Food Fortification Program in Pakistan Rolling District Study

Midterm Report: Round-2 Survey

FFP Rolling District Study

IMPORTANT NOTICE

This Midterm Report on Round-2 survey findings (the “Report”) has been prepared by Abacus Consulting Technology (Private) Limited and Gallup Pakistan (together the “Sub-Consultant”) solely for the benefit of Food Fortification Programme Pakistan (“FFP”) implemented by Mott Macdonald (the “Consultant”). The Report is based on the follow-up survey conducted in Lahore, Rawalpindi, Hafizabad and Gujranwala districts (collectively referred to as the “Early Districts” or “Group-1” districts), and the Baseline Survey carried out in Karachi, Peshawar, Rahimyarkhan and Narowal (collectively referred to as “Mid Districts” or “Group-2” districts) during the second round of FFP Rolling District Study (the “Study”). The information was gathered through a quantitative field survey conducted during April and May 2019. The findings may not necessarily be reflective of overall national or provincial patterns.

The information contained in this Report has been prepared in good faith to assist the Consultant and the Client in assessing the collected data in the eight surveyed districts against the study objectives laid out in the terms of reference. The statements, estimates, forecasts, projections and other information in this Report may reflect various assumptions and are subject to significant business, economic and market uncertainties and contingencies, many of which are beyond the control of the Sub-Consultant. These assumptions and bases may change over time and without notice. Accordingly, no representation or warranty is made by the Sub-Consultant and there can be no assurance that such statements, estimates and projections will be realized.

This document is confidential. We do not accept any responsibility for any loss or damage whatsoever occasioned to the Client or to any other party as a result of its circulation, reproduction or use of the Report contrary to the provisions of the Important Notice.

The Important Notice also applies in its entirety to any electronic copies or information transmitted over the internet or through other media.

GLOSSARY OF TERMS AND ABBREVIATIONS

Terms and Abbreviations

“Atta”

“CAPI”

Description

Wheat Flour ground at the Chakki (defined as such for this Report)

Computer Assisted Personal Interviewing

“Chakki” Local small-scale flour mill

“Consultant” Mott MacDonald Limited

“DfID”

“DHS”

Department for International Development

Demographic and Health Survey Program

“FAO” Food and Agriculture Organization

“FFP” Food Fortification Program

“g” Gram

“GAIN” Global Alliance for Improved Nutrition

“Ghee”

Relatively cheaper palm oil-based product commonly used as alternative for edible oil

“GWA” Gujranwala district

“Halwa” Dense and sweet confection made out of flour, carrots, or semolina

“HFZ” Hafizabad district

“HIES”

Household Integrated Economic Survey

“ÏU” International Unit

“Jalaibi” Sweet, deep-fried snack made out of refined wheat flour

“Karyana” Small scale grocery retailer

“KHI” Karachi district

“Khatai” Indigenous type of biscuit made out of refined wheat flour

“kg” Kilogram

“Kulcha” Type of local bread made out of wheat flour

“LHR” Lahore district

“ltr” Litre

“Maida” Refined white wheat flour

“MQSUN”

Maximising the Quality of Scaling Up Nutrition Programmes

“mg” Milligram

“ml” Milliliter

“Naan” Type of local bread

“Namakparay” Snacks made out wheat flour

“NNS”

National Nutrition Survey

“Paratha” Bread made out of wheat flour and fried in Ghee/ cooking oil

“Pakoray”

“PBS”

“PCA”

“PKR”

“PPM”

“PSQCA”

“PTA”

“PTCL”

“PWR”

“QA”

“QC”

Piece of vegetable or meat covered in batter and deep-fried

Pakistan Bureau of Statistics

Principal Component Analysis

Pakistani Rupees

Parts per Million

Pakistan Standard and Quality Control Authority

Pakistan Telecommunications Authority

Pakistan Telecommunications Limited

Peshawar District

Quality Assurance

Quality Control

“R-2” Round-2 of FFP Rolling District Study

“RDS” Rolling District Study

“RFP” Request for Proposal

“RTK” Rapid Test Kit

Terms and Abbreviations

Midterm Report: Round-2 Survey FFP Rolling District Study

Description

“Roti” Native bread made with wheat flour

“Roller Mill” Commercial flour producing mill in the formal sector

“RWP” Rawalpindi district

“RYK” Rahim Yar Khan

“Samosa” Savory pastry made out of fine wheat flour

“SEC” Socio Economic Class

“SKUs” Store Keeping Unit

“Sub-Consultant” The Consortium of Abacus Consulting Technology (Private) Limited and Gallup Pakistan

“TV” Television

“USAID” United States Agency for International Development

“WFP” World Food Program

1. EXECUTIVE SUMMARY

1.1 Background and Context

This Report is based on Round-2 of FFP’s Rolling District Study with the objective to assess relevant aspects of the target population’s food purchase and consumption habits, awareness and perception about food fortification and food economics - primarily with reference to fortification of wheat flour and Ghee/cooking oil. The Study was carried out by the consortium of Abacus Consulting and Gallup Pakistan in accordance with the agreed terms with Mott Macdonald, Consultants to DFID for the implementation of FFP.

Round-2 of the Study covers eight districts including four ‘Early Districts’, namely Lahore, Rawalpindi, Hafizabad and Gujranwala for which a follow-up survey was conducted; and four ‘Mid Districts’ namely Karachi, Peshawar, Rahimyarkhan and Narowal for which a baseline survey was carried out. The fieldwork was conducted during April and May 2019. Round-2 includes three survey layers including Households, Retail Users and Retail Suppliers as three target respondent segments. Total respondent base for Round-2 comprises 6,607 respondents as detailed in the table below:

Table 1.1: Respondent Mix for Round-2

Key findings of the surveys conducted under Round-2 are summarized below covering analysis along two dimensions i.e. a) analysis of all eight districts covered; and b) Early Districts comparison of Round-1 and Round-2. Changes in the survey approach in Round-2 allows for a limited extent of comparative analysis.

1.2 Key Findings from the Household Survey

1.2.1 Awareness – All Eight Districts

Top-of-mind awareness about food fortification among Household respondents was recorded at 11.2%, based on an unaided question added to Round-2 survey. Households in Karachi reported the highest awareness level (22.7%), followed by Lahore (16%) and Gujranwala (14.9%). Among the foods most widely reported as first mentions at ‘Food Fortification’ by respondents indicating top-of-mind awareness, Wheat Flour (26.8%) was most frequently cited, with the highest mentions in Gujranwala (41.3%) and Hafizabad (36.7%). Ghee and Cooking Oil also found a place in the top ten mentions, albeit reported by only 3.2% and 2.8% of the respondents, respectively.

In response to a prompted question specifically asking to identify which of the six selected foods were fortified, an overwhelming majority (95.4%) considered Wheat Flour to be fortified and about 73.4% identified Ghee/cooking oil was fortified. All 100% of the respondents posed the question in Hafizabad and Narowal stated wheat flour to be fortified followed by 98.7% in Gujranwala.

TV was cited by the majority (49.1% for flour and 63.5% for Ghee/oil) of respondents as the source of information about fortification of wheat flour and Ghee1. Word of mouth through discussions heard from people was the second source mentioned (28.5% for flour and 15.4% for Ghee/oil); and Family/Friends came out to be the third largest reported source (20.8% for wheat flour and 14.5% for Ghee/ cooking oil). The most frequently recalled message from the sources of information were Good for Health (37% for flour/ 28.8% for Ghee/oil). Other messages pertained to health and wellbeing benefits, higher nutrition, added vitamins etc.

1.2.2 Awareness – Early Districts Round-1 vs Round-2

Notwithstanding the slightly different survey approaches, following findings are interesting to note:

◼ As a first mention, Flour/ Wheat Flour grew from 12.9% in Round-1 to nearly 29.9% in Round2, with Roti, generally a wheat flour product, adding another 4% in Round-2 improving from 3.6% in Round-1. However, Ghee dropped from 7.5% to 4% with Cooking Oil remaining at 1% in both rounds

◼ Ability to identify fortified foods correctly appears to have improved also: of the six foods shown to the respondents, 97% respondents considered wheat flour to be fortified in Round-2 as compared to 71% in Round-1. Similarly, Ghee/cooking oil was also seen by a greater proportion as fortified – 73% as compared to 67% in the first round. The unaided approach in Round-2 further accentuates the improvement witnessed.

◼ Comparing the sources from where the respondents got to learn about food fortification of wheat flour and Ghee/cooking oil, TV, word of mouth from people in the network, family and friends remained the top cited sources, for both products and rounds.

◼ The messages perceived by the respondent through the above information sources/media were by and large similar in both rounds for both products, being good for health, having additional vitamins, being ‘pure’ and beneficial for growth largely cited

1.2.3 Usage and Consumption for Wheat Flour - All Eight Districts

A large majority (95.4%) of respondents (regardless of their average monthly household income) indicated that they used wheat flour to prepare foods in their households.

About 36.6% of respondents from the eight districts surveyed indicated using packaged, branded commercial wheat flour which they bought from the market – either as commercially branded wheat flour (14.7%) or branded as “Chakki” flour (21.9%)2. On the other hand, nearly 62.9% reported using unbranded Chakki Atta – either getting their own wheat grain ground from the local Chakki (43.2%) or buying it from the Chakki directly (19.6%) (see table below). The more urbanized districts of Karachi, Lahore and Rawalpindi appear split nearly evenly between branded and unbranded wheat flour. Peshawar was an outlier in terms of usage of commercial branded flour, with nearly 86.1% of respondents claiming to use it. The highest proportion of households using Chakki Atta were from the four major wheat production districts of Hafizabad (94.5%), Narowal (91.3%), Rahim Yar Khan (88.2%) and Gujranwala (72.6%). See Table 1.2.

1 The appears in line with the reported 81.2% of the surveyed Households claiming to own a TV.

2 This packaged flour branded as “Chakki” is considered to be commercial brand wheat flour from the formal roller mill sector in our estimates although some local Chakkis may also be marketing their product through retail stores in the vicinity.

Table 1.2: Sourcing of Wheat Flour by Households

A sizeable proportion (43.2%) of the Households, reported getting their own wheat grains ground at local Chakki mills. These appear to have an inverse relationship with monthly household income. The largest proportion of these Households belonged to the lowest income quintile (52.8%), while the highest proportion (48.3%) of the respondents from the highest income quintile reported sourcing commercial, branded wheat flour from the market.

Collectively, the majority of the respondents (60.5%) indicated that their branded wheat flour had been procured from their respective local retail stores – either Karyana shops or general/super stores.

Top five brands purchased by Households were reportedly Punjab, Super Fine, Special, Ashrafi and Sunny, a pattern that is more or less similar to the Urban profile as well. However, brands were generally seen to have localized popularity. While a few brands found a place among the top five in more than one districts (e.g. Punjab, Super Fine, Special and Zamindar), no single universally popular wheat flour brand was identified across all eight districts. Unbranded flour was the modal response across all districts, corroborating the wide usage of unbranded Chakki Atta by Households.

Nearly 70% of the Households reported buying wheat flour in loose form, the highest (97.1%) in Hafizabad. Peshawar (79.1%) as expected indicated the highest incidence of packaged purchases.

The top reason indicated by 48.5% of the Households for their brand choice was it being good for health – widely cited by respondents across all eight districts. Interestingly, about 3.3% of the respondents also indicated the brand being fortified as a major reason behind their choice – reported mainly in Hafizabad, Rahim Yar Khan and Lahore.

Wheat flour enjoyed a high level of product loyalty with 89.3% of the Households reporting not to have switched brands in the last one year. For the 7.7% who reported switching health benefits was the most widely cited reason:

The quantity of wheat flour last purchased by households across all eight districts averages out at 34.53 kg, with this quantity lasting for 26.24 days. So, a household consumes an average of 1.32 kg per day or about 40 kg per month. On a per capita basis this comes out to be 96.4 kg per year, using a mean household size of 4.98 members. Consumption across the five income quintiles is more or less consistent as wheat flour is a dietary staple. The per capita cost is estimated at PKR 3,359. These estimates do not include consumption through other ready-to-eat products bought directly from the market or food consumed outside home.

About 8.6% of the respondents reported that their last wheat flour purchase was not fortified. Of these, about 18.3% may be deemed as ‘Resisters’ intentionally avoiding using fortified wheat flour. Nearly 49.3% respondents, however, indicated that their last purchased wheat flour was fortified while 42.1% could not tell. It is important to note here that the spot tests conducted on a number of commercial wheat flour samples (marked and packaged as fortified) indicated that the wheat flour did not have added iron in them.

A study of consumption by various selected members of the household, of six widely consumed wheat flour-based products was added in Round-2 Study. This included the consumption patterns of Kulcha/Naan/Roti, Sliced Bread, Khatai/Biscuit, Rusk, Halwa and Paratha by household members including Respondent herself (most likely to be an adult woman of reproductive age), Adolescent Girl (10 – 14 years), Child under 5 years, and an Adult Male. Kulcha/Naan/Roti had been most widely consumed product category at home in the previous 24 hours, followed by Paratha, Khatai/Biscuit, Sliced Bread, Rusks and Halwa, with the pattern being more or less similar across districts and income quintiles with slight differences in ranking.

Kulcha/Naan/Roti were being predominantly prepared at home3 along with Paratha and Halwa; however Sliced Bread, Khatai/Biscuit and Rusk are being generally sourced from the market. Usage of food items bought directly from the market rather than prepared inhouse indicates that wheat flour consumption by the households is being supplemented by these ready-to-eat products from the market. This practice is fairly common across all five quintiles. However, the pattern of consumption varies from one household member to the other. Incidence of consumption of the six food items by each of the selected household members is summarized in the table below:

Quantity of consumption of the six food items by the household members in the past 24 hours, were weighted against the consumption frequency to arrive at the average daily consumption of these foods by the members reported to have consumed them. Consumption is summarized in the table below:

3 Note: The category ‘Kulcha/Naan/Roti’ covers all types of local breads including ‘Chapatti’ or ‘Roti’ generally made at home.

Table 1.3: Summary of Incidence of Consumption of Selected Food Items by Household Members in Last 24 Hours (U12a)

Table 1.4: Average Consumption by Household Members Having Consumed Selected Food Items in the Past 24 Hours (U12b & U12c)

A comparison of average consumption of the six wheat flour-based products by household members, taking into account all three consumption parameters - the Incidence, Frequency and Quantity of Consumption - is provided in the table below, keeping the Adult Male as the control variable.

Table 1.5: Average Consumption Comparison of Household Members

1.2.4 Usage and Consumption of Wheat Flour – Early Districts: Round-1 vs Round-2

An overall decline in Chakki Atta was reported from 72.9% in Round-1 to 67.1% in Round-2. In Round2, 67.1% respondents reported using unbranded Chakki Atta i.e. either buying flour directly from Chakkis (19.2%) or grinding own grains at the local Chakki mills (47.8%). In the previous round, about 72.9% households had indicated using Chakki Atta i.e. 26.3% buying from Chakki and 46.6% grinding their own wheat grain.

A significant increase in proportions consumed of commercial wheat flour (including branded commercial flour and packaged, branded Chakki flour) was witnessed across all Early Districts (except Hafizabad) from 27.1% in Round-1 to 32.6% in Round-2. A major change is also witnessed within the branded commercial wheat flour segment with households shifting from the more refined flour variety to branded Chakki flour, both reportedly being produced largely by the organized, roller mill sector. Branded Chakki flour appears to be gaining popularity and becoming the preferred alternative to both branded commercial flour and unbranded Chakki Atta, a trend visible across all income quintiles.

The top five brands of wheat flour in the first round were also among the top in the second round (i.e. Punjab, OK/OK, Zamindar, Islamabad, Sunny), with changes in the ranking order. However, a huge majority of the brands identified during the survey appear local to a narrow geography. Most cited reasons for brand choice remained largely the same across the two rounds, with ‘health benefits’ clearly in the lead.

The consumption of wheat flour in the Early Districts in Round-2, based on the quantity of wheat flour used at home, is estimated at 81.2 kg per capita per year; as compared to the range-based consumption estimate of 72 – 96 kg in Round-1. Average cost per unit in Round-2 was PKR 36.60/ kg with per capita cost estimated at PKR 2,972; while in Round-1 it was estimated in the range of PKR 1,922 – 3,840.

1.2.5 Usage and Consumption for Ghee/ Oil - All Eight Districts

All respondents in Round 2 have indicated using cooking oil, Ghee or both equally to prepare food at their households across all eight districts.

Ghee was used more often than oil for cooking by households across all districts except Karachi. Karachi stands out with the highest (71.6%) proportion of households using cooking oil, as well as both Ghee and cooking oil equally (18.7%). On the other side of the scale, Households in Hafizabad use the most Ghee with an overwhelming 88.9% indicating it. An inverse relationship between income and Ghee and a directly proportional relationship between income and cooking oil can be seen based on consumption by income quintiles.

Kulcha/ Naan/Roti Sliced Bread Khatai/ Biscuit Rusk Halwa Paratha

Nearly 98.4% respondents in Round-2 indicated that they had sourced their last purchased Ghee and/or cooking oil from the market. Sufi and Dalda overall appear to be the two most favored brands last purchased by Households, both being favored more by urban households as compared to rural, and remained predominant across all five income quintiles. Much like wheat flour, being good for health was cited as the primary reason for brand selection.

Ghee/cooking oil enjoyed a high brand loyalty among households with nearly 82.4% of the respondents indicating not to have changed brands in the past one year. For the 14.2% who switched to their current brand during the last year, the product being of a better quality was quoted most frequently (25.4%), followed by it being good for health (22.8%).

The average quantity of Ghee/cooking oil purchased across all districts comes out to 3.98 kg (or liters), with this quantity lasting the household for an average of 17.25 days. Average daily consumption per household is thus estimated at 0.23 kg (or liter) or 7 kg (or liter) per month. On a per capita basis this comes to about 17 kg (or liters) per year using a mean household size of 4.98 members. The per capita consumption cost is estimated at PKR 2,805. These estimates do not include Ghee/oil consumed through ready-to-eat products purchased directly from the market or foods consumed outside home.

