Sanku: Ending Hidden Hunger for Millions

Worldwide, 16,000 children die every day and 2 billion 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 6.5 billion people in developing countries who rely on small, often rural, mills for their flour.

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 anaemic, causing up to 40% of maternal deaths, and 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.

Sanku developed the first fortification technology for small-scale mills in East Africa, accompanied by a sustainable business model that is viable at scale. We partner directly with the millers who feed the majority of the population and equip them to add life-saving nutrients to the staple foods they produce without changing workflow or increasing costs. 

Sanku’s award-winning 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 are equipped with remote data transmission capabilities that enable our team to cost-effectively monitor and service hundreds or thousands of millers scattered across regions with poor infrastructure. 

Recognizing that neither millers nor their poor customers could pay more for fortified food, Sanku utilizes a social enterprise model that neutralizes the cost of dosifiers and ongoing nutrient supply: We purchase empty flour bags at wholesale prices, then sell them to millers for market price and use the small margin to cover nutrient premix. This model allows millers to charge the same prices for fortified flour, which is critical to ensuring access. Sanku will reach financial sustainability when we instal 13,000 dosifiers, which will feed 100M people.

Our goal is to extend the benefits of fortification to communities who aren’t reached by large-scale fortification supply chains. These communities have a higher incidence of poverty (~95% of the people we reach live on <$5 per day) and don’t have the income to purchase fresh, nutrient-dense foods or a diverse diet. Within these communities, micronutrient sufficiency is most critical for women of reproductive age, especially pregnant and lactating women, and children under 5. These populations have higher nutrient requirements that, when not met, and coupled with poor health infrastructure, often have fatal consequences. Micronutrient malnutrition also results in poor education-related outcomes and reduced productivity. 

We have engaged this 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. Our research revealed that our success would be limited by reliance on behavior change so we 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.

Ensuring nutritious diets for all is increasingly challenging as global food production becomes more vulnerable due to climate change, which has also proven to decrease the nutritional quality of crops. Food fortification is touted by the WHO as the most cost-effective solution that does not negatively impact the environment, unlike producing more food or more nutrient-dense foods to ensure the same impacts on populations. Fortification is thus essential to promoting nutritious diets without increasing strain on food production systems or the environment and Sanku’s solution is the only one capable of filling the huge gap left by large scale efforts.

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 covers 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 our solution does not change the taste, color, texture or preparation of the fortified product, we do not have any issues with consistent uptake.

Sanku’s core technology is our patented, IoT-enabled dosifier. The dosifier automatically and precisely adds nutrient premix into maize flour, improving the nutritional content of flour to WHO standards without changing appearance, texture, or taste. The dosifier requires the same energy as a 100W light bulb and is compatible with the hundreds of thousands of mills across Africa. It requires no tools or expertise to install. It is robust enough to withstand harsh mill conditions for 24,000 hours of continuous use and fortifies more than a metric ton of flour every hour, feeding over 5,000 people a day.

The dosifier was field-tested from 2009 to 2013, and is now scaling across East Africa, primarily Tanzania, with 450 installed dosifiers reaching more than 2 million people daily.

In 2018, each dosifier was upgraded with Vodafone’s Internet of Things (IoT) technology, optimizing Sanku’s operations and productivity. Mill production data is stored and sent via cellular link to a dashboard in Sanku’s enterprise resource planning (ERP) system powered by Oracle, resulting in faster and more efficient responses to mills that need servicing or restocking. Data is transmitted every 5 minutes to Sanku’s inventory management system, enabling Sanku to monitor miller compliance, fortification accuracy and reach; and send alerts to Sanku technicians for any dosifier maintenance issues. Furthermore, this remote monitoring feature allows a lean staffing model, key to Sanku’s sustainability at scale. 

We are currently working on adapting the dosifier to fortify rice to support expansion to Asia.

https://vimeo.com/244985030

The Sanku dosifier machine’s performance and accuracy has been evaluated by four leading independent laboratories (Intertek, Handelslabor Hofmann, Mühlenchemie, BioAnalyt), with test results confirming a Coefficient of Variation % within the industry accepted +/-10% range, thus certifying the dosifier as accurate and safe. The technology is also recommended by the Global Alliance for Improved Nutrition as the solution for small scale fortification. 

To ensure ongoing compliance with nutrition standards recommended by the World Health Organization (WHO) and mandated by the Tanzanian government, Sanku uses remote data transmission on dosifier performance to efficiently and effectively conduct quality control, which includes monthly service visits to ground-truth remote data and provide hands-on support. 

A survey designed and implemented by Helen Keller International (HKI) in the Morogoro region of TZ in 2016/2017 found that, post-Sanku, 90% of flour in households was fortified (up from 0). 

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, fortified flour:

• 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 in sub-Saharan Africa. 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. 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, our primary barrier is raising 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 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.

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. An 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.

 To attract and retain high-quality team members, we are:

• Working with local recruiters

• Staff referrals

• Boosting our “people” team

• Putting in place inclusivity practices for hiring

• Working to expand our advisory board, and put in place a local board

We are also seeking inclusion in networks such as MIT SOLVE’s, where we can connect with peers from diverse backgrounds and disciplines as thought partners.

