basic vitamins and minerals. Fortification (adding life-saving micronutrients to processed foods) is the most cost-effective nutrition intervention, but it has failed to reach the 6.5B people in developing countries who rely on small, often rural, mills for most of their food.

Sanku developed a technology and business model to enable the small mills that feed the most malnourished people to conveniently and affordably fortify staple grains. Our Dosifier precisely adds nutrients into flour during processing and our business model leverages economies of scale to offset any additional costs for millers and their customers, providing Sanku with revenue margins that increase as we scale. We have a plan to reach 100M across 10 countries in Africa by 2025, which will prevent millions from death and disease, boost productivity, and save billions of dollars in GDP.

Insufficient access to vitamins and minerals has devastating outcomes, particularly for children and women of reproductive age. Globally, 161M children are chronically malnourished. Chronic malnutrition causes annual GDP losses of $3.5 trillion worldwide. 

Food systems in East Africa and elsewhere in the developing world are failing to ensure access to sufficiently nutritious food for all people. An estimated 40% of all children in sub-Saharan Africa are chronically malnourished due to lack of sufficient, diverse micronutrients. In Tanzania, 45% of reproductive age women are anaemic, causing up to 40% of maternal deaths. An estimated 80% of children are zinc deficient, putting them at heightened risk for pneumonia and diarrheal disease.

Fortification has the proven potential to eliminate micronutrient malnutrition but the problem prevails in the absence of a widespread, sustainable method for fortifying the food sources most commonly consumed by malnourished populations (the fortification gap). In East Africa, maize flour accounts for 60% of calories in the average diet but only a fraction is processed in large mills with the mandate and technology to fortify their flour. Up to 95% of the population consumes maize flour from thousands of small village mills in villages, often located in remote areas.

Felix developed the first fortification technology for small-scale mills and a sustainable business model that is viable at scale. Sanku partners directly with the millers who feed the majority of Africans and equips them to add life-saving nutrients to the staple foods they produce without changing workflow or increasing costs. 

His patented Dosifier technology automatically and precisely adds WHO-recommended nutrients as grain flows through its weight-sensitive hopper, fortifying flour without changing the taste. Dosifiers are light but sturdy and transmit data remotely, enabling Sanku’s team to cost-effectively monitor and service thousands of millers scattered across regions lacking infrastructure. 

Neither millers nor their poor customers can afford to pay more for fortified food but Felix saw an opportunity for a social enterprise model that neutralizes the cost of Dosifiers and ongoing nutrient supply. He learned that millers’ primary cost is flour bags, which they buy in small quantities. Sanku purchases empty bags wholesale then sells them to millers for market price, using the margin to cover nutrient premix and direct expenses. This model allows millers to charge the same prices for fortified flour, ensuring access. Sanku will reach financial sustainability when we instal 13,000 Dosifiers, which will feed 100M people.

Sanku’s solution serves communities who aren’t reached by large-scale fortification supply chains, those that are also especially vulnerable to malnutrition, starting in Tanzania. We partner with millers whose customers have a high incidence of poverty (~95% of the people we reach live on <$5 per day and struggle to purchase a diverse, nutrient-dense diet) to ensure their access to sufficient micronutrients. 

Micronutrient malnutrition results in poor education-related outcomes and reduced productivity population-wide and is concentrated in the Global South. It presents further dangers for women of reproductive age and children under 5. These populations have higher nutrient requirements that, when not met, and coupled with poor health infrastructure, often have fatal consequences. 

We have engaged our target population in the development of our model over the last 7 years. Through collaboration with millers and community members, we decided to focus on maize flour as it is the most beloved food in East Africa. Rather than rely on behavior change, we researched and designed around the existing price, texture, taste, and preparation of maize flour in the local context. To maintain our close partnership and feedback loop with millers, we add value to their business by focusing on quality and consistency.