About 7% respondents indicated that the brand of Ghee/cooking oil last purchased by them was not fortified. Out of these, about 26.6% may be deemed as ‘Resisters’ as they appear to be intentionally avoiding purchasing fortified Ghee/cooking oil. 51.1% stated that their last purchased wheat flour was fortified, with 42% indicating they did not know.

1.2.6 Usage and Consumption for Ghee/ Oil – Early Districts: Round-1 vs Round-2

All Households in the Early Districts reported using cooking oil, Ghee or both across all four Early Districts in both rounds.

Nearly 98.2% of respondents in Round-2 indicated that they sourced the Ghee/cooking oil from the market, as compared to 98.9% in the first round.

Cooking oil consumption is seen to increase in proportion across all Early Districts except Lahore where it remained consistent; while at the same time a reduction in Ghee usage is seen across all districts except Rawalpindi. In Rawalpindi Households appear to have become more discerning, reporting either Ghee or cooking oil in the second round, rather than both like in the first round.

The top brands remain the same in both rounds (Sufi, Dalda, Kashmir, Shaan, Sawera, Sadiq) in the Early Districts, with a slight change in ranking - however Sufi retained the top position in both rounds followed by Dalda. Being good for health remained the top reason for brand choice in both rounds. Brand loyalty declined slightly with brand switchers increasing from 9.2% to 15%, perhaps due to the significant increase in market prices over the year, although the most cited reason was quality followed by price.

Per capita consumption of Ghee/cooking oil across Early Districts is estimated at 15.58 kg (or liters) per year in Round-2, while in Round-1, the estimated annual consumption ranged between 14.4 – 24 kg (or liter). Per capita cost of consumption is estimated at PKR 2,579, compared to PKR 1,802 – 3,600 in Round-1

1.2.7 Attitude and Perception – All Eight Districts

Mostly, respondents were unaware of people suffering from malnutrition or uncertain about it - less than 20% of the respondents actually knew of people within their social circle who may be suffering from a nutritional deficiency, with 33.8% being uncertain. 6

Respondents were asked to rate their response on a scale of 1 to 5 against a number of questions pertaining to their attitude and perception towards food fortification (with 5 indicating strength and 1 indicating weakness of response) after they were read out an explanatory statement briefly describing the idea of Food Fortification. The responses indicate a generally positive perception and attitude towards food fortification across all districts and income segments, with rural respondents indicating a greater appreciation than urban. About 75% of all households indicated that the idea of food fortification was a plausible one – including 55.4% strongly agreeing with the statement and 19.2% agreeing generally. About 81.3% thought that food fortification had major health benefits with 82.7% agreeing that it could be effective in improving the health of the entire family. However, only 57.5% of the households indicated that fortified foods were easily available in the market and even less (48.8%) indicated that related information was easily available. Interestingly, about 76% of all the respondents expected the taste of fortified foods to be different than unfortified foods and 71.7% thought even the appearance could be different.

Nearly 80% of all respondents stated that they would switch to fortified foods if those were available in the market alongside their unfortified alternatives, with 61.6% indicating a strong preference. Narowal respondents indicated the highest preference (85.6%) for fortified foods among all districts and Rawalpindi reported the highest aversion (10.6%). Health benefits were by far the most cited advantage across all districts. There was some variance in ranking of benefits across the surveyed districts, however most reasons may be linked to health benefits and prevention of illness.

1.2.8 Attitude and Perception – Early Districts: Round-1 vs Round-2

A significant improvement in attitude and perception regarding fortified foods was witnessed in the Early Districts, over the year – across most studied parameters including the plausibility of the idea, health benefits, effectiveness for the entire family’s health and the intention to switch to fortified foods. There was a deterioration, however, in the perception that information on fortification was easily available. Also, the confusion about the taste and appearance of fortified foods being different from unfortified alternatives is seen to persist over the two rounds: Nevertheless, in the ultimate test Households indicating shifting to fortified alternatives if available increased from 77% to 80% in Round-2, with the ratio of strong agreement growing from 34% to 65%.

Figure 1.1: Attitude and Perception about Food Fortification (Round-1 vs Round-2)

1.2.9 Price Perception and Sensitivity– All Eight Districts

WheatFlour

About 69.6% of the Households thought that fortified wheat flour was priced at more than the unfortified product. They demonstrated a relatively low level of price sensitivity:

◼ 78.5% Households indicated their willingness to purchase fortified wheat flour even at a cost higher by PKR 1 per kg than the unfortified alternative

◼ 85.2% indicated their willingness to buy if the price differential was reduced to PKR 0.50 per kg

◼ 8.8% (‘Resisters’) remained either undecided or unwilling to buy fortified wheat flour even if the price was the same as unfortified. This proportion was the highest for Rahim Yar Khan (14.5%) followed by Gujranwala (13.3%); and lowest for Lahore (4.3%).

Ghee/CookingOil

More than 77% of Households considered fortified Ghee/cooking oil to be priced higher than the unfortified alternative. They demonstrated a lower level of price sensitivity in this case:

◼ 81.6% Households indicated their willingness to buy fortified Ghee/cooking oil even if it was priced PKR 1/kg (or liter) higher than the unfortified version

◼ 86.4% indicated their willingness to buy if the price differential was reduced to PKR 0.50 per kg (or liter)

◼ 7.4% (‘Resisters’) remained unwilling or undecided even if the price was the same. This ratio was once again the highest for Rahim Yar Khan (12.9%) and the lowest for Lahore (4.5%).

1.2.10 Price Perception and Sensitivity – Early Districts: Round-1 vs Round-2

In terms of price sensitivity, Households in the Early Districts appear to have become slightly less price sensitive towards fortified wheat flour as well as Ghee/cooking oil, over the past one year. Furthermore, the proportion of Resisters has also declined for both products – for wheat flour more than Ghee/oil.

Table 1.6: Price Sensitivity Towards Fortified Wheat Flour and Ghee/Cooking Oil - Early Districts (Round-1 vs Round-2)

1.2.11 Communication – All Eight Districts

Most of the Households surveyed had never heard or seen any promotion about fortified wheat flour (67.7%) or Ghee/cooking oil (64.5%), with the Households in Hafizabad having the least recall for both products. Peshawar and Rahim Yar Khan also appeared to be among the least aware about such promotions. On the other hand, Narowal respondents reported the highest exposure for both wheat flour (45.7%) and Ghee/cooking oil (53.5%) claiming to have experienced at least some level of promotional activity related to fortified wheat flour or Ghee/cooking oil.

1.2.12 Communication – Early Districts: Round-1 vs Round-2

The section on Communication was considerably curtailed in Round-2, with the questions in both rounds not being directly comparable.

1.3 Key Findings from the Retail User Survey

1.3.1 Awareness – All Eight Districts

On being asked what food product came to mind first when Food Fortification was mentioned, Roti (33.6%) and Wheat Flour (25.6%) were by far the most frequently cited responses by Retail Users. Wheat (2.7%) and Naan (2.5%) also found a place among the top ten mentions. Ghee and Desi Ghee were mentioned only by 1% of the respondents each, with cooking oil mentioned by less than 0.5%.

In response to a prompted question specifically asking to identify which of the six selected wheat flourbased foods products were fortified, Roti (90.4%) was universally recognized as fortified, followed by Paratha (62.9%) and Kulcha/Naan (53.2%).

Word of mouth through discussions heard from people (31.6%) was cited as the main source of information about food fortification by Retail Users, followed by TV (27.2%). The message mentioned by most respondents over all was that it prevented illness (31.3%). This may be seen to support the ‘Good for Health’ message perceived by the Households.

1.3.2 Usage and Consumption – All Eight Districts

Retail Users overall indicated sourcing their wheat flour supply mostly from retailers (42.2%), however a difference in pattern was observed across more urban and rural districts. Flour mills were reported as a major source of supply for urban respondents (26.2%) with 32.5% sourcing their flour supply from retailers, while rural respondents depended primarily on retailers (54.7%) rather than flour mills (15.9%). Wholesalers and distributers were also cited as important sources.

The top five brands in use overall included 3 Share, OK/OK, Punjab, Muslim and Zamindar, among a large number of locally popular brands. The unbranded product was reported in considerably lower quantum than Households as a negligible percentage sourced their supply from Chakkis, with the exception of Karachi where 33.5% of the Retail Users reported usage of unbranded wheat flour.

A majority of the Retail Users consumed fine flour (53.9%), a relatively finer version of wheat flour, followed by regular wheat flour (26.7%). Maida or refined wheat flour was reported by 19.4%.

About 87.6% of the Retail Users reported buying packaged wheat flour, the highest in Peshawar (97.4%). Labels on about a third of the packages (33.5%) provided for inspection had some mention of the product being fortified, either in writing or logo. The top reasons cited for brand selection were quality (62.7%), availability (34.4%) and purity (27.2%). The wheat flour being fortified was also quoted by 7.6% of the respondents, mainly from Karachi (20%) and Gujranwala (10.8%). Brand loyalty was less among Retail Users than Households, with 13.4% having switched brands over the year as compared to 7.7% by Households. Better quality and ease of availability, both in terms of time and quantity, were cited as reasons for the switch.

The highest selling products at the Retail Users’ outlets were Roti (63.9%) followed by Kulcha/Naan (27.4%), Samosa (16.3%), Paratha (8.2%) and Khatai/Biscuit (4.2%). The wide consumption of Roti and Kulcha/Naan (commonly consumed as substitutes) indicates the staple nature of the items.

Average annual consumption was calculated at about 8,579 kg per outlet, with an average annual cost of PKR 333,245.

About 7.6% of the respondents indicated that they were not using fortified wheat flour, which is consistent with 8.6% reported by the Households. Of these, about 22.6% may be considered as intentionally avoiding the fortified alternative, and therefore termed as ‘Resisters’.

1.3.3 Price Perception and Sensitivity – All Eight Districts

Around 65.8% of the Retail Users considered fortified wheat flour to be priced higher than unfortified. While a relatively low level of price sensitivity was seen, they were still more price sensitive than the Households:

◼ 74.8% of the Retail Users indicated their willingness to purchase fortified wheat flour even at a cost higher by PKR 1 per kg than the unfortified alternative

◼ 80.6% indicated their willingness to buy if the price differential was reduced to PKR 0.50 per kg

◼ 12% (‘Resisters’) remained either unwilling or undecided even if fortified wheat flour was priced at par with unfortified. The highest proportion of these were in Gujranwala (19.1%), followed by Rahim Yar Khan (17.8%); while the lowest were in Hafizabad (4%) followed by Narowal (5.3%).

1.3.4 Communication – All Eight Districts

Most respondents (68.6%) overall indicated that they had never heard or seen any promotion about fortified wheat flour or related products, much like the Households. Lahore appeared to be the least aware of such promotions (82.1%) while Karachi reported to be the most aware with 49% claiming to have been exposed to at least some level of fortified wheat flour related promotion. The most frequently cited communication channels through which they had seen or heard of the promotion were word of mouth (35.8%) and TV (35.2%).

About 60.2% of the respondents indicated that their purchase decision could be moderately or strongly influenced by the promotions they saw or heard, with Retail Users in Narowal appearing to be the most strongly influenced and from Peshawar the least influenced by promotional activity.

1.4 Key Findings from the Retail Supplier Survey

1.4.1 Awareness – All Eight Districts

The highest overall first mention against ‘Food Fortification’ by Retail Suppliers, was Wheat Flour (33.2%), followed by Roti (15%). Ghee was mentioned by 4% and Cooking Oil by 3.3% of the Retail Suppliers.

On being asked to identify if the six selected wheat flour-based products were fortified, a vast majority perceived Roti (90.8%) to be fortified, followed by Paratha (63.8%) and Kulcha/ Naan (42.9%).

1.4.2 Awareness – Early Districts: Round-1 vs Round-2

While a direct comparison between the two rounds may not be possible due to changes in approach, it is worth noting that both Flour and Ghee were among the top 5 mentions in both rounds in the Early Districts overall. Also, first mentions of Flour grew from 20.7% to 41% in Round-2 even without the aid of an explanatory note (as in Round-1). Ghee’, however, lost its standing significantly over the year from 23.7% in Round-1 to 6.2% in Round-2.

1.4.3 Availability of Wheat Flour – All Eight Districts

A total of about 243 brands of wheat flour were reported to be in stock at the Retail Suppliers surveyed across the eight districts during Round-2. Wheat flour in loose form was available at 423 (54%) retail outlets out of the 780 having wheat flour in stock.

Punjab, Classic, Islamabad, OK/OK and Zameendar were the top five brands in stock overall. The findings show that the top brands in stock (with the exception of ‘Punjab’) were not necessarily the brands enjoying high visibility. A bias towards smaller, highly localized brands was observed.

Wheat flour was available in a variety of package sizes ranging from 1kg, 5kg, 10kg, 20kg to bulk packs of 40kg, 50kg and 80kg - in addition to being sold in loose form in the quantity required by the customer.

Rates ranged from PKR 32 to PKR 57 per kg, with an average of PKR 39.45 and a modal rate of PKR 40 per kg.

1.4.4 Availability of Wheat Flour – Early Districts: Round-1 vs Round-2

The top three brands in stock in Round-1 were also the top three in the second round, albeit with a different ranking – Zameendar ranked first in Round-1 but Punjab ranked first in Round-2.

The package sizes being marketed in both rounds remained the same except an additional bulk size of 80 kg was also found in stock in Lahore during Round-2.

Despite increase in inflation and a rise in wheat flour prices reported by PBS, average retail rates of brands in stock recorded a decline in the second round, with the modal rate decreasing to PKR 37.50 from PKR 40, and the average rate also down to PKR 39.50 from 39.80 per kg. This may be pointing towards an increasing tendency among retailers to stock a larger proportion of cheaper brands

1.4.5 Availability of Ghee– All Eight Districts

A total of about 111 different brands of Ghee were identified in stock with the Retail Suppliers interviewed across the eight districts in Round-2. Ghee was also available in loose form at 116 retailers out of 1,162 (10%) having Ghee/cooking oil in store at the time.

Sufi, Dalda, Kiran, Sadiq and Kashmir were the top five Ghee brands in stock overall. Dalda was ubiquitous in that it found a place among top five across all geographies barring Hafizabad. Major brands appeared to enjoy significant share of market and retail shelf space, as well as retail visibility.

A large variety of package sizes was available for Ghee but the most common sizes ranged from 250g, 500g, 1kg, 2.5kg, 5kg to bulk sizes of 10kg, 12kg, 15kg and 16kg. However, some brands were available in as small a size as 100g and 125g.

Rates ranged from about PKR 100 to PKR 260 per kg with an average of PKR 157.27 and a modal rate of PKR 160 per kg.

1.4.6 Availability of Ghee– Early Districts: Round-1 vs Round-2

The top-5 composition of brands in stock (Sufi, Dalda, Sadiq, Kashmir and Shaan) remained similar in the two rounds across the Early Districts with the change mainly seen in the rankings. After Sufi, Sadiq replaced Dalda as number two in Round-2.

The package sizes being marketed in both rounds remained the same except an additional minipack of 125 g was identified in Round-2.

A slight increase in average retail price was recorded over the period among the Early Districts, with the average rate per kg being PKR 161.42 in Round-2 as compared to PKR 161 in Round-1. An increasing trend in both mean and modal rates was seen across all districts except Hafizabad, where the average rate declined significantly, diluting the total average down for all Early Districts.

1.4.7 Availability of Cooking Oil – All Eight Districts

During the Round-2 survey in eight districts, 81 brands of cooking oil were identified to be in stock at the Retail Suppliers. Oil was also sold in loose form at 94 (8%) of the 1,162 retailers interviewed who had Ghee/cooking oil in store at the time.

Much like the Ghee market, in the cooking oil segment too, Dalda extended its presence beyond boundaries to all territories surveyed with 22% of the Retailer Suppliers interviewed stocking Dalda cooking oil. The top five brands overall with the highest share of retailer shelf space include Dalda, Sufi, Meezan, Kiran and Shaan.

A variety of package sizes for cooking oil was available at the Retail Suppliers commonly ranging from 500ml, 1 liter, 2.5 liters, 3 liters, 4.5 liters, 5 liters and bulk sizes of 10 liters, 12 liters, 15 liters and 16 liters. Minipacks of 100ml and 250ml were also stocked by a few retailers.

The rate per liter ranged from about PKR 110 to PKR 270 with an average of PKR 176.03 and modal rate of PKR 170 per liter of cooking oil.

1.4.8 Availability of Cooking Oil – Early Districts: Round-1 vs Round-2

The top three brands of cooking oil stocked by Retail Suppliers in the Early Districts were the same in both rounds with no change in the ranking either: Dalda, Sufi and Shaan.

Cooking oil was mostly available in package sizes ranging from 500ml to 5 liters, however in Round-2 additional packaging of 250ml and bulk sizes of 10, 12 and 16 liters were also identified in stock.

Average rate increased significantly in Round-2 from PKR 165.4 per liter to PKR 174.85, a trend observed across all Early Districts.

1.4.9 Price Perception and Sensitivity– All Eight Districts

WheatFlour

Nearly 73% of the Retail Suppliers indicated that fortified food products were priced higher than unfortified ones. They regarded their customers to be more price sensitive than indicated by the Households:

◼ 60% of the Retailer Suppliers suggested that their customers would be willing to buy fortified wheat flour if priced at PKR 1 per kg higher than the unfortified product.

◼ 70.8% suggested that their customers would be willing to buy if the incremental price increase was PKR 0.5 per kg

◼ 15.5% expected their customers would remain undecided or unwilling to switch to fortified wheat flour even if the price remained at par with the unfortified version

Ghee/CookingOil

As in the case of wheat flour, Retailer Suppliers considered their customers to be more price sensitive than the Households themselves indicated:

◼ 63.3% of the Retail Users indicated that their customers would be willing to purchase fortified Ghee/cooking oil if the product was available at an incremental price of PKR 1 per kg.

