Stanley Zlotkin

Two-thirds of children in developing countries suffer from vitamin and mineral deficiencies—so-called “hidden hunger.” Through grassroots mothers’ groups that provide essential health education, Stan Zlotkin is building a global network for distributing “Sprinkles,” a unique form of nutrition that enables families to inexpensively fortify many different foods.

Stan produces nutritional supplements that have the potential to improve the health of tens of millions of children around the world at very little cost. In addition, by distributing these supplements through local grassroots networks, he shifts the responsibility of health provision and education back into the hands of primary caregivers. His first product, Sprinkles, enables millions of economically deprived parents around the world to gain control of their children’s nutrition during the critical first five years. Stan developed Sprinkles to overcome the infrastructure and technological constraints of other methods of delivering nutrients (syrups, drops, tablets) that have failed. They come in the form of tiny capsules, easily added to semi-solid food, which mask the bitter taste of regular supplements and are excellent conduits of minerals and vitamins. More importantly, Stan has developed a unique distribution system that restores the autonomy of mothers over the nutritional health of their children and through which they can become community health advocates.

The combination of a product that works and a local network empowering caregivers to improve the health status of their families for only 1.5 cents a day per child. Beyond the adaptation of Sprinkles, the networks are primed for ongoing health education on nutrition and other subjects. This public health innovation solves a critical challenge to child survival while laying the foundation for future healthy development.

Ensuring the early health and full development of infants and children is a critical step in aiding the economic development of poor countries. Vitamin and mineral deficiencies (VMDs) are the leading cause of arrested development in children 6 to 24 months of age, and impede cognitive and physical development, health, learning, and productivity later in life. VMDs also lead to birth defects, and blindness. Chief among these deficiencies are iron and zinc. There is evidence that iron deficiency may even impact the economy of countries by reducing their GDP by as much as 2 percent; it is the most widespread nutritional problem, impairing normal mental development in 40 to 60 percent of infants in the developing world. Zinc deficiency is common where people consume little meat or dairy and is associated with weakened immune function and an increased rate of serious infectious disease. Infants of low birth weight may be especially vulnerable to zinc deficiency, which increases the likelihood of diarrhoea and pneumonia. Among school-aged children, common symptoms of zinc deficiency include hair loss, growth retardation, and recurring infections. For women of reproductive age, both iron and zinc deficiency during pregnancy affect the mother's health, the progress of the pregnancy, and its outcome.

Until recently, there were no effective and low-cost solutions to VMDs in infants and young children in the developing world. In 1996, a group of UNICEF consultants determined that the standard iron drops were ineffective, as adherence was poor; another option, crushed tablets, were indigestible for infants. Fortification is the only strategy showing limited success, yet only for those with access to fortified foods. Targeted fortification (commercial infant cereal) is an excellent way to increase micronutrients for infants and young children, and is largely responsible for the low rates of vitamin and mineral deficiencies in industrialized countries. However, these products are expensive and may also conflict with traditional infant feeding practices. Home fortification enables families to enrich their own foods at an appropriate and safe level with needed micronutrients. The challenge has been to develop a product that is effective, and widely accessible and acceptable in a number of diverse cultural settings as a public health strategy.

Over the last ten years, Stan has piloted Sprinkles in six countries, demonstrating their technical and medical success while honing the distribution strategy and securing local production. The former task is virtually complete, with the scientific community providing consensus on the efficacy of Sprinkles. For local adaptation, Stan forms “clusters” of partnerships among private, public, local, and international institutions. For example, a cluster may include a local women’s group that acts as the implementing agency, working with UNICEF or another UN agency, and the country’s Ministry of Health. Additionally, each cluster includes a licensed private sector production partner.

The grassroots organizations that join the partnership are critical because they facilitate the cultural adaptation and implementation of Sprinkles to ensure that the concept does not remain a mere ‘import’ pre-packaged solution. These organizations form public health networks that work directly with communities to provide health education. Mothers are especially active in these networks, as the local organizations are often women’s groups. With their new knowledge of health solutions, their status as decision makers in the family and the community improves. Unlike the situation of dependency on foreign imports of fortified formula or cereal, here mothers’ autonomy over the nutrition of their children is restored.

Stan and his organization are starting distribution programs in more than 18 countries. Target countries are chosen based on four criteria: Need, population size, political receptivity to Sprinkles, and potential for workable in-country partnerships. In order to reach 50 million children worldwide by 2010, their program goals are to target the following countries for nation-wide scale-up: Indonesia (12 million children), India (20 million children), Pakistan (10 million children), and Bangladesh (7 million children). Stan has established pilot projects in each of these countries and has working ‘clusters’ in Indonesia, Pakistan, and Bangladesh.

The implementation is focused on the particular public health challenges of each setting. Since VMDs are at the root of many health problems, Sprinkles is being used to combat anaemia and rickets, to combat disease spread and malnutrition in disaster stricken areas, and to improve vision. Sprinkles have successfully moved between cultures and geographies. For example, in Mongolia, Sprinkles were proven effective in a World Vision Canada integrated nutrition program to address rickets and anaemia, a program funded by the Ministry of Health of Mongolia. To date, thousands of children in nine World Vision Area Development Programs aged 6 to 59 months have received Sprinkles. After two years, the prevalence of anaemia had decreased by 38 percent. By the end of 2005, over 400,000 children had received Sprinkles.

Sprinkles is aimed at all children at-risk for and suffering from VMD, mostly in developing countries. With a more recently developed product, SuppleFem, they are also targeting pregnant and lactating women. Another recent development, a zinc supplement, will target populations at risk for diarrhea and pneumonia. Stan’s team expects to have reached over 2 million child beneficiaries worldwide from the 18 target countries by the end of 2006. Stan owns an international company, PEDMED, which holds the patent for Sprinkles and provides local technical support; all profits are channelled back into the project.

After he barely survived a fire at age 17, Stan felt a responsibility to make his life purposeful. His first social innovation came when he created the first production and distribution of bicycle helmets in Canada. Once the market took off, Stan stepped aside and refocused on his medical career. Having trained in Nigeria, Stan knew the critical role of a strong healthy start for children. He became involved in the nutrition research and advocacy community in Canada, crafting national policy and serving as chair of the Nutrition Committee of the Canadian Paediatric Society.

Stan developed Sprinkles in the kitchen of the hospital where he was based—literally working all night after normal hospital business hours. In 1991 he made his first trip to Mongolia to observe the product at work. He witnessed the physical and emotional change in children, who transformed from lethargic and distant to talkative and full of energy. He spoke to mothers who no longer felt that their children’s survival was out of their hands. This trip reconfirmed his vision and mission, and he returned to perfect the production and design the accompanying distribution and spread strategy.