Widespread micronutrient malnutrition is preventing generations born in the Global South from ever reaching their full mental and human potential. Daily, it causes preventable deaths. Ensuring nutritious diets for all is an increasingly pressing challenge as global food production becomes more vulnerable from climate change. While food fortification is touted by the WHO as a proven, cost-effective solution, it isn’t yet benefiting many who need it most. Sanku’s technology and business model is uniquely capable of filling the huge gap left by large scale efforts. We are driving awareness and action around small-scale processors’ necessary role in realizing fortification’s promise.

My cofounder, David Dodson, first witnessed the fortification gap driving through rural Rwanda, seeing first-hand that no matter how successful large-scale fortification efforts were, that flour wouldn’t reach beyond urban centers. I met David shortly thereafter, in 2010, and was inspired by the potential to solve a problem affecting the lives of 1B people. We partnered to pursue a simple but impactful goal: Close the fortification gap. I set off to Nepal on a one-way ticket with some rough sketches of a prototype machine from Stanford engineering students and spent the next few years refining it in village flour mills. By 2012, the resulting Dosifier machine was ready for field testing. After hours of bumping along a dirt road, up and down mountains, the Dosifier and I reached the secluded hilltop village of Sankhu, where I witnessed the first installation at a mill with anticipation. Relief, bewilderment and lots of tears followed once the Dosifier was switched on, ran smoothly and fortified flour. Seeing the entire village celebrate, I became even more committed to fighting malnutrition and Sanku was officially born, named in honour of that tiny Nepali village, which I knew would be the first of many.

Before founding Sanku, I lived in Cambodia for four years, directing an education center for at-risk street children. Many of the children had learning disabilities and were often sick. Several passed away from preventable illnesses. This broke my heart. I felt that I had failed them, that all the center's good work was essentially a Band-Aid without addressing the issues at the root of the problem. 

It was there that I discovered my passion for nutrition as a preventative measure, understanding that ensuring this one thing in the first 100 days of a child’s life could prevent the most common and tragic health problems before they occur. I co-founded Sanku in 2013 with the mission to end malnutrition by guaranteeing that every meal, for every mother and child, contains life-saving nutrients, forever. I have two small children now that have the privilege of eating nutritious food every day. I strongly believe that this should be a right, not be a privilege, and I have dedicated my life to developing a technology and business model capable of providing the basic human right to good nutrition to the millions of children and adults excluded by status-quo efforts.

For the last fourteen years, I have lived in the Global South alongside those I serve. I have dedicated my life to social work and collaboratively developing innovative solutions that meet communities’ most pressing needs. I have refined micronutrient delivery systems and developed economic models for sustaining small-scale flour fortification at scale. I led all aspects of product development and engineering for the Sanku Dosifier technology, and designed the innovative business model that will ultimately sustain our operations without external investment. 

I have built an organization from a one-man show to over 30 passionate employees in Tanzania that will soon be 300 globally. I have personally surveyed over 500 small mills throughout South Asia and East Africa, gaining an expert level understanding of the small-scale flour production industry and maize value chain. With these skills and knowledge, and having been part of Sanku’s journey from day one, I’ve reached expert standing in the small-scale milling sector and am able to tell the story of Sanku with passion. This is my life’s work, and I am driven by our mission: I will not stop until we achieve it. I infuse this “never give up” culture into our team and empower the millers we partner with as critical change-makers for their own communities. With the right platform, I know I can galvanize others, bring awareness to the injustice of prevailing malnutrition, and end it once and for all.

Ten years ago, the fortification sector thought small-scale fortification was futile if not impossible. Consensus was that it was a waste of time and money, and that small millers would never be incentivized to fortify. I saw it differently. I saw millions of children being denied a basic human right. Failing to extend the proven solution of fortification was irresponsible and morally wrong. At the time, I didn’t have the answers, I dedicated myself to learning from the millers and individuals standing to benefit from a solution. By 2016, we had a new technology in 100 small mills. Our initial financial model was to sell nutrients to the millers as our revenue stream. It didn’t work. Millers weren’t fortifying and they owed us a lot of money. I could hear the collective “I told you so” from my fortification peers but I didn’t give up, I kept innovating until I came up with our current cost neutralizing model, leveraging economies of scale by buying flour bags wholesale and selling them to millers with nutrients included for no additional cost. It was a game-changer. Now, demand from millers is so high, we can hardly keep up.