◼ 73.6% suggested that their customers would be willing to buy if the incremental price increase was PKR 0.5 per kg

◼ 13.3% expected their customers would remain unwilling or undecided to make the switch to fortified oil/Ghee, even if it were available at the same price as the unfortified product

1.4.10 Price Perception and Sensitivity – Early Districts: Round-1 vs Round-2

The Retail Suppliers’ perceived price sensitivity of their customers towards both fortified wheat flour and Ghee/cooking oil was seen to increase significantly in Round-2 as compared to Round-1. This is in contradiction to the decline observed in the price sensitivity of Households as proxy of consumers.

On the other hand, more than 17.4% of the retailers surveyed in Round-2 opined that the customers may not buy fortified wheat flour even if it was available at the same price, an increase from 14.9% in the first round indicating an anticipated rise in the Resisters. However, for fortified Ghee/cooking oil, Retail Suppliers’ assumption on the ratio of Resisters declined from 14.1% to 12.2% in Round-2.

1.5 Product Sample Test Results

1.5.1 Wheat Flour Testing

A two-tier testing approach was adopted during Round-2 for wheat flour, that is spot testing of branded commercial flour at respondent premises through Rapid Test Kits (as the first step); and lab testing of samples found to be fortified through RTK to measure added Iron content (as the second step)

Only two out of 3,342 samples tested across eight districts through RTKs were validated as fortified with 45 yielding ambiguous results. Against a target of 200 samples of wheat flour, only 47 could be tested at the laboratory, out of which only one was found to be adequately fortified.

A massive decline in the ratio of wheat flour samples being fortified was seen over the two annual rounds: from nearly 13% to about 0% in Round-2.

1.5.2 Ghee/Cooking Oil Testing

A total of 201 samples were collected against the target of 200 for testing at the laboratory for vitamin A content. According to the lab reports, 82.1% of the samples tested were found to be adequately fortified.

A decline in the ratio of Ghee/cooking oil samples being fortified was observed, from 100% in Round-1 to 91.1% in Round-2.

2. BACKGROUND AND CONTEXT

The Consortium of Abacus Consulting Technology (Private) Limited and Gallup Pakistan (the SubConsultant“) was formally engaged by Food Fortification Programme Pakistan (“FFP” or the “Consultant”) on Dec 21, 2017 to conduct a Rolling District Study (the “Study”) through primary consumer surveys in 8 districts. The main objective of the Study is to determine if, and to what extent, the poor households are benefiting from the initiatives taken by FFP. It undertakes to assess the baseline and impact of FFP’s food fortification projects among target population segments in the 8 test districts, through their food purchase and consumption patterns, knowledge and perceptions, usage patterns and price perception of fortified wheat flour and Ghee/cooking oil. The Study comprises three rounds of research study to be conducted over a period of 3 years. This document is the first Midterm Report covering the findings from 8 test districts selected for Round-2 of the Study. The Report should be read in conjunction with the Research Design and Sampling Framework report annexed to this document as Annex-1, along with the questionnaires used for the Household (Annex-2), Retail User (Annex-3) and Retail Supplier (Annex-4) surveys, as well as the detailed data tabulations for all three surveys (Annexes 5, 6 and 7, respectively). Test results as reported by Qarshi Laboratories on Added Iron in Wheat Flour and Vitamin A in Ghee/ Cooking Oil have been appended as Annex 8 and 9 to this Report, respectively.

Round-2 of the Study covers 8 districts including 4 Early Districts namely Lahore, Rawalpindi, Hafizabad and Gujranwala and 4 Mid Districts namely Karachi, Peshawar, Rahimyarkhan and Narowal. Round-2 includes a follow-up survey for Early Districts and a baseline survey for the Mid Districts. Narowal has been a recent addition replacing the earlier selected district of Shangla where the field survey had to be discontinued as a result of security and operational issues. Dates for completion of key activities are provided in Table 2.1 below.

Table 2.1: Activity Timelines

Activity Completion Date

Amendments in Round-2 and signing of Revised Contract

Approval of questionnaire

Submission of Research Design and Sampling Framework

Field Trainings

Fieldwork (7 districts: Lahore, Rawalpindi, Hafizabad, Gujranwala, Karachi, Rahim Yar Khan, Peshawar)

Shangla dropped as the 8th district and Narowal selected as replacement

Cleaning and sorting of collected data for 7 districts

Fieldwork for Narowal

Data Tabulation for Analysis – Early Districts

Data Tabulation for Analysis – Mid Districts

Submission of Draft Mid-Term Report

Submission of Final Draft Mid-Term Report

Submission of Final Mid-Term Report

Mar 4, 2019

Mar 27, 2019

Mar 27, 2019

Apr 1 - 2, 2019 (Islamabad)

April 3 – 4, 2019 (Lahore)

April 8 – 9, 2019 (Karachi)

Apr 8 - May 16, 2019

May 17, 2019

May 8 – 17, 2019

May 20 – 30, 2019

May 13, 2019

May 19, 2019

May 30, 2019

June 29, 2019

Sep 24, 2019

In addition to the four new Mid Districts, Round-2 also incorporates a number of changes in the research design and structure as compared to Round-1, however the most significant differences include addition of a third survey layer of Retail Users (Naan shops and bakeries) to assess usage at this level; spot testing for commercially produced wheat flour at user level to ascertain the sample’s fortification before sending it for quantitative analysis to the lab; and addition of the ‘Household Characteristics and Assets Module’ for data analysis by FFP in line with the FACT survey.

2.1 Methodology

The approach and methodology adopted to undertake the Study has been detailed in the Inception Report already submitted. A high level plan for conducting Round-2 of the Study is presented in Figure 2.1.

2.2 Respondent Base

The target sample size was 4,000 for Households, and 1,200 each for Retail Users and Retail Suppliers, against which a respondent base of 4,152, 1,221 and 1,234 was achieved, respectively, in line with the agreed sample design. Respondent profiles based on sample allocation for all three Household, Retail User and Retail Supplier modules are provided below based on key segmenting factors.

2.2.1 Household Module

A total sample size of 4,152 female respondents was achieved against the target of 4,000 (based on 500 respondents per district). The respondent mix and profile, based on agreed parameters and sample design, are summarized in the tables below:

Table 2.2: Respondent Mix for Household Module

Respondent profile based on category of household member and income segment, are summarized in the table below.

Table 2.3 a: Respondent Profile for Household Module – Demographics

Table 2.3 b: Respondent Profile for Household Module –Socioeconomic Status

WealthIndex

The Wealth Index, as defined by the USAID Demographics and Health Survey (“DHS”) Program, is a composite measure of a household's cumulative living standards. It makes use of data on households, such as ownership of assets, materials used for construction of houses, and types of water access and sanitation facilities available to calculate the Index.

For Round-2 of the Study, the Index has been calculated replicating the same methodology used in the DHS Wealth Index. Principal Component Analysis (“PCA”) technique is used to construct the Index. As the first step, categorical variables are created for all the variables defined to be included in the Index calculation. This is followed by generating household wealth scores using PCA at three levels:

1. Common wealth score calculated using variables common for both rural and urban areas

2. Urban wealth score calculated using variables relevant for urban areas only

3. Rural wealth score calculated using variables relevant for rural areas only

This is followed by carrying out a regression of the urban and rural wealth scores on the common wealth scores to obtain relevant parameters to estimate the composite wealth score. Once the composite wealth scores are generated for each household, households are divided into five quintiles to match the five quintiles in accordance with those stated in the Household Integrated Economic Survey. Lastly, households falling in the lowest two quintiles are classified as belonging to low socioeconomic status, whereas households from the remaining three quintiles are classified into a category of ‘Other’. This variable is then used as a categorical variable to disaggregate the results for all questions in the survey by socioeconomic status. (Refer to Annex 2).

Table 2.4: Average Size of Household

See Annex-2 for the questionnaire used for the Household Survey and Annex-5 with the complete tabulated data for households collected during the survey in Round-2.

* Based on the Wealth Index. See description below.

Midterm Report: Round-2 Survey FFP Rolling District Study

2.2.2 Retail User Module

Total sample size of 1,221 retail users was achieved during Round-2 survey of FFP RDS, against the target of 1,200 (at 150 respondents per district). Respondent mix and profile as per the agreed sample design is summarized in the table below:

Table 2.5: Respondent Mix and Profile for Retail User Module

See Annex-3 for the questionnaire used for the Retailer User Survey and Annex-6 with the complete tabulated data for Retail Users, collected during the survey in Round-2.

2.2.3 Retail Supplier Module

A total sample size of 1,234 Retail Suppliers was achieved during the first follow-up survey in Round-2, against the target of 1,200 (based on 150 respondents per district), as per the agreed sample design. The respondent mix and profile are summarized in the table below:

Table 2.6: Respondent Mix for Retail Supplier Module

See Annex-4 for the questionnaire used for the Retailer Survey and Annex-7 with the complete tabulated data for retailers, collected during the follow-up survey in Round-2. 17

3. MIDTERM SURVEY FINDINGS - HOUSEHOLDS

This section covers the Midterm Survey findings for the Household module against the following key parameters:

 Awareness about Food Fortification

 Usage of Wheat Flour and Cooking Oil/ Ghee

 Attitude and Perception towards Food Fortification

 Price Perception and Sensitivity to Fortified Foods especially Wheat Flour and Cooking Oil/ Ghee

 Communication habits and access to media

A total of 4,152 respondents were surveyed across the eight districts of Lahore, Rawalpindi, Hafizabad, Gujranwala, Karachi, Rahim Yar Khan, Peshawar and Narowal. Of these, a total of 3,962 respondents (95.4%) indicated using wheat flour to prepare foods at their households, while all 4,152 reported using cooking oil, Ghee or both.

3.1 Awareness about Food Fortification

Based on the learnings from Round-1, an unaided awareness question was added to assess the Households’ top-of-mind awareness about food fortification, and only 11.2% of total respondents indicated that they were aware of the concept of food fortification. Households in Karachi reported the highest awareness level (22.7%), followed by Lahore (16%) and Gujranwala (14.9%).

Table 3.1: Top-of-Mind Awareness (A0, Unaided)

Further exploratory questions were asked only of the respondents indicating awareness about food fortification. On being asked what food product first came to mind when ‘Food Fortification’ was mentioned, the most frequently cited response was Wheat Flour (26.8%) with the highest mentions in Gujranwala (41.3%) and Hafizabad (36.7%). These were followed by Milk (21.2%), Roti (10.6%), Fruit (4.8%), and Wheat, Salt and Meat all cited by 3.7% of the respondents (see table below). It may be pointed out that Roti and Wheat are directly linked with Wheat Flour as a product and may be grouped together to obtain a more comprehensive estimation for wheat flour i.e. 41.1%. Ghee and Cooking Oil also found a place in the top ten mentions, albeit it was mentioned as the first product by only 3.2% and 2.8% of the respondents, respectively (see Table 3.2).

Midterm Report: Round-2 Survey FFP Rolling District Study

Table 3.2: First Food Item to Come to Mind when ‘Food Fortification’ was mentioned (A1, Unaided)

In response to a prompted question specifically asking about six selected foods whether they were fortified, an overwhelming majority (95.4%) considered Wheat Flour to be fortified and about 73.4% believed that Ghee/cooking oil was fortified. All 100% of the respondents posed the question in Hafizabad and Narowal stated wheat flour to be fortified followed by 98.7% in Gujranwala. Households in Karachi, Rawalpindi and Hafizabad had the highest response for Ghee/cooking oil at 89.5%, 80.6% and 80%, respectively. Rice was considered to be fortified by the least number of respondents (50.3%).

Table 3.3: Food Products Commonly Perceived to be Fortified (A3 Aided)

Respondents indicating Wheat Flour or Ghee/cooking oil in A3 above were asked about the source of this information. TV was cited by the majority (49.1% for flour and 63.5% for Ghee/oil) which is in line with the fact that 81.2% of all respondents claimed their households to own a television. Word of mouth through discussions heard from people was the second source mentioned (28.5% for flour and 15.4% for Ghee/oil); and Family/Friends came out to be the third largest reported source of information about fortification (20.8% for wheat flour and 14.5% for Ghee/ cooking oil). See Table 3.4 and Table 3.5 below.

Table 3.4: Information Source regarding Wheat Flour Food Fortification (A4)

Table 3.5: Information Source regarding Ghee/cooking oil Food Fortification (A5)

Respondents were then probed to indicate the message conveyed by the medium/information source. The top five messages indicated by the respondents were:

Table 3.6: Top Messages Conveyed on Fortification (A4a and A5a)

Gives Energy (14.2%)

Full of Nutrition (13.7%)

Additional Vitamins (11.4%)

Pure (11%)

For Better Growth (10.3%)

Additional Vitamins (19.9%)

Free of Cholesterol (13.6%)

Better Quality (8.6%)

Stronger Bones (7.1%)

Additional Nutrients (6.2%)

3.2 Early Districts Comparison on Awareness – Round-1 vs Round-2

Based on learnings from Round-1, a decision was taken not to read out the explanatory brief about Food Fortification to the respondents at the outset so as to gauge the level of unaided awareness among targeted households. Consequently, a number of awareness questions were removed from the interview. Analyzing the survey results for Early Districts in Round-1 and Round-2, we have the following observations:

3.2.1. Difference in Approach

A direct comparison of the Awareness section between the two rounds may not be drawn primarily due to the aided and unaided question structures in the two rounds. The approach adopted in Round-2, however, appears to be a more accurate assessment of top-of-mind awareness levels among the target households of the Study and helps address the perception bias issue witnessed during Round-1 where an explanatory statement about Food Fortification was read out to the respondents at the outset resulting in 73.6% of the respondents indicting awareness about the concept.

Another difference to be borne in mind when analyzing this section is the respondent base which in Round-2, unlike the first round, comprises only of the respondents indicating unaided awareness about the concept of food fortification.

3.2.2. Top Food Mentions

Having said the above, it is very interesting to note the nature of food products mentioned by respondents as the first food to come to mind at the mention of Food Fortification. The mention of Flour/ Wheat Flour has grown from about 13% in Round-1 to nearly 30% in Round-2, with Roti, generally a wheat flour product, adding another 4% in Round-2 improving from 3.6% in the first round. This could potentially be due to communication drives run by FFP in the Early Districts. The general use of the term ‘Wheat Flour’ in Round-2 instead of ‘Flour’ is also telling of greater awareness among the households. While Milk has retained its significance over the two rounds remaining at around 20%, Ghee dropped from 7.5% to 4% in Round-2 with Cooking Oil remained at 1% in both rounds (and not among the top mentions). Interestingly, confusion about fruits being fortified still persists.

Figure 3.1: Top Food Mentions against ‘Food Fortification’ – Early Districts Comparison (Round-1 vs Round-2)

Awareness about Food Fortification

Awareness about food fortification and consumers’ ability to identify fortified foods correctly appears to have improved. Awareness about wheat flour fortification increased considerably in the Early Districts –97% of the respondents considered wheat flour to be fortified in Round-2 as compared to 71% in Round-1. Similarly, Ghee/cooking oil is also seen by a greater proportion as fortified – 73% as compared to 67% in the first round (see Figure 3.2 below). The findings are a result of a prompted question asked about specific food items with a key difference between the two rounds being the explanatory statement read out about ‘Food Fortification’ in Round-1, which was not done in Round-2. This indicates an understanding about fortified foods among the respondents in Round-2 prior to the survey interview, and hence accentuates the extent of improvement over the two rounds. Interestingly, the perception about salt being fortified has seen a decline over the year.

Figure 3.2: Foods Perceived to be Fortified (Prompted) (A3)

Early Districts Comparison (Round-1 vs Round-2)

3.2.4. Sources of Information about Fortification

Comparing the sources from where the respondents got to learn about food fortification of wheat flour and Ghee/cooking oil, TV, word of mouth from people in the network, family and friends are the top cited sources irrespective of the product or time period/round. The prominence of ‘TV’ in both rounds as a source of information makes sense especially when this finding is cross corroborated with responses

Midterm Report: Round-2 Survey FFP Rolling District Study

received against ownership of assets by household (added for Round 2 4), ownership of TV was reportedly fairly high universally amongst the surveyed households with nearly 81.8% of respondents indicating the same. Nearly 66.9% of respondents also indicated that their households owned cable tv/dish.

A difference in the significance of some sources, however, is interesting (see table below). TV, Family/Friends, Shopkeeper and Radio see a decline in Round-2 for both wheat flour as well as Ghee/cooking oil; while Newspaper, Social Media, Reading, School, Teacher and Billboards see an increase. This may point at changing dynamics over the year, or may simply be a result of a different profile of the respondent base.

The messages perceived by the respondent through the above information sources/media were by and large similar in both rounds for both products, being good for health, having additional vitamins, being ‘pure’ and beneficial for growth largely cited.

Table 3.7: Sources of Information regarding Food Fortification (A4 and A5)

Early Districts Comparison (Round-1 vs Round-2)

Note: Red indicates a decline from Round-1 and Green indicates an increase from Round-1

3.3 Usage and Consumption Pattern of Wheat Flour

3.3.1. Usage of Wheat Flour

A large majority (95.4%) of respondents (regardless of their average monthly household income) indicated that they used wheat flour to prepare foods in their households. Households in Rawalpindi and Gujranwala were the only two districts indicating a less than 90% usage and diluting the overall average for districts surveyed. Wheat flour is a staple food for Pakistanis, especially in the province of Punjab where nearly 80% of the country’s wheat is produced5 .

3.3.2. Sourcing and Type of Wheat Flour Used

About 36.6% of respondents from the eight districts surveyed indicated using commercial branded wheat flour which they buy from the market – either as commercially branded wheat flour (14.7%) or packaged

4 In Round-1, the survey had asked respondents to indicate the communication channels used as a source of information and 86% of respondents had claimed TV to be this source.