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23 Full-time staff

2 Part-time staff

4 Consultants

Felix Brooks-church is the inventor of Sanku’s dosifier technology that enables broad geographic coverage and accurate nutrient dosing, two key barriers to effectiveness of food fortification in developing countries. Since 2017, Felix has led the team implementing the business model in Tanzania that enables the dosifier to fortify flour for 2 million people across East Africa every day for only $0.53/person. Our Board Chair, David Dodson, is a successful entrepreneur and professor at Stanford’s Graduate School of Business who co-Founded and ran Project Healthy Children for 10 years. Sanku’s Country Manager, Nicholas Fernandes, is an experienced Tanzanian operator who scaled his last company across sub-Saharan Africa, overseeing a team of 100 staff. The leadership team also includes Sanku’s CFO, Mary Chowning, a former partner at Arthur Andersen with 30 years of broad-based finance experience, serving as the CFO and COO of large multinationals. Anne Wanlund is the Head of Impact and Strategy, who has led multi-million dollar nutrition projects across East and West Africa and formerly led operations for Sanku during a high growth period. Our talented local team of food scientists, nutritionists, engineers, and marketing experts provide the inspiration, feedback, drive, and creativity to fuel our field operations and improve the quality of our work.

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

While we equip millers with the tools to fortify, we also support them with basic business development services. This makes us a valuable partner, as we identify and address constraints on their businesses, which ultimately allows them to sell more fortified flour. We provide high quality, specialized bags that they would not be able to afford otherwise. The bags look unique because they are attractive, bright, and have updated branding. This helps millers differentiate their flour on the market. We also advise them on good manufacturing practices in order to access government certifications to operate. We link them to maize markets and farmers to get better prices for raw maize. We provide these services for free, and charge market prices for the bags we sell them (bundled with premix). These are all ways in which we improve our partner millers’ businesses, while also equipping them with the tools to fortify.

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

Ultimately, Sanku’s work with millers makes an affordable, healthy product available on the market for 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.

MIT Solve's underlying philosophy aligns with how our program has made its greatest leaps so far: Working with partners to leverage comparative advantages and expertise, and using a design-centered approach. To continue our momentum, we seek to usher in new ways of approaching the challenges we face, bring in new expertise to challenge our assumptions, understand new ways of thinking about the core problems we’re tackling, and improve the overall quality of our work. We seek to build the capacity of our team to do this work better by fostering connections with institutions who will change our perspectives, and be exposed to other cutting edge technology-based solutions. 

Our two most significant barriers to scale are funding and access to high quality talent to propel our growth. We believe that the MIT Solve network will help us to address both of these challenges. In particular, the Solve network will expose us to some of the most creative and innovative approaches -- and the people behind them -- who share our goal of improving access to healthy foods. We hope to join experts, other solvers, MIT faculty and staff, and funders who share our vision and will tackle issues around food access together.

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 space as we would have liked. We believe that building out our network will help us to recruit advisors who operate across the global food system: sustainable food access experts, technology gurus, social-impact minded engineers, and others who can help us build out a talent pool to bolster our team and help to make our decision-making and advisory bodies more inclusive and diverse.

On the value chain, we are a last mile distributor, sitting between manufacturers and our client millers. We primarily provide 3 things to our millers - the dosifier, nutrient premix, and empty flour bags. Our pricing strategy is that we do not charge for the premix and dosifier, and recover those costs through bag sales. Considered another way, we aggregate the demand of many small millers for empty flour bags and nutrient premix. Our value-add to our millers is that our scale enables us to purchase bags at more competitive rates, and to import premix and manage premix inventory for an entire population of millers (which would be impossible for a single small miller to do). 

We purchase these empty flour bags from multiple bag manufacturers in Tanzania, and then sell these to millers. As we continue to scale, we will continue to strengthen our logistics and inventory management capabilities while continuing to reduce this cost so that we can fulfill our mission and achieve sustainability. We are 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.

In 2017, Sanku began a program to address the growing population of 18 million refugees who have escaped war and are now displaced in Sub-Saharan Africa. Refugees often end up in overcrowded refugee camps where they are plagued by malnutrition, causing 100,000 child deaths annually. 

Currently, the Sanku dosifier is the only viable technology and mode of delivery available to fortify food in these refugee camps. Sanku has partnered with the World Food Programme (WFP) since 2015 to successfully provide fortified meals to over 80,000 children from the Kakuma refugee camp, located in the arid northwest corner of Kenya. Building on this successful program, in 2019, Sanku expanded its Refugee Initiative to Tanzania with WFP to reach 300,000 Burundian and Congolese refugees in Eastern Tanzania.  

Sanku’s goal is to reach 1 million refugees in 2021. In support of this goal, in March 2020 we participated in the UNHCR-led global pledge to expand services and assistance to refugees across the globe, beginning in East Africa.

2 billion people worldwide suffer from micronutrient deficiencies, which are at the root of 30% of all maternal deaths. 50% of pregnant women suffer from anemia, the most common and devastating micronutrient deficiency. It threatens all stages of life, from birth to adulthood. 

These young women and their children are the future of Africa and the rest of the world, but the effects of nutrient deficiencies on productivity and economies are devastating. When women are undernourished, they can’t work their fields or sell their goods in the market, resulting in lost income. Girls who are stunted are 33% less likely to escape poverty as adult women. They will never realize their full income-generating potential. Supporting nutrition is high impact and cost-effective -- every $1 invested returns $35 toward improving the nutrition of mothers and children  

 Sanku’s proven model is a powerful, scalable solution that uniquely empowers women and girls by preventing micronutrient deficiencies: Micronutrients Sanku adds to flour (iron/folate/B12) are critical for red blood cell production and for preventing iron and folate anaemia. According to the WHO, adequate nutrition can raise productivity levels by 20%. We are currently reaching 500,000 women of reproductive age with these nutrients. Our flour is the most important source of micronutrients for women who consume it, as up to 60% of calories come from maize flour in the average diet.