When COVID-19 hit Tanzania in March, panic and fear struck my team and the communities we serve. I was concerned for my team’s safety and for Sanku’s mission, knowing a pandemic would force me to make some tough decisions. One option was to layoff half my team, stop supplying our millers and hibernate to weather the storm and uncertainty around future fundraising. I couldn’t let down the millions of people who depend on Sanku for their daily nutritious food to avoid risk, I had to get innovative to keep serving millers while protecting our team. I proactively transitioned all of Sanku’s staff to remote work, including field staff by outsourcing deliveries to a third-party  logistics company and shifting their  responsibilities  to  strategic  partnership development. In order to provide essential supplies to millers, Sanku’s staff and their families amidst a shortage of face masks in TZ, I repurposed deadstock flour bags and produced them ourselves. We provided “health kits” including mask, gloves, hand sanitizer and disinfectant soap to over 1,500 people so that 350 millers could continue the critical job of fortification safely. No jobs were lost, and the fortified flour chain was not broken.

We are officially registered as a US 501c3 under the name Project Healthy Children Inc. We are more commonly known internationally as Sanku-Project Healthy Children, or just “Sanku”.

Food fortification efforts have been almost exclusively focused on large-scale processors, particularly in Africa. Recognizing fortification’s effectiveness for advancing nutrition, governments including Tanzania have mandated the practice at central food production plants but these sources feed less than 10% of the population, typically wealthier urban-dwellers. Sanku addresses the huge remaining fortification gap by targeting our solution to small, rural millers that produce staple foods. Our model was designed to achieve wide geographic coverage and get critical nutrients to the people who need them most and are least likely to be reached through existing methods- the rural poor. 

Eradicating malnutrition in East Africa necessitates inclusion of small-scale millers and Sanku has developed the only technology tailored for their unique realities. Our proprietary tech is paired with a social enterprise business model that leverages philanthropy to neutralize the costs that millers and their customers cannot absorb without creating reliance on external funding, which has stalled most non-profit nutrition interventions. Once we are reaching 100M people, our revenue will cover the cost of growth, allowing Sanku to maintain our impact through the market. The majority of micronutrient interventions require government subsidies.  

Most nutrition interventions rely on behavior change. For example, vitamin supplementation programs struggle with adherence, as behaviors around taking pills are challenging to influence. Because we  worked closely with end users to ensure our solution does not change the taste, color, texture or preparation of the fortified product, we do not have any issues with consistent uptake.

Micronutrient malnutrition causes productivity losses, preventable illnesses, and fatalities, including the death of 16,000 children/day. There is a high burden in sub-Saharan Africa, where ~40% of children are stunted. Fortification is a proven solution that does not reach up to 95% of people in the region.

Key Assumptions & Supporting Evidence:

1. Food fortification is a cost-effective solution to micronutrient malnutrition.

   1. The WHO recommends fortification as the most effective and cost-effective solution to micronutrient malnutrition (2006 flour fortification guidance). 

2. If the costs of fortification are neutralized, then small millers will fortify their flour.

   1. Millers are demanding and adopting Sanku’s fortification model. We currently partner with >450 millers, close to 200% growth from 2018. 

3. If the cost of fortified flour is the same cost as unfortified flour, then consumers will choose to buy fortified flour.

   1. Customers are choosing fortified flour: Sanku is reaching 2M people/day. 

 Activities:

1. Develop a fortification technology for small mills with remote monitoring mechanisms (Sanku Dosifier);

2. Equip small mills with the technology to fortify flour and the support to sustain it at no additional cost: Sanku uses a philanthropic subsidy and economies of scale to provide millers with fortification tools including the Dosifier, nutrient premix, and flour bags. 