5 Source: Agriculture Marketing Information Service (AMIS) Directorate of Agriculture (Economics & Marketing) Punjab

Midterm Report: Round-2 Survey

FFP Rolling District Study

flour branded as “Chakki” flour (21.9%)6. On the other hand, nearly 62.9% reported using unbranded Chakki Atta – either getting their own wheat grain ground from the local Chakki (43.2%) or buying it from the Chakki directly (19.6%). It is evident from the survey results that the more urbanized districts of Karachi, Lahore and Rawalpindi are split nearly evenly between branded and unbranded wheat flour. An outlier in terms of usage of branded flour is Peshawar district, with nearly 86.1% of respondents claiming to use branded wheat flour – either in the form of commercial flour or branded Chakki flour procured from the market. Peshawar’s low wheat production and proximity to a porous border (known for smuggling of locally produced wheat and wheat flour) with Afghanistan may explain this anomaly.

Table 3.8: Sourcing of Wheat Flour by Households (U2)

The highest proportion of households using Chakki Atta were from the four major wheat production districts of Rahim Yar Khan, Gujranwala, Hafizabad and Narowal. All four districts are located in the Punjab province, and collectively account for around 12.65% 7 of the province’s wheat production. This fact makes these districts amongst the largest wheat production districts not only of Punjab, but by extension of Pakistan as well. About 94.5% of the respondents from Hafizabad mentioned that their households used unbranded Chakki Atta, with 86.7% grinding their own grain and another 7.8% buying Atta from the local Chakkis. Hafizabad is closely followed by Narowal in the use of non-branded, Chakki Atta with 91.3% respondents including 80.7% grinding their own grains at the Chakki and 10.6% buying unbranded Atta from the local Chakki mills.

The predominant reliance by Hafizabad and Narowal on Chakki Atta, despite being smaller wheat production districts than Rahim Yar Khan, may be down to the fact that Rahim Yar Khan is a significantly larger and relatively more developed district than the other two, with greater access to industrial and commercial infrastructure including large scale wheat flour roller mills. Hafizabad and Narowal are smaller, less developed districts. The population of Hafizabad and Narowal stand at about one-quarter and one-third of Rahim Yar Khan’s, respectively8, therefore sourcing through local Chakkis may be more convenient9. Rahim Yar Khan closely follows Narowal in the proportion of households

6 This packaged flour branded as “Chakki” is considered to be commercial brand wheat flour from the formal roller mill sector in our estimates although some local Chakkis may also be marketing their product through retail stores in the vicinity.

7 Statistical Pocket Book of Punjab 2018

8 Source: Census 2017

9 Chakkis are reported to be relatively small sized/local operations (even in larger cities such as Lahore), and are generally

Midterm Report: Round-2 Survey FFP Rolling District Study

using Chakki Atta (88.2%) where 67.8% grind their own grains while 20.4% buy it from the Chakkis. Gujranwala comes in fourth with 72% of the total households buying Atta from the Chakkis (16.6%) or grinding own grains (55.8%).

Commercial wheat flour usage recorded between 49% to 50% among households in the more urbanized districts of Karachi, Lahore and Rawalpindi is in line with previous studies such as GAIN10

A sizeable proportion (43.2%) of the respondents surveyed in Round-2, reported getting their own wheat grains ground at local Chakki mills. The largest proportion of such households belonged to the lowest income quintile (52.8%), which by definition have a monthly household income of less than PKR 20,000. In the case of commercial branded flour, the highest proportion (48.3%) of the respondents from the highest income quintile (monthly income more than PKR 34,000) reported to be sourcing commercial, branded wheat flour from the market (i.e Chakki branded wheat flour plus regular commercial brands). Commercial wheat flour usage remained above 40% in four quintiles, with only the lowest quintile reporting usage of about 30%.

Households procuring Chakki brand wheat flour from the market remained more or less consistent around 23% to 26% across all income segments except the lowest quintile with less than 18%. We understand that Chakki brand commercial wheat flour may generally include wheat flour marketed by the roller mills, however local Chakkis may also be marketing their product through retail stores in the vicinity. The greatest proportion of sourcing Chakki branded wheat flour has been reported in Peshawar. Respondents from Karachi, Lahore and Rawalpindi too have indicated higher than mean value for sourcing of Chakki brand wheat flour.

Figure 3.3: Sourcing of Wheat Flour by Household Incomes (U2)

This brief explanatory note on the section is being provided for clarity of understanding on the four categories of wheat flour discussed herein based on their sourcing, and their classification in our estimates and analysis:

a) Grind own grains at Chakki Wheat flour obtained through grinding grains (either from self-grown or purchased wheat) at the local Chakkis

servicing local area needs.

10 Source: Punjab Large-scale Wheat Flour Fortification Project - Punjab, Pakistan Wheat & Wheat Flour & Fortification Supply Chain Study’, September 2014, Global Alliance for Improved Nutrition (GAIN)

Atta. Not considered as commercial brand wheat flour from the formal roller mill sector

Midterm Report: Round-2 Survey FFP Rolling District Study

Category Description

b) Buy unbranded Atta from Chakki Wheat flour purchased directly from the local Chakkis (deemed to be unpackaged and unbranded)

c) Buy commercial brand flour from market Wheat flour purchased from the market as a packaged and branded product

d) Buy Chakki brand flour from market Wheat flour purchased from the market, packaged and branded as a Chakki brand

Classification

Chakki Atta. Not considered as commercial brand wheat flour from the formal roller mill sector in our estimates

Considered to be commercial brand wheat flour from the formal roller mill sector in our estimates

Considered to be commercial brand wheat flour from the formal roller mill sector in our estimates*

* In our analysis we have grouped together categories a) and b) as unbranded Chakki Atta and categories c) and d) as branded commercial flour. It may be pertinent to mention here that category d) may not comprise wholly of the roller mill sector product, with a portion being produced at the local Chakkis and marketed through the Karyana network in the vicinity bearing the brand/label of the Chakki or the retail store.

3.3.3. Supplier Identification

An additional set of questions was asked in Round-2 to identify retailers from where commercial or branded wheat flour was sourced by households. The rationale of the question is to help understand the supply side dynamics for branded, commercially marketed wheat flour as it is the current focus of FFP’s interventions, by studying it in isolation excluding informal Chakki Atta. Collectively, a majority of the respondents (60.5%) indicated that their branded wheat flour had been procured from their respective local retail stores – either Karyana shops or general/super stores. Karyana stores are typically small local retail outlets that sell routine grocery items including essential food products such as wheat flour, Ghee, edible oil etc. Less than 2% sourced their branded wheat flour from large scale nationwide supermarkets such as Utility Stores, CSD, Metro Cash & Carry etc. Another 1.4% sourced it directly from the flour mills and 0.6% from the Chakki mill. Nearly a third of the total respondents did not know where the branded wheat flour used in their households was sourced from.

Table 3.9: Suppler Identification (U3c)

3.3.4. Wheat Flour Brand and Type

As earlier indicated 36.6% of the Households in Round-2, claimed to routinely use branded wheat flour. A list of top 5 brands of wheat flour last purchased by respondents across each of the eight districts is included in the table below. Unbranded flour was the modal response across all districts – with

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FFP Rolling District Study

Hafizabad at top with 95.1% of the Households using unbranded wheat flour and Peshawar 11 at the bottom with 10.3% - corroborating the findings from U2 above.

Table 3.10: Brand of Wheat Flour Last Purchased by Households (U3)

The table above indicates the top five brands overall to be Punjab, Super Fine, Special, Ashrafi and Sunny, a pattern that is more or less similar to the Urban profile. However, it is evident from the table above that the popularity of the wheat flour brands is quite localized. While a few brands find a place among the top five in more than one districts (e.g. Punjab, Super Fine, Special and Zamindar), there is no single universally popular wheat flour brand across all eight districts.

A majority of the Households reported to having last purchased brown wheat flour (66.5%); and when viewed with the results from U2 and U3 where a majority had reported using unbranded Atta explains the high utilization of this courser less white flour variety among households. We understand that most of these old-fashioned Chakki mills characteristically prepare a less refined, coarser or whole wheat variety of Atta and many of them cannot grind grains to the level achievable at commercial flour mill operations. Around 91% of respondents from Hafizabad indicated using brown flour and was the highest response across the eight districts, with 37.6% of respondents from Peshawar indicating the same and was coincidentally the lowest. Peshawar’s reliance on branded wheat flour is the highest among the eight districts and has been discussed as such earlier. A relatively finer version of wheat flour which is whiter in colour, Fine flour, was reportedly being used by 32.6% of Households overall. Maida a more refined variety of wheat flour, which is generally used for baking and making Samosas, sliced bread, Khatai/biscuits etc. was reported in use by less than 1%, with no households from either Hafizabad or Narowal indicating any usage (see Figure below). The Urban-Rural profile is more or less similar with about twothirds of the respondents having last bought Brown flour and about one-third Fine flour, with barely 1% having bought Maida. Items prepared from Maida are usually sourced from the market and this explains its negligible utilization among households.

11 It may be worth mentioning here that nearly 31% respondents from Peshawar could/did not answer which brand was in use.

Midterm Report: Round-2 Survey FFP Rolling District Study

Nearly 70% of the Households reported buying wheat flour in loose form, the highest (97.1%) in Hafizabad, followed closely by Narowal (92.1%). However, Peshawar (79.1%) as expected indicated the highest incidence of flour purchased in packaged form (see Figure 3.5), and was followed by Rawalpindi (45.2%).

3.3.5. Reasons for Purchasing Brand of Wheat Flour

The top reason indicated by 48.5% of the Households behind their choice of the last purchased wheat flour brand was that it was good for health – being cited by a large number of respondents across all eight districts. The highest proportion of such respondents were from Narowal (67.2%), followed by Gujranwala (62.6%). Other major reasons cited for choice of last purchased wheat flour brand included its purity (36.8%), better taste of the Roti made out of it (31.1%) and ease of availability (28.9%). The top ten reasons for the purchase as indicated by respondents are tabulated below.

Figure 3.4: Type of Wheat Flour Purchased by Households (U3aa)

Flour (Brown) Refined Flour (Maida) Fine Flour (White)

Figure 3.5: Packaged or Loose Flour Purchased (U3a)

Loose flour Packaged flour

Table 3.11: Reasons for Purchasing Brand of Wheat Flour (U4)

Interestingly, as highlighted in the table above, about 3.3% respondents indicated the brand being fortified as a major reason behind their choice of last purchased brand. This response was provided by nearly the same percent of respondents across Lahore (4.5%), Hafizabad (4.7%) and Rahim Yar Khan (4.7%).

3.3.6. Product Loyalty

Wheat flour used at households appears to enjoy a high level of product loyalty with 89.3% of the respondents reporting not to have shifted to the current product or brand in the last one year. For the 7.7% of all the Household respondents who reported switching, the following reasons were cited as the primary reasons, with health benefits being the most widely cited reason:

Table 3.12: Top Reasons for Switching Wheat Flour (Brand/Type) by Households (U8)

3.3.7. Quantity of Wheat Flour Consumed

In Round-2 the respondents were asked the quantity and cost questions in absolute terms rather than range based. The respondents were requested to indicate the quantity of wheat flour their household had purchased the last time, and also for how long this quantity had lasted. This approach helps in estimating a more accurate average household consumption (by potentially reducing longer term recall bias), and allows for a meaningful cross comparison with previous studies.

Estimates of average wheat flour consumption by households and related average cost have been developed on the basis of the survey findings (see Table 3.13 for the detailed profile). The quantity of wheat flour last purchased by households across all eight districts averages out at 34.53 kg, with this quantity lasting for 26.24 days. So a household consumes an average of 1.32 kg per day or about 40 kg per month. On a per capita basis this comes out to be 96.4 kg per year, using a mean household size of 4.98 members. This finding is in line with previous studies such as GAIN 12 and MQSUN13 which had indicated averages of 96 kg and 121 kg, respectively.

It should, however, be borne in mind that the wheat flour purchased by a household may be supplemented in varying degrees by other food products made primarily out of wheat flour bought from the market and consumed at home in the form of ready-to-eat food items. Questions U11 and U12, covered later in this Section relate to such most commonly consumed wheat flour based products (namely Kulcha/Naan/Roti, Sliced Bread, Khatai/Biscuit, Rusk, Halwa and Paratha) as well as the quantum purchased from the market or prepared at home. Such an approach can help FFP in more accurately assessing potential aggregate consumption levels of wheat flour among target demographic groups and support FFP in planning fortification intervention.

Table 3.13: Household Consumption and Cost Profile for Wheat Flour*

* Note: Estimates are based on the survey of eight test districts during Round-2 of FFP RDS using the last purchased quantity of wheat flour for the household. Estimates do not include any ready-to-eat food item made with wheat flour purchased directly from the market, or wheat flour products consumed by household member/s away from home.

Using this information, an analysis of per capita consumption of wheat flour by income group was also carried out. Comparison shows a more or less consistent level of consumption across all segments which may be explainable due to the staple nature of the food product. The annual per capita consumption calculated for the five income quintiles is provided below:

◼ Household income less than PKR 20,000 per month: 99.05 kg

◼ Household income PKR 20,000 – PKR 24,000 per month: 91.62 kg

12 Source: Punjab Large-scale Wheat Flour Fortification Project - Punjab, Pakistan Wheat & Wheat Flour & Fortification Supply Chain Study’, September 2014, Global Alliance for Improved Nutrition (GAIN)

13 Source: Pakistan Food Fortification Scoping Study’, April 2014, Maximizing the Quality of Scaling up Nutrition Programmes (MQSUN)

◼ Household income PKR 24,001 – PKR 28,000 per month: 98.31 kg

◼ Household income PKR 28,001 – PKR 34,000 per month: 95.94 kg

◼ Household income more than PKR 34,000 per month: 99.99 kg

3.3.8. Cost of Wheat Flour Consumed

The average rate of wheat flour last purchased by the Households across the eight districts surveyed, comes out to PKR 34.84/kg14. This means that each household consumed wheat flour worth an average of PKR 45.85 per day, with an estimated average monthly cost of PKR 1,395 (see Table 3.13).

Using the mean household size of 4.98 members across all eight districts, the per capita cost of wheat flour comes out to be PKR 3,359 per year.

3.3.9. Perception of Wheat Flour Consumed as Fortified

For Round 2, Households were asked an unprompted question regarding perception about their last purchase of wheat flour. The question was targeted at all respondents and the intent was to discreetly identify households which may have been deliberately trying to avoid consumption of fortified wheat flour.

About 8.6% of the respondents reported that their last wheat flour purchase was not fortified and cited the following main reasons for not buying fortified wheat flour:

 Not aware of wheat flour being fortified (68.2%)

 Not aware that fortified wheat flour was available in the market (15.6%)

 Did not want to buy fortified wheat flour (13.8%)

 Fortified wheat flour was not affordable (1.8%)

 Fortified flour was not good (1.8%)

 Fortified flour was not eaten by children (0.9%)

Of the above only about 18.3% of the respondents using unfortified wheat flour, or 62 respondents in all, appear to be actively avoiding fortified wheat flour and may be deemed as ‘Resisters’ to the use of fortified foods.

Nearly 49.3% respondents, however, indicated that their last purchased wheat flour was fortified. It is important to note that the spot tests conducted on a number of commercial wheat flour samples (marked and packaged as fortified) indicated that the wheat flour did not have added iron in them. Therefore, although the household perception regarding the last purchased wheat flour brand might have been correct based on the package labels, however this may not represent the actual consumption of fortified wheat flour. By the same token, a significantly lower number of samples than planned could be sent to the laboratory for analytical testing because they did not test out to be fortified.

Awareness regarding fortification however remained relatively low as evidenced by the 42.1% ‘Don’t know’ response to this question. The response is supported by the low (11.2%) top of mind awareness around food fortification. This considerably large ‘Don’t Know’ response indicates a need for an effective promotional campaign as larger commercial consumers surveyed (see Retail Users, Section 4) have indicated that promotional drives can have a significant impact on the purchase decision of wheat flour.

14 Note: As per PBS average price per kg in the country for wheat flour was PKR 38.86 per kg, and in the case of wheat averaged PKR 34.64 per kg as at end Apr 2019. On a year-on-year basis, PBS has reported a 3.24% increase in the price of wheat flour and 3.99% for wheat.(Data July – Apr 2019)

3.3.10. Household Consumption of Selected Wheat Flour Food Items

In Round-2 an extensive section on six selected wheat flour products that are commonly consumed by households in Pakistan, was added (covered under U11 and U12). The section attempts at assessing the consumption pattern of ‘Kulcha/Naan/Roti’, ‘Sliced Bread’, ‘Khatai/Biscuit’, ‘Rusk’, ‘Halwa’ and ‘Paratha’ by various selected members of the household. This would help in assessing the consumption pattern of various household members especially FFP’s key target segments i.e. women of reproductive age, adolescent girls and children under 5, and also estimate the aggregate consumption of households more accurately. It would also allow putting into perspective the average indicated quantity of wheat flour consumed per household on a per capita basis, and importantly understand access to these products to the target respondents. An assessment of demand side dynamics through this analysis may also support FFP in planning their supply side interventions.

Table 3.14: (Selected) Food Items Consumed by Households in Last 24 Hours (U11)

Respondents from all districts by and large appear to have broadly similar preferences for these six food items, with Kulcha/Naan/Roti being the modal food consumed in all districts except Rawalpindi where Kulcha/Naan/Roti is the second largest food group after Paratha. Paratha and Khatai/Biscuit were reported as, respectively, the second and third most consumed food items by households in the past 24 hours. Gujranwala and Peshawar specifically appear to be more similar in consumption of these foods. Interestingly, both districts share quite similar population statistics as well. Paratha being the modal reported food from Rawalpindi makes the district a bit of an outlier. Also, more urbanized districts of Lahore and Karachi have reported a greater consumption of sliced bread, Khatai/biscuits and rusks.