3. Identify geographic areas with many small commercial mills to reach market saturation.

Outputs & Validation:

1. Millers produce fortified flour with consistent levels of nutrients that meets WHO standards. 

   1. Monitored through bag and premix sales data and real-time remote transmission of production data. In 2019, the CDC and Sanku administered a survey of >400 samples of fortified flour and found that 90% of flour was fortified correctly and 100% of flour was fortified correctly after follow-up.

2. Populations served by small millers purchase and consume fortified flour daily. 

   1. A 2016/7 survey by Helen Keller International (HKI) in the Morogoro region of TZ found that 90% of flour in households was fortified (from 0% before Sanku was active in the region).  

Outcome:

Populations with high incidence of micronutrient malnutrition are consistently consuming critical micronutrients, ending hidden hunger, which will prevent millions from death and disease, boost productivity, and save billions of dollars in GDP.

Direct beneficiaries who access nutritious food:

• 2M in 2020

• 5M in 2021

• 100M in 2025

By September 2021, our goal is to reach 5M people (10% of Tanzania’s population) with fortified flour, which is proven to help decrease maternal deaths, improve cognition and learning in children, and ensure all individuals live longer, healthier lives. We are on-track to meet this goal: Each year, our reach has doubled. We will achieve it by saturating 4-5 regions and installing an additional 264 Dosifiers. 

Our subsequent goal is to reach 100M people by 2025 across 10 countries. To achieve it, we will deepen our presence in Malawi, Rwanda, Kenya and Mozambique, while expanding into Ethiopia, Sudan, Zimbabwe, Zambia, and Uganda because of their strong fit with Sanku’s criteria: millions suffering from micronutrient deficiencies, governments readying passage of nationwide fortification bills, and homogenous consumption of staple foods.

Transforming the SME milling sector and achieving broad geographic coverage of fortified maize flour, thus ensuring its consumption by 100M people, will help to prevent over 20k maternal deaths annually, contribute to improved cognition for 6.5M children, and decrease the number of years lost to illness, disability, or premature death (DALYs) by 14M- a striking opportunity cost the world currently bears.

As Sanku works towards this primary impact goal, we will continue innovating to refine our sustainability and expansion models. We have ongoing pilots exploring a Dosifier leasing model to diversify our revenue, development of a rapid iron test to ensure quality control at scale, and a Dosifier modification to fortify rice for expansion to Asia.

Sanku has designed our model around cultural and market realities and is poised to accomplish our goals of expanding our reach in East and Southern Africa in the next year and the next five years. Our solution is proven and requires no behaviour change, the primary barrier to reaching our lofty goal is funding and visibility, meaning that the resources that come with the prize would be pivotal to ending micronutrient malnutrition. 

The primary cultural barriers faced by food fortification programs are inability to drive behaviour change around eating new foods or adherence to supplements. Our technology eliminates these barriers by fortifying food without changing its flavor or texture. Our financial model addresses market barriers by ensuring fortified food is available to price-sensitive customers at the same price as non-fortified alternatives and neutralizing any costs of fortification for millers. Because this requires Sanku to raise philanthropy through 2025 when we reach full cost-recovery, we must raise sufficient grant capital to maintain our growth, particularly with changes to the fundraising landscape in the wake of the global pandemic. 

Sanku also recognizes the importance of prioritizing inclusive recruitment of a dynamic team and developing strong internal systems to ensure we maintain accountability and depth of impact as we expand rapidly during this planned high-growth phase. Without building a network of advisors and seeking the input of peers, we will run a higher risk of encountering barriers that we might avoid from drawing on outside experience.

Raising sufficient philanthropy to meet our growth targets: To ensure Sanku is positioned to meet our fundraising goals we have set ambitious metrics to quantify and track efforts to expand our pipeline of funding prospects and initiate more written submissions and conversations towards funding. We have identified a combination of earned revenue and philanthropic funding streams with compelling value propositions. Sanku contracted experienced social enterprise fundraising consultants to guide strategy and implementation on these fronts. We still need added visibility to reach new audiences and expand our funding prospects. Another important aspect of growing our fundraising is conducting external research to validate the impact of our programs on health outcomes, which will enable us to approach and secure new types of funders.