Analysis by income quintiles is reported in the figure below. Kulcha/Naan/Roti appears to be the most consumed food item across all five income quintiles, followed by Paratha. Paratha is usually eaten during breakfast and like Kulcha/Naan/Roti, its consumption is fairly universal regardless of income quintile in the respondent populations. Consumption of Khatai/Biscuit was the highest in the highest two income quintiles, whereas consumption of Sliced Bread and Halwa were the lowest in the lowest income quintile.

Figure 3.6: (Selected) Food Items Consumed by Households in Past 24 Hoursby Income Segment (U11)

Follow up questions U11a and U11b about the six selected food items reveal that Kulcha/Naan/Roti are being predominantly prepared at home15 along with Paratha and Halwa; however Sliced Bread, Khatai/Biscuit and Rusk are being generally sourced from the market. Usage of food items bought directly from the market rather than prepared inhouse indicates that wheat flour consumption by the households is being supplemented by these ready-to-eat products from the market. This practice is fairly common across all five quintiles.

Table 3.15: (Selected) Food Items Bought from Market or Prepared Inhouse (U11a & 11b)

15 Note: The category ‘Kulcha/Naan/Roti’ covers all types of local breads including ‘Chapatti’ or ‘Roti’ generally made at home.

Naan/ Roti Paratha Khatai/ Biscuit Sliced Bread Rusk Halwa

3.3.11. Consumption of Selected Food Items by Household Members

In addition to determining the household consumption of the above six selected food items made out of wheat flour in the past 24 hours, and assessing their respective sourcing, respondents were also asked to indicate consumption of these foods by specific members of the household including:

 Respondent herself (most likely to be an adult woman of reproductive age)

 Adolescent girl (10 – 14 years)

 Child under 5 years of age

 Adult male (not necessarily the head of family)

The respondents were asked questions regarding consumption of the six selected food items - namely Kulcha/Naan/Roti, Sliced Bread, Khatai/Biscuit, Rusk, Halwa and Paratha - by the four household members mentioned above. Each question had three components:

 Incidence of Consumption – i.e. whether the specified person had the specified food item in the past 24 hours (U12a)

 Frequency of Consumption – i.e. how many times the specified person had the specified food item in the past 24 hours (U12b)

 Quantity of Consumption – i.e. how much or what portion of the specified food item was consumed by the specified person in one sitting during the past 24 hours (U12c). A chart showing standard portion sizes provided by FFP was shown to the respondents to assess their portions consumed. Portion sizes used to obtain feedback from respondents are summarized in the table below.

Table 3.16: Food Item Units and Portions

Source: Food Portion Photo Grid (FACT Survey 2017)

While analysis of U12a echoes the findings from other areas that Kulcha/Naan/Roti and Paratha were the most commonly consumed products among all four selected household members, differences in the consumption pattern among the household members become more obvious. A little more than 80% of the households reported that the Respondent herself and an adult Male at home had had Kulcha/Naan/Roti in the last 24 hours with only 60.5% reporting this for the child of under 5. On the other hand, the Adolescent Girl was reported to have had a Paratha the most times (59.5%) with the Child having had it the least times (40%). The Child was reported to have had Khatai/Biscuit (46.5%), Rusk (15.4%) and Sliced Bread (12.8%), the highest among all four members analyzed.

Midterm Report: Round-2 Survey FFP Rolling District Study

Table 3.17: Incidence of Consumption of Selected Food Items by Household Members in Past 24 Hours (U12a)

Figure 3.7: Consumption Incidence of Selected Food Items in the Past 24 Hours by Household Member Category (U12a)

Kulcha/ Naan /Roti Sliced Bread Khatai/ Biscuit Rusk Halwa Paratha

Responses to Questions 12b and 12c for each household member were then analyzed to estimate the average consumption of the selected food items by each of the four selected household members having consumed the products during the previous 24 hours (see figure below for a comparison and Table 3.18 for the details).

The figure above shows that while on average adult males consume the highest quantity of the said food products among the four household members, there is not too large a difference between the adult male and the respondent herself (most likely to be an adult woman of child bearing age) - both in terms of consumption and pattern. The minor differences in food intake between the two may be due to different natural calorific requirements between males and females. Consumption by the adolescent girl is slightly lower in quantum than the adult female (or the Respondent) but quite different in terms of pattern. The girl consumed less of Kulcha/Naan/Roti and Paratha but more Biscuit/Khatai and Rusk. The Child under 5, on the other hand, consumed significantly lower quantities of the specified food items and, like the adolescent girl, consumed proportionately more of biscuits and rusks than the other items. This analysis indicates the consumption based on the household members reporting to have consumed the selected products over the previous 24 hours. It should be viewed in conjunction with the consumption incidence of the six food items (U12a) if the objective is to estimate the quantity of wheat flour consumed through these products.

Figure 3.8: Average Consumption by Household Member Category Having Consumed the Selected Food Items in the Past 24 Hours (U12b & U12c)

Kulcha/Naan/Roti Sliced Bread Khatai/Biscuit Rusk Halwa Paratha

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Table 3.18: Average Consumption by

Household Members Having Consumed Selected Foods in the Past 24 Hours (U12b & U12c) 16

16 Note: This analysis is based on Questions 12b and 12c and indicates the daily consumption of household members reporting to have consumed any or all of the 6 selected products over the previous 24 hours. If the objective is to estimate the average quantity of wheat flour consumed by household members through these products, these quantities shall need to be weighted against consumption incidence (U12a), and then multiplied by the average quantity of wheat flour in each product.

Particular

An analysis of consumption by each of the aforementioned household member category consuming the six selected food items, based on the frequency and quantity consumed of the said foods in the previous 24 hours, is presented below.

3.3.12. Consumption by Respondent Herself

Overall consumption by the Respondents who reported eating the selected items during the past 24 hours points at the following average daily consumption: 2.15 Naan/Roti of any type, 2.68 slices of bread, 4.03 biscuits of any type, 2.65 rusks, 0.42 plate of Halwa and 1.05 Parathas. Of these, the Roti, Paratha and Halwa are mostly made at home while bread, biscuits and rusks are bought from the market and supplement the wheat flour purchased by the household. The Respondent herself, the most knowledgeable female of the household, is most likely to be a woman of reproductive age under 50 years.

Quantity consumed of Kulcha/Naan/Roti was the highest by the Respondent in Gujranwala and Rahim Yar Khan, and the lowest in Peshawar; while Paratha consumption was the highest in Narowal and lowest in Rawalpindi. Rusks, biscuits and bread, all mostly bought from the market, were the most eaten in Peshawar. Bread was the least eaten in Rawalpindi and biscuits the least consumed in Rahim Yar Khan. The ladies of Narowal who had the said food items consumed most of them in the largest quantities (see figure below, refer to Table 3.18 for details).

3.3.13. Consumption by Adolescent Girl

Adolescent girls, 10 to 14 years of age, form a key target segment for FFP’s intervention. Analysis based on average overall consumption indicates that adolescent girls who reportedly had the selected food items in the past 24 hours consumed 1.73 Naan or Roti of any kind, 2.46 slices of bread, 4.12 biscuits, 2.93 rusks, 0.41 plate of Halwa and 0.9 Paratha. Girls in Rahim Yar Khan had the most Kulcha/Naan/Roti as well as Parathas, while in Peshawar these local breads were not consumed in large quantities. Rusks and biscuits, mostly from the market, were more popular among adolescent girls than Naan or Roti - rusks and biscuits being eaten in the largest quantity in Narowal. Girls in Gujranwala and Karachi also ate more rusks; and in Karachi and Rawalpindi they had more biscuits. Halwa, apparently not a very popular food item generally, was not eaten at all by girls in Narowal (see figure below, refer to Table 3.18 for details).

Figure 3.9: Average Consumption by Respondents Having Consumed Selected Food Items in the Past 24 Hours (U12b & U12c)

Kulcha/ Naan/ Roti Sliced Bread Khatai/ Biscuit Rusk Halwa Paratha

Midterm Report: Round-2 Survey FFP Rolling District Study

3.3.14. Consumption by Child Under 5

Based on overall consumption of the six items reported for children under 5 (another key target segment for FFP) in the households surveyed, consumed 0.78 Naan or Roti of any type, 1.54 slices of bread, 3.82 biscuits, 1.87 rusks, 0.30 plate of Halwa and 0.51 Paratha. Kulcha/Naan/Roti takes a back seat in this category of household members, with biscuits, bread and rusks becoming more significant. The highest consumption of Kulcha/Naan/Roti and Paratha was reported among children of Narowal who also ate the most rusks. Children in Peshawar ate the most bread and in Karachi they ate the most biscuits. Low quantities consumed of the selected foods among children may not necessarily point at insufficient diet for growing children as their diet may be supplemented by other food items not covered herein (see figure below, refer to Table 3.18 for details).

Figure 3.10: Average Consumption by Adolescent Girls Having Consumed Selected Food Items in the Past 24 Hours (U12b & U12c)

Kulcha/ Naan/ Roti Sliced Bread Khatai/ Biscuit Rusk Halwa Paratha

Figure 3.11: Average Consumption by Children Under 5 Having Consumed Selected Food Items in the Past 24 Hours (U12b & U12c)

Kulcha/ Naan/ Roti Sliced Bread Khatai/ Biscuit Rusk Halwa Paratha

3.3.15. Consumption by Adult Male

Inclusion of an Adult Male, not necessarily the head of the household, in the survey has largely been for comparison purposes as this is not a core target demographic for FFP. However, it should be borne in mind while analyzing his food intake that this may constitute only his partial consumption. A portion of his regular consumption may potentially include food eaten at work that may not be brought home and therefore not covered under this survey (see Table 3.19 below for comparison). Based on the analysis of selected foods eaten at home by the Adult Males reported to have had the said foods in the previous 24 hours, consumed on average 2.59 Naan or Roti of any type, 2.72 slices of bread, 4.41 biscuits, 2.92 rusks, 0.52 plates of Halwa and 1.29 Paratha. Consumption of Kulcha/Naan/Roti as well as Paratha seemed to be highest among the more rural districts with Narowal, Rahim Yar Khan, Hafizabad and Gujranwala indicating the highest quantities consumed. Coincidentally, these four districts are also amongst the major wheat producing districts nationally. Men in Narowal and Gujranwala consumed relatively more of the selected foods generally. Peshawar had the highest consumption of bread (for details refer to Table 3.18).

Figure 3.12: Average Consumption by Adult Males Having Consumed Selected Food Items in the Past 24 Hours (U12b

See table below comparing the consumption of household members, keeping Adult Male as the control variable. This calculation takes into account all three consumption parameters namely, the Incidence, Frequency and Quantity of Consumption of the selected products.

& U12c)

Table 3.19: Average Consumption Comparison of Household Members

3.4 Early Districts Comparison on Wheat Flour Usage – Round-1 vs Round-2

The Round-2 ‘Usage’ section has been significantly revised from Round-1 with the intent to better understand consumption patterns of wheat flour in target households. The most significant change has been the addition of questions regarding consumption patterns of wheat flour-based products by specified individual members of the household. Furthermore, questions on consumption in Round-2 pertain to the ‘last purchased’ rather than the ‘routinely purchased’ wheat flour in Round-1. The intent was to minimize long term memory recall on key consumption related questions. Nonetheless, a meaningful comparison may be drawn based on results received; a summary analysis of survey results for Early Districts in both rounds is presented below:

3.4.1. Usage of Wheat Flour by Households

Nearly all respondents across both rounds have reported to using wheat flour in the Early Districts, with the only change between the two rounds being 6.2% of respondents in Round 2 stating that their household did not prepare foods using wheat flour. Nearly 50% of these were from Gujranwala and Hafizabad combined. We understand that both these districts are major rice producing districts, and some of these respondents may be predominantly relying on that commodity. No specific rice usage question was put forward to respondents in Round 2 unlike Round 1, where the modal monthly quantity consumed by households had been reported between 6 – 10 kg.

3.4.2. Sourcing of Wheat Flour

Findings from Early Districts in Round-2 indicate that 67.1% respondents were using unbranded Chakki Atta (i.e. either buying flour directly from Chakkis (19.2%) or grinding own grains at the local Chakki mills (47.8%). On comparison between the rounds, in Round-1 about 72.9% households surveyed had indicated using Chakki Atta (26.3% buying from Chakki and 46.6% grinding their own wheat grain). Hence an overall decline in Chakki Atta was reported from 72.9% in Round-1 to 67.1% in Round-2.

Similarly, the branded commercial wheat flour (including branded commercial flour and branded Chakki flour) was reported in use by 32.6% in Round-2 as compared to 27.1% in Round-1, a significant overall increase in proportions consumed, witnessed across all Early Districts except Hafizabad. Hafizabad’s production district characteristics and reliance on Chakki Atta is clear with 94.5% of respondents stating usage of Chakki Atta compared with 94% in Round-1. Nearly 50% respondents from Rawalpindi reported using Chakki Atta, down from 55% in Round-1. The decline has been made up by a proportionate increase in offtake of branded commercial flour.

A major change can be seen over the two rounds within the branded commercial wheat flour segment, with households shifting from more refined versions of commercial flour to branded Chakki flour, both reportedly being produced largely by the organized, roller mill sector. This finding may potentially be pointing at a significant behavioral shift by household consumers which is driving the flour mills to rethink their product mix. The shift from branded commercial flour to branded Chakki flour may be seen across all Early Districts, being more pronounced in Rawalpindi (from 1.2% to 24.4%), Gujranwala (from 2.2% to 25.1%) and to a relatively lesser degree in Lahore (from 5.2% to 29.1%).

Fig 3.13: Wheat Flour Sourcing by Household

Unbranded Chakki Atta

Branded Commercial Flour

Midterm Report: Round-2 Survey FFP Rolling District Study

In terms of the urban-rural split, about 61% of respondents from urban areas reported using unbranded Chakki Atta, with no significant increase from Round-1; while about 76% of the households in rural areas indicated using Chakki wheat flour in Round-2 as compared to 86.8% in the first round.

Figure 3.14: Sourcing of Wheat Flour by Households - Early Districts (Round-1 vs Round-2)

Buy unbranded Atta from Chakki Grind own grains at Chakki Buy Chakki brand flour from market Buy commercial brand flour from market

Midterm Report: Round-2 Survey

FFP Rolling District Study

The difference between rural and urban consumption patterns of Chakki and branded commercial wheat flour in both rounds may also be explained by the MQSUN17 2014 study, according to which local Chakkis accounted for 70-75% of wheat flour supply in rural locations while their estimated contribution stood at 30-40% in urban settings – across Pakistan. This means that by and large findings across the two rounds of RDS are in line with the findings of the MQSUN study. The slightly higher numbers for Chakki Atta in the rural/semi-urban centers like Hafizabad and Gujranwala are possibly down to the fact that these two districts are considered to be fairly major wheat production districts of Pakistan.

Table 3.20: Sourcing of Wheat Flour Comparison by Income Quintile (U2) - Early Districts (Round-1 vs. Round-2)

* Income refers to monthly household income in Pak Rupees

Note: Red indicates a decline from Round-1 and Green indicates an increase from Round-1

As noted from the table above, there has been a decline across various income quintiles in sourcing of wheat flour by grinding own grains at the local Chakki. However, it still remains the modal choice across the board with more than one-third of the respondents from each quintile reportedly obtaining their wheat flour this way, as compared to at least 42% last year. There has also been a decline in the sourcing of Atta directly from Chakkis across the five quintiles, with the most significant decline being reported by the respondents from the highest income quintile (30.8% in Round-1 vs. 17.2% in Round-2). On the other hand, the biggest gainer seems to be the branded Chakki flour as discussed above. In Round-1, this was reported to be a negligible source of supply. Also, as the sample is biased towards the lowest two quintiles (nearly 60%), it is important to note that whilst unbranded Chakki Atta is still the dominant source, branded Chakki flour appears to be an upcoming alternative (especially in the urban centers). Reportedly, branded Chakki wheat flour is also marketed by flour mills producing regular wheat flour, and to some extent, also by some Chakki mills through the retailer network in the vicinity.

The highest number of respondents which indicated buying branded commercial flour (19.5%) belonged to the highest income category, and the lowest proportion belonged to the second lowest quintile. Recapitulation of results from Round-1 reveals that the greatest proportion of individuals procuring commercial flour (27.1%) belonged to the second highest income quintile, and the lowest proportion belonged to the highest quintile (15.0%).

3.4.3. Brands of Wheat Flour Purchased

Respondents in Round-2 were asked to identify the brand of wheat flour their household had last purchased, as compared to the routinely purchased brand of wheat flour in Round-1. As is evident from the sourcing question earlier, proportion of branded wheat flour purchases has increased in the Early Districts with 27.1% respondents in Round-1 to 32.6% in Round-2. Top ten brands purchased by households across both rounds are presented in the table below.

17 Source: Pakistan Food Fortification Scoping Study’, April 2014, Maximizing the Quality of Scaling up Nutrition Programmes (MQSUN)

Midterm Report: Round-2 Survey FFP Rolling District Study

Table 3.21: Top Brand of Wheat Flour Purchased by Households (U3) - Early Districts (Round-1 vs Round-2)

Most of the top brands in the first round are also among the top in the second round, with changes largely in the ranking order. Also, the regional nature of brands is obvious. For instance, Punjab is the leading brand in Lahore, Islamabad in Rawalpindi and OK/OK in Gujranwala. Hafizabad’s case is unique with a very high unbranded wheat flour usage, although among major brands Punjab has been reported by respondents in this district as well. ‘Fine’ as a brand was not accepted in Round-2 and responses indicating ‘Fine’ have been cross referenced against flour mills marketing Fine in respective districts. This exercise was done to avoid a repeat of Round-1, where it was discovered that Fine wheat flour was distributed as both a brand as well as a category - a more refined, whiter version of wheat flour. An effort was made during Round-2 to report the brands as accurately as possible.

The most cited reasons for brand choice indicated by respondents across both rounds have remained largely the same (with a slight change in order), and are presented below.

Table 3.22: Top Ten Reasons for Wheat Flour Brand Choice (U4)

Early Districts (ROUND-1 vs. Round-2)

From the assessment of responses from Early Districts on the reasons explaining their brand of choice, it appears being ‘good for health’ is the predominant factor driving households’ purchase decision with respondents in all four Early Districts citing it as a major reason. A greater proportion of rural respondents (48.8%) made this claim as compared to urban (47.5%). The greatest proportion of respondents giving the said choice was from Gujranwala in both rounds. For respondents in Lahore in

Round-2, the Roti’s taste was indicated as the primary reason behind choice of the brand choice and in Hafizabad it was its purity.

Other attributes mentioned, also revolve around health, quality and purity and are more or less similar across both rounds. Interestingly, nearly 4% of the respondents in Round-2 indicated the brand being fortified as a major reason for purchase – a reason which has not been mentioned previously. This potentially points towards a communication drive on fortified flour in these districts which seems to have developed this opinion.

3.4.4. Chang in Behavior

It appears from responses in Round-2 that despite wheat flour brands reportedly enjoying a high brand loyalty (90.5%), 7.7% of respondents did indicate switching brands over the last one year. Shifting to the current brand was highest as reported by respondents in Lahore (14.1%), followed by Rawalpindi (6.6%), Gujranwala (5.2%) and Hafizabad (4.4%). Read in the light of the behavioral changes in sourcing of wheat flour, this makes sense with a more than proportionate shift from unbranded Chakki Atta to branded flour, predominantly in the districts of Lahore and Gujranwala.

Comparing the results to Round-1, it may be observed that only 3.4% of respondents had indicated to switching brands during the last one-year period, with the greatest proportion of such respondents being from Lahore (although this number was 4.4%). This was, however, in the case where 73% of respondents had claimed to be using Chakki Atta, and therefore brand switching was of much lower significance.

3.4.5. Quantity of Wheat Flour Consumed

Change in approach to this question in Round-2 as earlier indicated has helped in ascertaining a more accurate consumption of wheat flour both at household and per capita levels. In addition to mentioning quantity of wheat flour last purchased and length of time it lasted, no set ranges of quantity were given to respondents to select from, and they were asked to provide absolute numbers.

The average quantity of wheat flour purchased in the Early Districts comes out to be 30.55 kg in Round2, with this quantity lasting for an average of 26.56 days. This indicates an annual consumption of 81.2 kg per capita, using the mean household size of 5.17 members. This compares with Round-1 findings of per capita consumption between 72 – 96 kg per year. It may be worth mentioning here that the consumption of wheat flour estimated for the Early Districts in Round-2 is less than the per capita consumption estimated for all eight districts at 96.4 kg. The following factors may be considered to potentially explain this differential:

◼ Among the four Early Districts, Gujranwala and Hafizabad are Pakistan’s major rice producing districts as well - Gujranwala being the largest and Hafizabad the third largest rice producing district of Punjab (Punjab accounts for nearly 52% of rice and 74% of wheat production in Pakistan 18). Rice may be consumed in greater proportions in these districts in place of wheat flour as both products are widely used as substitutes.

◼ Also among the Early Districts are the more urbanized Lahore and Rawalpindi districts which, even with a survey bias towards the lowest income segments, have greater food choices available for households. These may include ready-to-eat food items (wheat flour-based or otherwise) purchased directly from the market rather than prepared inhouse. Since the consumption per capita calculated here is based specifically on the wheat flour consumed by households, the per capita figure comes out to be lower for the Early Districts.

◼ Among the Mid Districts, Rahim Yar Khan is the second largest wheat producing district of Pakistan (even larger than Hafizabad and Gujranwala)19 and therefore has significantly higher wheat flour consumption.

18 Ministry of National Food Security and Research, FY2017

19 Ministry of National Food Security and Research, FY2017

Midterm Report: Round-2 Survey FFP Rolling District Study

According to the GAIN20 Study, consumption for Punjab is estimated at about 101 kg (5% higher than the national average), which is about 20% higher than the consumption hereby estimated. However, it may be borne in mind while comparing the two that this estimated per capita consumption of 81.2 kg is partial only and therefore understated. It is based only on the wheat flour consumed at home and does not include any ready-to-eat wheat flour-based food products purchased directly from the market for consumption by household members within or outside home.

3.4.6. Cost of Wheat Flour Consumed

Average cost reported by respondents from Early Districts in Round-2 comes out to be PKR 36.60/ kg, indicating a cost of PKR 42.10 per day or a monthly household cost of PKR 1,263 which compares to the modal cost range of PKR 801 - 1,600 for a quantity of 30 - 40 kg of wheat flour reported in Round-1.

The corresponding per capita cost of consumption for wheat flour, using the mean household size of 5.17 members in the Early Districts, comes out at PKR 2,972 per year in Round-2, compared to the cost range of PKR 1,922 – 3,840 reported in Round-1.

3.5 Usage Pattern of Cooking Oil and/or Ghee

All respondents in Round 2 have indicated using cooking oil, Ghee or both equally to prepare foods at their households across all eight districts.

Figure 3.15: Usage of Gheeor Cooking Oil by Households (U13a)

As is evident from the graph above, Ghee is used more often than oil for cooking by households across all districts except Karachi. Karachi stands out among the surveyed districts with the highest (71.6%) number of households using cooking, as well as the highest proportion using both Ghee and cooking oil equally (18.7%). On the other side of the scale, Hafizabad households use the most Ghee with an overwhelming 88.9% indicating it. Rawalpindi is the other major district where usage of cooking oil was reported to be higher than Ghee, with the proportion using both also considerably higher. An urban-rural split is evident with more urbanized districts like Karachi, Lahore, Rawalpindi tending to use more cooking oil and the rural/semi-urban districts like Hafizabad, Rahim Yar Khan, Narowal, Gujranwala and Peshawar using more Ghee. Interestingly, Ghee/oil usage trends in the similarly populated Gujranwala and Peshawar districts21 appear quite similar.

Source: Punjab Large-scale Wheat Flour Fortification Project - Punjab, Pakistan Wheat & Wheat Flour & Fortification Supply Chain Study’, September 2014, Global Alliance for Improved Nutrition (GAIN)

Midterm Report: Round-2 Survey FFP Rolling District Study

The lowest three income quintiles indicated mostly using Ghee, with the other three higher quintiles reporting using mostly cooking oil. In fact a trend can be observed across all five quintiles with the Ghee usage steadily declining as income increases and vice versa for cooking oil showing an inverse relationship between income and Ghee and a directly proportional relationship between income and cooking oil.

3.5.1. Sourcing

Nearly 98.4% respondents in Round-2 indicated that they had sourced their last purchased Ghee and/or cooking oil from the market, with respondents from Hafizabad and Karachi indicating a slightly higher number for homemade products as compared to the other districts. No obvious urban-rural distinction was observed in responses.

3.5.2. Brands of Ghee/Cooking Oil

Respondents were asked to indicate the brand of their last purchase. A number of brands were identified, and the top ten brands indicated by respondents in each of the eight districts are listed in the Table 2.23 below. Unlike wheat flour, products purchased were generally branded.

21 Source: Census 2017. Peshawar has a populations of 4.27 million with an urban : rural split of 46% : 54%); and Gujranwala has a population of 5.01 million with an urban : rural split of 59% : 41%.

Figure 3.16: Usage of Gheeor Cooking Oil at Households – by Income Quintile (U13a)

Ghee Mostly Used Oil Mostly Used Both Used Equally

Table 3.23: Top Brands of Ghee/Cooking Oil Purchased (U15)

From the table above, it can be observed that Sufi and Dalda overall appear to be the two most favored brands of Ghee/cooking oil last purchased by households. Both these brands are favored more by urban households as compared to rural. Sufi appears to have been the most common last purchased brand as reported by households in Hafizabad and Gujranwala, whereas Dalda was the most popular brand in Rawalpindi. Shaan has a more regional presence in Lahore, with the brand bought by 30.4% of the respondents in the district, beating Sufi by a narrow margin. Kashmir is another major regional brand in Hafizabad, with Shahbaz being the most commonly identified regional brand in Rahim Yar Khan with 56.4% of the district’s respondents indicating having purchased it. In Peshawar Shama took the lead, while Kiran was by far the most popular brand in Narowal. Other than Sufi and Dalda, there are few other brands that enjoy popularity among users across regional boundaries, however none of them are among the top in all districts. Interestingly, while essentially Ghee/oil purchased in seven out of eight districts was reported to be branded, more than a third of the households in Karachi indicated using unbranded, unpackaged Ghee/cooking oil, it being the modal response for the district. There may be a number of reasons explaining this phenomenon22 however we have not conducted any targeted research to assess the situation.

22 Note: We understand that Vanaspati Ghee is slowly being phased out nationwide due to ill effects on human health, and as per Punjab Pure Food Rules 2018 a complete ban on sale of Vanaspati Ghee effective July 2020 has been imposed. Other provinces are expected to follow suit. Also both Malaysia and Indonesia the leading exporters of palm oil (including raw canola oil/RBD) to Pakistan have imposed bans on raw palm oil exports. This is driving importers to bring in refined Olien and Super Olien (palm oil based refined cooking oil) as an alternative to Vanaspati Ghee. Based on anecdotal evidence, Karachi being the country’s major port city has access to larger volumes of Olien and Super Olien available at competitive rates, and a number of oils are marketed in loose form. Interestingly, four sample tests of cooking oil (especially three of Taaza a company based in Karachi but marketing nationwide) as well as one of Shahbaz have been found to have no Vitamin A. Shahbaz Vanaspati and cooking oil are also amongst a number of brands which have failed PFA’s food safety tests as per the last 2018 test. The import of Olien and Super Olien and the large reported consumption of loose oil may potentially explain this finding.

From the income perspective, Sufi and Dalda remained prevalent across all five quintiles, with Kiran and Shahbaz being popular in the lower income quintiles only. As indicated in the table above, Kiran and Shahbaz appear to be extremely popular local brands in Narowal and Rahim Yar Khan, respectively, and this may have skewed the results for the lowest income quintile. It is noteworthy that Sufi and Dalda retain their usage and popularity across districts and income segments despite being amongst the more expensive Ghee/cooking oil brands. While this may appear as an anomaly as pricing plays a critical role in the purchase decision for lower income households, a host of other marketing factors are also at play which cannot be ignored. A company’s marketing and distribution strategy, promotional campaigns, retailer incentives, packaging, SKU sizes, plant location etc, as well as awareness among the consumers, also influence the purchase decision – especially if it is deemed as an important product for the whole family’s health.

Table 3.24: Most Popular Brands of Ghee/Cooking Oil – by Income Quintile

The top ten cited reasons indicated by Households for their brand choice are listed below:

Table 3.25: Reasons for Buying Brand of Cooking Oil/ Ghee(U16)

It appears that like wheat flour, households give high weightage to the product being good for health, being the modal response across all districts except Karachi where it is next to the modal response after Better Quality (51.3%). Other important considerations indicated were related to quality, ease of availability, pricing, lowering cholesterol level (which again may be dovetailed as a health consideration) etc. Interestingly, the brand being fortified was also cited as an important reason for its selection by 5.2% of all Households, being higher for urban respondents (6.8%) than rural (3.1%) and quoted most by Karachi households (9.6%) followed by Gujranwala (6.8%).

3.5.3. Product Loyalty

Ghee/cooking oil enjoyed a high brand loyalty among households with nearly 82.4% of respondents indicating not to have changed brands in the past one year. The proportion of respondents indicating shifting to the brand last purchased (14.2%) is nonetheless higher than that for wheat flour (7.7%). Nearly a fifth of the households in Lahore, Hafizabad and Rahim Yar Khan indicated switching brands over the past one year, while respondents from other districts appear to be more brand loyal. Having stated that, the higher switching behavior witnessed in cooking oil prices may have been due to the sharp increase in prices – increasing by an average of about 9.75% year-on-year as of April 2019, while Ghee prices increased by 6.35% as reported by Pakistan Bureau of Statistics (“PBS”) 23 . On the other hand, prices of wheat flour increased by an average of 3.24% and wheat by 3.99%.

Several reasons were cited for switching to their current brands as listed in Table 3.26. The product being of a better quality was quoted most frequently by 25.4% of respondents, followed by it being good for health (22.8%). Other reasons cited pertained to its cost effectiveness, ease of availability, taste, smell etc as provided in the table below.

Table 3.26: Top Reasons for Switching Ghee/Oil Brand (U20)

Respondents citing quality as the reason were the largest in Karachi (53.3%) followed by Gujranwala (25.5%). Health benefits were cited the most by Narowal (43.3%) and Rawalpindi (22%) respondents. Ease of availability ranked high for Households in Peshawar, whereas respondents from Hafizabad appeared to be more price conscious with 29% stating that their choice was guided by the brand being more economical. Respondents from Gujranwala appeared to value better taste (29.1%) as the top reason for their choice of brand last purchased.

3.5.4. Quantity of Ghee/Cooking Oil Consumed

The quantity and cost questions for Ghee/cooking oil have also been restructured in Round 2, and follow the same methodology highlighted earlier for wheat flour. The respondents were asked to indicate the quantity of cooking oil/ Ghee last purchased for the household, and also how long that quantity lasted. See Table 3.27 for the detailed consumption and cost profile based on the responses.

The average quantity of Ghee/cooking oil purchased in all districts comes out to 3.98 kg (or liters), with this quantity lasting the household for an average of 17.25 days. Average daily consumption per household is thus estimated at 0.23 kg (or liter) or 7 kg (or liter) per month. On a per capita basis this comes to about 17 kg (or liters) per year using a mean household size of 4.98 members. For reference, a 2013 report on edible oil by Global Agriculture Information Network estimated Pakistan’s national average consumption at 19 kg per capita24

23 Source: PBS (Average Monthly Prices of 53 Essential Items for the month of April 2019)

24 Sourced from ‘Pakistan Food Fortification Scoping Study’, April 2014, Maximising the Quality of Scaling up Nutrition

Table 3.27: Household Consumption and Cost Profile for Ghee/ Cooking Oil*

* Note: Estimates are based on the survey of eight test districts during Round-2 of FFP RDS using the last purchased quantity of Ghee/cooking oil for the household. Estimates do not include any ready-to-eat food item using Ghee/cooking oil purchased directly from the market, or products consumed by household member/s away from home.

3.5.5. Cost of Ghee/Cooking Oil Consumed

The average rate of Ghee/ cooking oil last purchased by Households across all districts surveyed was calculated at PKR 165.8725 per kg (or liter). Therefore, on an average, each household consumed Ghee/cooking oil worth PKR 38.29 per day, with an estimated monthly cost per household of PKR 1,165. On a per capita basis this corresponds to a consumption cost of PKR 2,805 per year, using the average household size of 4.98 members (see Table 3.27 above).

3.5.6. Perception of Ghee/Cooking Oil Last Purchased Being Fortified

An unprompted question on respondents’ perception about their Ghee/cooking oil was asked. The intent was to identify if any households were deliberately trying to avoid consumption of fortified Ghee/cooking oil and understand their point of view.

About 7% respondents indicated that the brand of Ghee/cooking oil last purchased by them was not fortified and gave the following reasons for not buying fortified Ghee/cooking oil:

 Not aware of Ghee/cooking oil being fortified (58.8%)

 Did not want to buy fortified Ghee/cooking oil (17.6%)

 Not aware that fortified Ghee/cooking oil was available in the market (14.2%)

 Fortified Ghee/cooking oil was not affordable (8.7%)

 Fortified Ghee/cooking oil did not taste good (0.3%)

Out of these, only about 26.6% or 77 respondents in all appear to be intentionally avoiding purchasing fortified Ghee/cooking oil and therefore may be considered as ‘Resisters’.

On the other hand, 51.1% of the Households stated that their last purchased Ghee/cooking oil was fortified. It may be noted here that fortification of Ghee/cooking oil was mandated at the federal level in 1965 under the ‘West Pakistan Pure Food Ordinance’ and has been retained in the Provincial Food Rules ever since. Having stated this, it appears that general awareness regarding fortification of cooking oil remains almost at par with that witnessed in the case of wheat flour, and a large proportion of respondents reported not to be aware of it. Also, when respondents were pressed to indicate reasons for purchasing or switching to the currently used brand, ‘fortification’ did not come out as one of the top 5

Programmes (MQSUN)

25 Note: Average price of Vegetable Ghee (loose) as of April 2019 was recorded at PKR 160.41, whereas that of tinned vegetable oil (2.5 liter) recorded at PKR 521.35 or ~ PKR 208 per liter. (Source: PBS)

reasons but did make the top 10 list. The response is in line with the respondents’ low (11.2%) top of mind awareness around food fortification.

Response pattern on this question remained largely uniform across all five income quintiles. Respondents indicating that their last purchased brand was fortified ranged between 51.1% to 52.6% across all the income segments; and between 6.9% to 9.6% for ‘Unfortified’ response, with no obvious pattern.

3.6 Early Districts Comparison on Ghee/Cooking Oil Usage – Round 2 vs. Round 1

The ‘Usage’ section in Round-2 has also been revised for Ghee/cooking oil although the changes are not as substantial as wheat flour. Questions on consumption in Round-2 pertain to the ‘last purchased’ rather than the ‘routinely purchased’ wheat flour in Round-1. The intent was to minimize long term memory recall on key consumption related questions. Based on survey results, meaningful comparison may still be drawn across the Early Districts between the two rounds, as presented below:

3.6.1. Usage of Gheeor Cooking Oil by Households

All Households reported to be using cooking oil, Ghee or both across all four Early Districts in both rounds. When usage trends are analyzed by district, we see a change in cooking oil consumption increasing across all Early Districts except Lahore where it remains consistent; while at the same time a reduction in Ghee usage is seen across all districts except Rawalpindi. The most marked change has been witnessed in Rawalpindi where cooking oil jumped from 35.9% in Round-1 to 45.3% in Round-2 while at the same time Ghee usage was also reported to have increased from 29.6% to 42.1%. Households in Rawalpindi are seen to have become more particular about using either oil or Ghee rather than using both equally like more than a third of the Households had reported in Round-1.