Attracting and retaining a diverse and high-caliber team: To ensure that our organization’s staff is reflective of the communities we serve, dedicated to our mission and poised to grow, we are investing in our “people” team, creating opportunities for capacity building and staff development and putting in place inclusivity practices for hiring all roles. We work with local recruiters in the countries where Sanku has operations and are in the process of electing a local board.

Growing pains from rapid expansion: We are seeking inclusion in networks where we can connect with experts and peers from diverse backgrounds and disciplines as thought partners.

Small-scale flour millers are Sanku’s most important partners. We have signed agreements with all 450 millers with whom we work. Due to the focus of Sanku’s model, these previously unregulated and disenfranchised millers become empowered to play an important role in improving their own communities and businesses. 

Sanku works closely with The Government of Tanzania. We have an active 5-year MOU with the Ministry of Health of Tanzania that enables us to easily scale to new regions in strategic partnership with Health Officers and the Tanzania Food and Drug Agency (TFDA) to enforce fortification activities in mills.  

Sanku has partnered with the World Food Programme (WFP) since 2015 to provide fortified meals to over 80,000 children from the Kakuma refugee camp in Northwest Kenya. In 2019, we increased this reach to 300,000 Burundian and Congolese refugees through equipping WFP and their partner mill with 17 Dosifiers. Sanku is projected to reach four million refugees throughout East and Central Africa by 2025, working closely with WFP, UNHCR and the host countries.

Sanku partnered with technical experts at Vodafone and Oracle Corporation when developing and iterating on the Dosifier. Our partnership with Vodafone resulted in cellular-enabled technology for the Dosifiers, making them “smart.” Sanku flour mills can now be monitored remotely in real time. 

Sanku developed the Dosifier in partnership with Stanford University.

Sanku is a last mile distributor, sitting between input manufacturers and millers. We provide three primary inputs: A Dosifier, nutrient premix and empty flour bags. While we equip millers with the tools to fortify, we also support them with basic business development services, adding value to their businesses, which ultimately allows them to sell more fortified flour. 

Our pricing strategy is to provide Dosifiers, nutrient premix and added services for free to millers and recover those costs through bag sales. Aggregating many small millers’ demand for empty flour bags enables us to purchase higher-quality bags at more competitive rates. We work with millers to make the bags look unique with updated branding, helping to differentiate their flour on the market. We also advise on manufacturing best practices in order to access government certifications and link millers to maize markets and farmers to get better prices for raw maize. 

Our Region Managers develop close relationships with millers and are responsible for Dosifier installations and business development support. Once mills become Sanku’s partners, Region Managers serve as customer relations representatives while servicing Dosifiers and gathering data, generally overseeing between 20 - 50 mills, depending on the region.

Ultimately, Sanku’s model ensures that prices remain constant for millers to put a healthy product on the market for the same, affordable end price, reaching consumers who otherwise would not be able to access nutritious flour.  Replacing a nutrient-poor food with a nutrient-dense alternative has a positive impact on the health of these consumers.

Sanku currently advances and sustains its model through a combination of charitable giving (including philanthropic grants, individual donations and government funding) and a growing revenue stream from millers’ purchases of flour bags bundled with micronutrient premix. In 2019, Sanku’s total income was $2.9 million, with 24% coming from earned income (a 379% increase from 2018) and the remainder from philanthropy. Sanku is steadily growing both revenue streams and we expect to break even by 2023 and achieve profitability by 2025. At this scale, Sanku will be a completely self-sustaining social enterprise independent of philanthropic support.