3.6.2. Sourcing of Ghee/Cooking Oil

Using a slightly different approach in Round-2, respondents were asked to identify the source of the last purchased Ghee/cooking oil, as opposed to the routinely purchased product in Round-1. The responses in the two rounds were quite similar. Nearly 98.2% of respondents in Round-2 indicated that they had sourced the Ghee/cooking oil from the market, as compared to 98.9% in the first round.

Figure 3.17: Ghee/Cooking Oil Use by Household (Round 1 vs. Round 2) (U13a)

3.6.3. Brands of Ghee/Cooking Oil Purchased

The top brands of Ghee/cooking oil last purchased as reported by Households in both rounds are presented in the table below. Sufi has remained the most common brand of Ghee/cooking oil in the Early Districts in both rounds, with nearly 28.8% in Round-2 and 18.8% in Round-1 indicating this brand as a choice. However, Sufi was not reported as a favourite brand in Rawalpindi where Dalda seems to be the most popular choice, which is consistent with the findings from Round-1. In Lahore district, Shaan seems to have increased its presence, with nearly 30.4% households indicating it as the last purchased brand. In the previous round nearly 25% respondents had opted for this brand (including Shaan Ghee and oil) . Sufi remained the brand of choice amongst respondents from Hafizabad and Gujranwala across both rounds. Othe brands common between the two rounds have been highlighted in the table below. Sufi and Dalda seem to have retained their usage and popularity over the two rounds, being the two most commonly used and cited brands in the Early Districts, despite being priced higher than most competing brands.

Table 3.28: Top Brands for Ghee/Cooking Oil (U15) – Early Districts (Round-1 vs Round-2)

Note: For Round-2 responses have been combined under the brand name as opposed to separately mentioning brands for cooking oil and Ghee in Round-1.

3.6.4. Reasons for Choice of Brand

For the brand indicated as last purchased, respondents were asked to indicate the reasons behind this choice, and being good for health topped the list across both rounds, with the largest number of respondents from Gujranwala indicating this choice across both rounds. If lowering the cholesterol level is included, then being good for health becomes an even stronger reason for brand choice. Respondents from Lahore also gave importance to quality and ease of availability, with their response being greater than the four-district average in both rounds. Other key reasons for brand choice are highlighted in the table below. Interestingly, about 5% respondents did indicate that their choice was driven by the brand being fortified and compares with only one respondent who indicated additional vitamins as a major reason in Round-1.

Table 3.29: Top 10 Reasons for Buying Ghee/Cooking Oil Brand (U16) – Early Districts (Round-1 vs Round-2)

3.6.5. Change in Behavior

Ghee/cooking oil enjoyed a high brand loyalty with about 83.8% of the households in the Early Districts in Round-2 indicating not to have switched brands over the last one year, as compared to nearly 90% in Round-1. Nevertheless, the proportion of switchers at 15% in Round-2 is significantly higher than 9.2% witnessed in the first round. About 20% of the respondents from Lahore and Hafizabad switched brands in Round-2, which is almost double the number for Rawalpindi and Gujranwala. Comparing this to Round-1, a similar trend could be seen with nearly double the respondents from Lahore and Hafizabad indicating switching as compared to Gujranwala and Rawalpindi, albeit the quantum of change was significantly higher in Round-2. The increase in prices of cooking oil and Ghee over the past year (nearly thrice the increase in wheat flour prices) may explain the lower brand loyalty in Ghee/cooking oil brands.

The top reasons cited by households for switching to their current brands remained largely consistent in both rounds, with a slight change in the ranking order. They include ‘better quality’, ‘cheaper/economical’, ‘good for health’, ‘easily available’ and ‘better tasting’.

3.6.6. Quantity of Ghee/Cooking Oil Consumed

The average quantity of Ghee/cooking oil purchased in the Early Districts in Round-2 comes out to 3.65 kg (or liter), with this quantity reportedly lasting for an average of 17.09 days. This indicates monthly household consumption of 6.41 kg (or liters) or a daily consumption of 0.21 kg (or liter). On a per capita basis this calculates to 15.58 kg (or liters) per year using a mean household size of 4.92 members. In Round-1, the estimated annual consumption of Ghee/cooking oil, based on modal range-based response, was 14.4 – 24 kg per capita.

3.6.7. Cost of Ghee/Cooking Oil Consumed

Average cost per kg (or liter) of Ghee/cooking oil in the Early Districts in Round-2 was recorded at PKR 170.95 (overall eight-district average in Round-2 at PKR 163.15). Monthly household cost, therefore, comes to PKR 1,096. Per capita cost of consumption for Ghee/cooking oil is estimated at PKR 2,579 per

year, using the mean household size of 4.92, and compares against the range of PKR 1,802 – 3,600 in Round-1.

3.7 Attitude and Perception about Food Fortification

A wide range of questions were asked about fortified food products to obtain insights into respondents’ attitude and perceptions towards fortified foods. It was found that less than 20% of the respondents actually knew of people within their social circle who may be suffering from a nutritional deficiency, with 33.8% being uncertain. Respondents from Rawalpindi (32.8%) were most aware of such persons, followed by Peshawar (24.3%). Mostly, respondents were unaware of people suffering from malnutrition or uncertain about it.

Table3.30: Knowledge of Persons Suffering from Nutrition Deficiency (AT2)

Respondents were asked to rate their response on a scale of 1 to 5 against a number of questions pertaining to their attitude and perception towards food fortification (with 5 indicating strength and 1 indicating weakness of response). It is pertinent to note that before asking these questions, the respondents were read out an explanatory statement26 briefly describing the idea of Food Fortification. The responses indicate a generally positive perception and attitude towards food fortification across all districts and income segments, with rural respondents indicating a greater appreciation than urban. About 75% of all households indicated that the idea of food fortification was a plausible one – including 55.4% strongly agreeing with the statement and 19.2% agreeing generally. About 81.3% thought that food fortification had major health benefits with 82.7% agreeing that it could be effective in improving the health of the entire family. Interestingly, about 76% of all the respondents expected the taste of fortified foods to be different than unfortified foods and 71.7% thought even the appearance could be different. However, only 57.5% of the households indicated that fortified foods were easily available in the market and even less (48.8%) indicated that related information was easily available. Nearly 80% of all respondents stated that they would switch to fortified foods if those were available in the market alongside their unfortified alternatives, with 61.6% indicating a strong preference. Narowal respondents indicated the highest preference (85.6%) for fortified foods among all districts and Rawalpindi reported the highest aversion (10.6%). Details are provided in the table below.

26 The explanatory statement was provided by FFP and was the Urdu translation of: “Global experts and scientist consider food fortification as one of the top four strategies for reducing micronutrient diet deficiency. Food fortification (additional nutrients) means that additional minerals and vitamins be included in the basic food so that deficiency of these nutrients can be improved. Basic eatable foods like wheat flour is usually fortified with iron, folic acid, vitamin B12 and zinc which helps in preventing anemia and birth defect, develop resistance to infection amongst the young and improve their mental growth. Similarly, edible oils/Ghee is also fortified with vitamin A and D. In developing countries, deficiency of Vitamin A is the biggest reason of blindness among children, and Vitamin D helps the human body in resistance against bone diseases. Besides, it helps fight against several metabolic diseases as well as a number of other medical complications (especially in women)”

Table 3.31: Attitude and Perceptions (AT, Rating)

Midterm Report: Round-2 Survey

FFP Rolling District Study

Finally, the respondents were asked to state the top three benefits of fortified foods in their perception. Health benefits were by far the most cited advantage across all districts. There was some variance in ranking of benefits across the surveyed districts however. The most cited benefits exceeding 1% of all responses, are presented in the table below. Some reasons cited were quite specific (e.g. ‘Added Iron’) while some were general (e.g. ‘Full of Nutrition’), however most reasons may be linked to health benefits and prevention of illness.

Table 3.32: Perceived Benefits of Fortified Foods – based on Top 3 Unaided Responses (AT19)

3.8 Early District Comparison on Attitude and Perception – Round-1 vs Round-2

On comparison of survey findings against attitude and perceptions across the four Early Districts, we have the following observations:

 Public skepticism among the households regarding the believability of the idea has significantly improved from Round-1 to Round-2. Not only has the perceived believability about food fortification increased in absolute terms from 69% to 71%, but also the relative strength of perception has grown substantially. The respondents strongly agreeing with the idea of believability has improved from 21% in Round-1 to 53% in Round-2.

 The perception about the benefits for health from food fortification has also seen a major Improvement – again both in terms of absolute percentages - from 67% in Round-1 to 79% in Round-2, with respondents feeling strongly about it increasing from 22% to a decisive 61%.

 Similarly, the overall perception about the effectiveness of food fortification for the health of the entire family in the household has also jumped from 78% in Round-1 to 81% in Round-2, with respondents feeling strongly about this benefit increasing from 38% to a resounding 66%.

 There has, however, been an overall decline in the perception that information on food fortification is easily available – from 56% to 52%. Despite that, however, respondents feeling strongly about ease of information has actually increased from 22% to 39%. This should be viewed together with the jump in strong dissatisfaction with information availability from 3% to a nearly 24%. This, however, may not necessarily be a cause of concern for FFP as it hints at an increase in public awareness about food fortification and hence a greater demand for more knowledge regarding the same.

 Confusion about the taste and appearance of fortified foods being different from unfortified alternatives is seen to persist over the two rounds: respondents perceiving the taste to be different increased from 70% in Round-1 to 77% in Round-2 while those expecting the appearance to be different increased from 57% to 73%. Among these respondents, the ratio of those feeling strongly about this perception also increased substantially. Interestingly, however, the proportion of households perceiving the two alternatives to taste similar also increased slightly, with those feeling strongly about it growing significantly.

 There was significant reduction in respondents claiming to actually know persons in their social network who are suffering from malnutrition. Households were more certain in Round-2 that they did not know persons suffering from nutrition deficiency.

Figure 3.18: Perception on Taste and Appearance of Fortified Foods - Early Districts (Round-1 vs Round-2)

Taste of Fortified Foods

Appearance of Fortified Foods

 In a positive culmination of the section, the Households indicating they would switch to fortified alternatives of food products rather than unfortified if both were available in the market has also grown from an overall 77% in Round-1 to 80% in Round-2. Furthermore, the respondents indicating a strong will to switch to fortified foods have jumped from 34% to nearly 65%. This appears to be an encouraging outcome of FFP’s efforts in the Early Districts over the last one year

Figure 3.19: Attitude and Perception about Food Fortification (Round-1 vs Round-2)

3.9 Price Perception and Sensitivity of Wheat Flour

About 69.6% of all the respondents thought that fortified wheat flour was priced at more than the unfortified product, with 18.4% perceiving it to be at the same price and 12% considering it to be priced lower. The pattern is more or less similar across income groups and districts except Karachi where 50% of the respondents indicated that fortified wheat flour was more expensive, 45% understood it to be at the same level as unfortified and only 5% said that was cheaper.

Households demonstrated a relatively low level of price sensitivity with about 78.5% of the respondents indicating their willingness to purchase fortified wheat flour even at a cost higher by PKR 1 per kg than the unfortified alternative (see Table 3.33 below). Low price sensitivity was seen across all income levels, with higher quintiles showing even lower sensitivity. The highest price sensitivity was reported Rahim Yar Khan where 70.1% respondents indicated their willingness to buy at an additional PKR 1/kg. The tendency to buy fortified flour increased to 85.2% overall if the price differential was reduced to PKR 0.50 per kg, while 91.2% of all respondents indicated their willingness to buy fortified wheat flour if it was priced at the same level. About 8.8% of the households, however, remained either undecided or unwilling to buy fortified wheat flour. This proportion was the highest for Rahim Yar Khan (14.5%) followed by Gujranwala (13.3%); and lowest for Lahore (4.3%). The reason for resisting fortified wheat flour may be attributable to the significantly more economical wheat flour obtained through grinding own wheat grain at local Chakki mills, as Rahim Yar Khan is among the largest wheat growing districts of Pakistan and Gujranwala is a major production district also. More urbanized districts demonstrated a lower level of price sensitivity and a greater openness to shift to fortified wheat flour with the lowest proportion of resisters.

Table 3.33: Price Sensitivity towards Fortified Wheat Flour (P2 – P4)

3.10 Price Perception and Sensitivity of Ghee/Cooking Oil

More than 77% of all the respondents thought fortified Ghee/cooking oil is priced higher than the unfortified alternative, with 13.7% understanding it to be at the same level and 9.2% to be lower. Much like the wheat flour responses, the pattern is more or less consistent across all income groups and all districts except Karachi where 57% of the respondents perceived fortified Ghee/cooking oil to be priced higher, 38% to be at par and only 5% thought it was cheaper. Also, in Narowal, nearly 94% of the respondents thought fortified Ghee or oil was priced higher, which is significantly higher than other districts.

For fortified Ghee/cooking oil also, the Households demonstrated a considerably low level of price sensitivity with about 81.6% of all respondents indicating their willingness to buy the fortified version even if it was priced PKR 1/kg (or liter) higher than the unfortified product. Price sensitivity was seen to be consistently low at more or less the same level across all income segments. The districts also showed a similar pattern with Rahim Yar Khan indicating the highest price sensitivity with the ratio of respondent willing to buy at an incremental PKR 1/kg at 72.7%. In Hafizabad this ratio was the highest at 89.7%. Willingness to buy fortified Ghee/cooking oil increased to 86.4% overall at an incremental cost of PKR 0.50/kg rather than PKR 1, while 92.6% of all respondents were willing to buy fortified if it was available at the same price as the unfortified alternative. There were, however, 7.4% of the households who indicated their unwillingness or uncertainty about buying fortified cooking oil/ Ghee. This ratio was once again the highest for Rahim Yar Khan (12.9%) and the lowest for Lahore (4.5%).

Table 3.34: Price Sensitivity towards Fortified Oil/Ghee(P6-P8)

3.11 Early Districts Comparison on Price Perception – Round 2 vs. Round 1

On analyzing the findings of Round-1 and Round-2 with respect to pricing perception and sensitivity among households, we make the following observations:

3.11.1. Price Sensitivity - Wheat Flour

Our observations on the comparison between Round-1 an Round-2 on price perception and sensitivity of Households against wheat flour are highlighted below:

 The perception question comparing the pricing of fortified and unfortified wheat flour may not be comparable as two slightly different questions were asked in the two rounds. While in Round1 the households were asked as to ‘how should’ fortified wheat flour be priced viz-a-viz the unfortified product, in Round-2 they were asked ‘how was’ it priced. The responses to the two questions are therefore very different. While the majority of the respondents wanted the fortified product to be priced lower or at par to incentivize its consumption (in Round-1), the majority in Round-2 thought that fortified wheat flour was priced higher or at par with the unfortified alternative.

 In terms of price sensitivity, Households in the Early Districts have become slightly less price sensitive towards fortified wheat flour over the past year. It is interesting to note that the retailers perceive consumer price sensitivity to have increased significantly over the year.

 Households willing to buy even at a higher price by PKR 1 per kg as compared to the unfortified alternative, have increased from 76% in Round-1 to 82% in Round-2. Willingness to buy at an incremental PKR 0.5/kg has also increased from 84% to 86%. Overall propensity to shift to fortified wheat flour has increased with a marked improvement among rural households.

Table 3.35: Price Sensitivity towards Fortified Wheat Flour (P2-P4) - Early Districts (Round-1 vs Round-2)

 The proportion of households in the Early Districts remaining unwilling or undecided to buy fortified wheat flour (the ‘Resisters’) declined from 10.9% to 8.6% in Round-2 (see Table 3.36 for details).

 Among districts, the most noticeable improvement was observed in Hafizabad with price sensitivity improving significantly and the ratio of ‘Resisters’ declining from nearly 25% in Round-1 to 8.6% in the second round. Conversely, households in Gujranwala reflected a negative change in perception with ‘Resisters’ increasing from about 8% to more than 13%. This shift is in line with the perception of Retail Suppliers surveyed during the two rounds as well, although less pronounced. See Table 3.36 below.

Table 3.36: ‘Resisters’ against Fortified Wheat Flour and Cooking Oil/ Ghee(P2-P4)

Note: ‘Green’ indicates an improvement in Round-2 from Round-1, ‘Red’ indicates deterioration and ‘Yellow’ indicates no change.

3.11.2. Price Sensitivity – Ghee/ Cooking Oil

Our observations on the comparison between Round-1 an Round-2 on price perception and sensitivity of Households against Ghee/Cooking Oil are highlighted below:

 Price sensitivity appears slightly less for fortified oil/Ghee than wheat flour - a finding that is consistent with Retail Suppliers’ perception.

 Just as for wheat flour, the perception question comparing the pricing of fortified and unfortified Ghee/cooking oil may also not be comparable due to the two slightly different questions posed during the two rounds (refer to Section 3.11.1 above). While the majority of the respondents wanted the fortified product to be priced lower or at par to incentivize its consumption (in Round-1), the majority in Round-2 thought that fortified Ghee/cooking oil was priced higher or at par with the unfortified alternative.

 In terms of price sensitivity, Households in the Early Districts have become slightly less price sensitive towards fortified Ghee/cooking oil over the past one year. It is interesting to note that the Retail Suppliers perceive consumer price sensitivity to have increased significantly over the year.

 Households willing to buy fortified oil/Ghee even at a higher price by PKR 1 per kg (or liter) as compared to the unfortified alternative, have increased from 78% in Round-1 to 84% in Round2. Willingness to buy at an incremental PKR 0.5/kg and the overall tendency to buy fortified Ghee/cooking oil has remained more or less consistent over the two rounds, with rural households showing a slight improvement.

 Rural respondents in the Early Districts have also shown a decline in ‘Resisters’ i.e. households remaining unwilling or undecided to buy fortified oil/Ghee – from 7.5% in the first round to 6% in Round-2 (see Table 3.36 for details).