The more Dosifiers Sanku installs in small mills, the more fortified flour is produced and sold – generating more income for Sanku to cover its operating expenses. As we scale, we will continue to strengthen our logistics and inventory management capabilities to reduce costs. Sanku’s reliance on philanthropic partners will reduce until we can self-sustain our operations and growth. We leverage an existing market, eliminating the need for community buy-in since the demand for staple flour already exists. With the government’s national mandate on fortification programs and Sanku’s expertise in small-scale food fortification, it is only a matter of time before Sanku drives greater scale in rural communities and achieves full sustainability by 2025.

Total philanthropic funding needed to reach the goal of 100M people served with fortified flour will be $20M over a 7-year period – or a one time cost of $0.20/person to fortify their diets in perpetuity.

Sanku maintains a healthy funding pipeline for current and future fiscal years, as well as a buffer of three months (minimum) operating costs at all times. Last year, we almost doubled our fundraising and halved our cost per person reached:

             Funds raised      Cost per person

FY2019   $2.2M                $0.53

FY2018   $1.2M                $0.82

Our approach is to balance risk mitigation while also pursuing our bold growth targets. To do this, we seek to develop strong relationships with partners who invest in Sanku over the course of multiple years. We also maintain an even distribution of categories of donors, including foundations, multilateral and bilateral institutions, and individuals.

Our Top Funders in 2019 were: The Zayed Sustainability Prize, The James Percy Foundation, The Mulago Family Foundation, King Philanthropies, and GiveWell (all grants).

In keeping with our growth, our earned revenue has exponentially increased over the last several years:

• In FY17, revenue from sales was $39,219 

• In FY18, this increased to $146,600 (+274%) 

• In FY19 our revenue was $690,737 (+371%)

Sanku is seeking to raise $2.9M in grant funding by October 1, 2021 to meet our FY2021 fundraising goal.

Sanku’s projected expenses for FY2020 are $2.2M.

I am applying to The Elevate Prize to reach new audiences and inspire them to join Sanku’s movement to end micronutrient malnutrition. To date, we have largely made a name for ourselves within the nutrition sector, proving the value and efficacy of small-scale fortification to our peers who had long doubted its viability. We have reached a critical juncture where we need a platform for catalyzing broader awareness and support for our mission and work to continue increasing our momentum and scale.  

Our most significant barriers to scale are raising sufficient philanthropic funding, inclusively growing a high quality team, and maintaining efficiency and integrity during rapid growth. Having access to the platform and resources that come with winning The Elevate Prize would be truly pivotal in overcoming these barriers and realizing my vision of ending micronutrient malnutrition. I believe that, with the right backing and support, I can inspire others to join our fight by spreading awareness around the tragic burden of hidden hunger and the promise and potential of our solution, which will help us raise charitable funds over the coming years until we reach profitability.  

Being part of a network of change makers and experts capable of building the organization’s capacity, as well as my own capacity as a leader, will help us grow into a stronger organization. As a deep believer in the power of collaboration, I am likewise eager to share our own learnings, experience, and network with other innovators in the prize community.

Because we’ve operated in a highly specialized and local context, we have not built as many relationships with actors in the broader food, technology, and innovation spaces and are drawn to the multi-sectoral nature of The Prize. We believe that building out our network will help us reach new advisors and supporters from diverse fields that impact food systems. Inclusion in a new network that is aligned with our values will also help us expand the talent pool for our staff and Board while ensuring recruitment remains inclusive.

We are interested in partnering with marketing experts and content creators. Because we designed our model to avoid behavior change, we have accomplished uptake from millers and their end customers without any additional marketing. As an organization, Sanku’s external communications have largely attracted institutional funders familiar with nutrition. Creating new content to tell our story, and the story of hidden hunger, could advance our business and organizational growth and that of our partner millers. 

We are also exploring vertical integration by manufacturing our own flour bags, which will save Sanku (and the millers) costs. As such, we would be interested in working with GM to incorporate their expertise into our plans. We would also be very interested in working with Microsoft to build out and integrate our data platforms as well as MIT’s supply chain faculty and Johnson & Johnson to learn from and contextualize their extensive supply chain expertise and systems.