Table 3.37: Price Sensitivity towards Fortified Ghee/Cooking Oil (P6-P8) - Early Districts (Round-1 vs Round-2)

Midterm Report: Round-2 Survey FFP Rolling District Study

 Among districts, the biggest improvement was once again observed in Hafizabad with price sensitivity easing and the ratio of Resisters decreasing from about 11% in Round-1 to only 2.5% in the second round. On the other hand, households in Gujranwala indicated a negative change in perception with Resisters increasing from about 4.5% to 9.7%. This trend is consistent with the perceptions indicated by the Retail Suppliers surveyed during the two rounds as well.

Figure 3.20: Price Sensitivity Towards Food Fortification (P6-P8) - Early Districts (Round-1 vs Round-2)

3.12 Communication

The section on Communication has been significantly reduced in Round-2 from the previous round with only two questions posed to the respondent. Highlights of the findings are presented in this section exploring the following two areas:

 Extent to which the respondents saw or heard any promotion about fortified wheat flour and related food products.

 Extent to which the respondents saw or heard any promotion about fortified Ghee/cooking oil and related food products?

3.12.1. Exposure to Promotion Related to Fortified Wheat Flour

The modal response from all eight districts was that (67.7%) respondents had never heard or seen any promotion about fortified wheat flour or related products, with the households in Hafizabad being the least aware of any such promotion (83%), followed by Rahim Yar Khan (77%), Peshawar (76.4%) and Lahore (73.2%). Narowal, Gujranwala and Rawalpindi, on the other hand, indicated the highest level of exposure with 45.7%, 42.3% and 42.2%, respectively, claiming to have experienced at least some level of promotion related to fortified wheat flour. About 9.5% of the households in Gujranwala and 9.3% in Narowal indicated having often seen or heard such promotion – being the highest in all surveyed districts. Households in Karachi also had a relatively high level of exposure to promotions regarding wheat flour fortification (38.7%). It appears that there has been some level of promotional activity in all surveyed districts (whether by FFP or other sources) based on their responses of ‘Often’, ‘Occasionally’ and ‘Sometime’, though Narowal, Gujranwala, Rawalpindi and, to a lesser extent, Karachi indicate a relatively higher recall.

Figure 3.21: Exposure to Promotion on Fortified Wheat Flour (CM16) – Households

Analyzing results by income quintiles, it appears that whilst the modal response remains ‘Never’ in all segments, the highest proportion of households in the lowest income segment indicated never to have seen or heard any promotion about wheat flour. Rural respondents indicated lower exposure than urban with, respectively, 71.2% and 65% households recalling never to have seen any related promotion.

3.12.2. Exposure to Promotion Related to Fortified Ghee/Cooking Oil

A very similar pattern to wheat flour is seen for fortified Ghee/cooking oil also, with a slight improvement in recall. A majority of respondents (64.5%) across all eight districts indicated never to have seen or heard any promotion regarding fortified Ghee/cooking oil. Respondents in Hafizabad had the least recall with 80.8%, followed by Peshawar (77%), Rahim Yar Khan (73%) and Lahore (70%). Narowal households had the highest exposure with 53.5% respondents claiming to have seen or heard at least some level of related promotion, and 24.2% (the highest in all districts) indicated to have experienced it often. Respondents from Gujranwala and Rawalpindi followed closely with 48.3% and 44.8% overall exposure, with Karachi (40%) also indicating a relatively higher level of exposure to promotions related to fortified Ghee/cooking oil. An inference can be made in this case also that all districts had some exposure to such promotional activity as even Hafizabad reported 19.2% recall of related promotions.

Figure 3.22: Exposure to Promotion on Fortified Ghee/Cooking Oil (CM16a) – Households

Analyzing results by income quintile, a similar pattern is seen with ‘Never’ being the modal response across all income segments, and the lowest exposure to promotional activity reported by the lowest income quintile. Rural households indicated a slightly lower exposure than urban with 67.8% and 61.9%, respectively, indicating never having seen or heard any related promotion.

3.13 Early Districts Comparison on Communication – Round 1 vs. Round 2

The section on Communication was considerably curtailed in Round-2, from 18 questions in Round-1 to only two questions in the second round. We understand a separate study has been commissioned by FFP to evaluate promotional activity in selected districts as well as target population’s communication habits and access to media.

Furthermore, the questions in both rounds are different and a direct comparison is not possible. While in the first round the extent of exposure to promotional activity related to ‘fortified foods’ in general is assessed, the second round specifically address ‘fortified wheat flour’ and ‘fortified Ghee/cooking oil’ in two separate questions.

While a direct comparison between the two rounds would not provide an accurate comparison, it may be interesting to draw a broad, product-based analysis. A comparison between the two rounds indicates that while a majority of households in the Early Districts recall some level of promotional activity related to fortified food products in general, most of them did not remember any promotions related specifically to fortified wheat flour or Ghee/cooking oil (see graph below).

Midterm Report: Round-2 Survey

FFP Rolling District Study

Figure 3.23: Exposure to Promotion on Fortified Foods – Households - Early Districts Comparison (Round-1 vs Round-2) (CM16 and CM16a)

4. MIDTERM SURVEY FINDINGS – RETAIL USERS

In an effort to ascertain in a more holistic manner the access of target resident population in the surveyed districts to fortified wheat flour, a new layer of respondents namely ‘Retail Users’ has been included in the Round-2 survey for FFP Rolling District Study. These Retail Users located within the vicinity of the households surveyed include commercial retailers of routinely consumed food items that are produced inhouse using wheat flour as a primary raw material. As the focus of this module is wheat flour, no Ghee/cooking oil related questions have been asked.

In accordance with the design of the survey instrument, the Retail User Survey findings for this module are presented under the following heads:

 Awareness about Food Fortification

 Usage of Wheat Flour

 Price Perception and Sensitivity towards Fortified Wheat Flour

 Communication and Awareness of Fortified Wheat Flour

A total of 1,221 Retail Users were surveyed during Round-2 from across the eight districts. Of these 652 were Naan shops, 69 branded bakeries, 344 roadside restaurants and 156 non-branded bakeries. The six most commonly sold food items by these Retail Users were reported as:

4.1 Awareness about Food Fortification

Screened Retail Users of wheat flour were asked an unaided question, as in the case of Households, to assess their top of mind awareness regarding fortified wheat food products, without any introductory explanation about food fortification. On being asked what food product came to mind first when Food Fortification was mention, Roti (33.6%) and Wheat Flour (25.6%) were by far the most frequently cited responses (see table below). Wheat (2.7%) and Naan (2.5%) also found a place among the top ten mentions. Ghee and Desi Ghee were mentioned by only 1% of the respondents each, with cooking oil mentioned by less than 0.5%. About 5.7% of the respondents could not think of any fortified foods.

Table 4.1: First Food Item to Come to Mind when

mentioned

‘Food Fortification’ was

(A1, Unaided)

Midterm Report: Round-2 Survey FFP Rolling District Study

Retailer Users were also asked to indicate their perception about fortification of six selected wheat flourbased products (slightly different from the ones used for Households), and the results have been tabulated below. Roti was universally perceived as a fortified product across all eight districts with 90.4% respondents indicating that overall, followed by Paratha (62.9%) and Kulcha/Naan (53.2%).

Respondents indicating wheat flour as a food which came to mind when fortification was mentioned, were asked about the source of this information, and word of mouth through discussions heard from people (31.6%) was cited the most times, followed by TV (27.2%), through own experience(12.8%), retailer/wholesaler from where wheat flour was sourced (12.1%) and family/friends (12.1%). Interestingly, word of mouth was communicated as a more important medium surpassing television and the reasons may be attributable to the fact the respondent, unlike in the case of Households, is exposed to a larger number of more well-informed influencers such as suppliers, employees, competitors and customers.

Respondents were then probed to indicate the message conveyed by the medium or information source where he had learned about fortification of wheat flour. The top five messages perceived by Retail Users are provided in the table below which were widely cited by respondents across the eight districts. The message mentioned by most respondents over all was that it prevented illness (31.3%). This may be seen to support the ‘Good for Health’ message perceived by the Household.

Table 4.3: Messages Conveyed Through Information Source on Wheat Flour Fortification (A4)

Table 4.2: Selected Wheat Flour Products Perceived to be Commonly Fortified (A3)

Midterm Report: Round-2 Survey FFP Rolling District Study

4.2 Usage and Consumption Pattern of Wheat Flour

Several usage questions were posed to Retail Users to understand their utilization and sourcing of wheat flour, brands and type of product in use, quantity consumed and sale of selected wheat flour-based food products. Findings are presented below.

4.2.1. Sourcing of Wheat Flour

The table below shows the reported source of wheat flour routinely bought by Retail Users across all the districts surveyed.

Table 4.4: Source of Routinely Purchased Wheat Flour (U1)

Analysis shows that while the retailer is the largest cited source, overall, of wheat flour obtained by the Retail Users, flour mills are the predominant source of supply for urban districts like Lahore, Rawalpindi and Karach. Most Retail Users from the more rural/semi-urban districts like Hafizabad, Rahim Yar Khan and even Peshawar rely primarily on retailers. In Gujranwala, wheat flour is sourced more or less equally, about a third each, from retailers and flour mills. Unlike the Households category, the Chakki is not a major direct source of wheat flour amongst Retail Users, even in the major production districts. This may be potentially due to the fact that Retail Users need to purchase regularly in bulk quantities and a steady, reliable source of wheat flour is a critical need which a Chakki, being typically a localized, informal, small capacity operation, may not be able to comply with. The retailer can act as the middleman between the Retail User and Chakkis/flour mills/wholesalers to provide this service for Retail Users.

Midterm Report: Round-2 Survey FFP Rolling District Study

Figure 4.1: Sourcing/Procuring of Wheat Flour by Retail Users (U1)

4.2.2. Brand and Type of Wheat Flour

About 243 brands were reported to be in use by Retail Users in addition to unbranded wheat flour which remained the overall modal type with 10.8% - though considerably less than as reported by Households. Unbranded wheat flour had the highest utilization by Retail Users in Karachi. A significant number of respondents (9.7%) could not answer which brand of wheat flour was being used by them. Other than the few major brands, nearly all other reported were less known local brands. Top 10 brands reported to be in use by respondents from across the eight districts are tabulated below, with the more popular brands across multiple geographies colour coded.

Table 4.5: Top Brands of Wheat Flour Used (U2)

Midterm Report: Round-2 Survey FFP Rolling District Study

A majority of the Retail Users consumed fine flour (53.9%), a relatively finer version of wheat flour which is whiter in colour, with respondents in Gujranwala reporting the highest usage of nearly 74%. This was followed by regular wheat flour (26.7%), a slightly courser and browner variety normally used in households for making Roti, which was used the most in Rawalpindi (45.3%). Maida or refined flour, which is generally used for making Samosas, bread, Khatai/biscuits etc was reported in use by the fewest respondents (19.4%), with no respondents from Lahore indicating usage (see Figure 4.2 below).

4.2: Type of Wheat Flour in Use by Retail Users (U5)

4.3: Packaged or Loose Flour Purchased (U6)

About 87.6% of the Retail Users reported buying packaged wheat flour, the highest (97.4%) in Peshawar. However, respondents in Narowal (30.9%), Hafizabad (28%) and Karachi (23.9%) indicated the highest incidence of flour purchased in loose form (see Figure 4.3). Upon inspection of the packaging (81.6% of the packaged wheat flour users provided the packaging for inspection), the following observations were made:

Figure

(Brown)

Figure

Loose Flour Packaged Flour

◼ Labels on about a third of all packages (33.5%) had some mention of fortification, either in writing or logo, with a number of packages indicating in writing that the wheat flour in them was fortified27 .

◼ Urban Retail Users had a greater incidence of packages indicating fortified wheat flour (38.9%) as compared to rural (26%)

◼ Rawalpindi had the least proportion of packages indicting fortification (6.7%) followed by Peshawar (13.7%)

◼ Karachi’s packages had the highest proportion of fortification labeling (59.7%), followed by Gujranwala (46.1%)

On being asked why the particular brands were purchased, the top five reasons quoted by Retail Users are tabulated below.

Table 4.6: Reasons for Purchasing Brand of Wheat Flour (U7)

The wheat flour being fortified was quoted as a reason for choice by 7.6% of the respondents as shown above, with Karachi citing it the highest at 20%. Although a relatively low ratio overall, it is considerably better than Households’ response and indicates a greater level of awareness about food fortification and its value among Retail Users.

A question was asked to gauge switching behavior regarding wheat flour (similar to the Households survey). About 13.4% of the Retail Users indicated that they had switched during the past one year to the brand they were currently using, as compared to 7.7% for the Households. Given the quantum of consumption (estimated at an average of average of 23.5 kg per day) and the business perspective of the Retail Users, it appears that cost, availability and other supply chain related factors may be relatively more important for this category of respondents than brand loyalty.

Nevertheless, a relatively high level of brand loyalty was observed across all districts with over 80% of respondents from five out of eight districts, i.e. Lahore, Rawalpindi, Hafizabad, Karachi and Rahim Yar Khan, indicating that they had not switched brands during the previous one year. Interestingly, the lowest switching behaviour was observed in Karachi where the use of unbranded wheat flour was reported to be the highest among all districts. Reasons cited for shifting to their current brands are tabulated below.

Table 4.7: Reasons for Switching to the Current Brand of Wheat Flour (U9)

27 Note: None of the 807 samples tested were verified as fortified.

4.2.3. Quantity and Cost of Wheat Flour Used

Following the same approach as the Households, Retail Users were asked to indicate the quantity of wheat flour used by their respective establishments during the last one month. They were also asked to indicate how long this quantity of wheat flour usually lasted. Average quantity reported to have been purchased by each entity was recorded at 698 kg, lasting for an average of 29.7 days or nearly a month. This indicates an average annual consumption of about 8,579 kg and monthly consumption of around 715 kg.

The average rate of purchase reported for the wheat flour was PKR 38.84 per kg, indicating an average yearly cost of PKR 333,245 per Retail User or PKR 27,770 per month.

4.2.4. Sale of Wheat Flour Based Products

The Retail Users were asked to indicate the highest selling products at their outlets and Roti stood out with 63.9% followed by Kulcha/Naan (27.4%), Samosa (16.3%), Paratha (8.2%) and Khatai/Biscuit (4.2%) –being the top five products. The wide consumption of Roti and Kulcha/Naan (commonly consumed as substitutes) indicates the staple nature of the items.

4.2.5. Perception of Wheat Flour Used as Fortified

Retail Users were asked an unaided question about their perception about the wheat flour being used at their establishment whether it was fortified or not. The intent was to find out if any Retail Users were deliberately trying to avoid fortified wheat flour. Much like the Household segment, a small proportion (7.6%) of the respondents indicated that they were not using fortified wheat flour, which is consistent with 8.6% reported by the Households. They gave the following reasons for not using fortified wheat flour:

Table 4.8: Highest Selling Wheat Flour Products at the Retail User Outlets (U13)

 Not aware of wheat flour being fortified (60.2%)

 Not aware that fortified wheat flour was available in the market (16.1%)

 Did not want to buy fortified wheat flour (21.5%)

 Fortified wheat flour was adulterated (1.1%)

Of the above respondents reporting use of unfortified wheat flour, only about 22.6% may be considered as intentionally avoiding the fortified alternative, and therefore termed as ‘Resisters’.

About 62.5% of the Retail Users, however, reported that they were using fortified wheat flour at their outlet, with almost a third (29.9%) not knowing. This may be read together with the above finding that 33.5% of the packaging examined were found to have labels stating a fortified product (bearing in mind that 81.6% of the respondents provided the enumerators their product packaging).

4.3 Price Perception and Sensitivity of Wheat Flour

Around 65.8% of all the respondents thought that fortified wheat flour should be priced at more than the unfortified product, with about 23.7% expecting it to be at the same price while 10.6% thought it should be priced lower. The pattern is more or less similar across all districts except Karachi where the modal response (49%) was for the two products being priced at the same level, followed closely by the fortified product being more expensive (45.2%), while only 5.8% expected fortified wheat flour to be cheaper than the unfortified alternative.

While Retail Users demonstrated a relatively low level of price sensitivity, they were still more price sensitive than Households perhaps because wheat flour formed an important raw material for their businesses with a direct impact on profitability margins. About 74.8% of the respondents indicated their willingness to purchase fortified wheat flour even at a cost higher by PKR 1 per kg than the unfortified alternative (see table below). More or less similar levels of price sensitivity was seen across all districts except Narowal and Hafizabad where the Retail Users showed a significantly lower price sensitivity at 86.8% and 86.7%, respectively. This was followed by Karachi at 77.4%. Peshawar was the most price sensitive with 66.2% indicating willingness to buy at an additional PKR 1 per kg. The tendency to buy fortified flour increased to 80.6% overall if the price differential was reduced to PKR 0.50 per kg, with Narowal growing to 93.4%, Hafizabad to 90% and Karachi to 82.6%. About 88% of all the Retail Users indicated willingness to buy fortified wheat flour if it was available at no additional cost to unfortified wheat, with nearly 12% remaining either unwilling or undecided. The highest proportion of these ‘Resisters’ was found in Gujranwala (19.1%), followed by Rahim Yar Khan (17.8%); while the lowest were found in Hafizabad (4%) followed by Narowal (5.3%).

Table 4.9: Price Sensitivity towards Fortified Wheat Flour (P2 – P4, Single Response)

4.4 Communication

The following three areas related to communication and media were explored for Retail Users:

 Extent to which the respondent saw or heard any promotion about fortified wheat flour and related food products.

 For respondents indicating having seen or heard such promotions, identification of the most frequent source of communication channel of information

 Extent to which the respondent’s purchase decision is influenced by such promotion.

Most respondents (68.6%) indicated that they had never heard or seen any promotion about fortified wheat flour or related products, in fact this was the modal response overall much like the Households. Surprisingly, respondents in Lahore appeared to be the least aware of such promotions with 82.1% reporting they had never seen or heard such promotions, followed by Narowal (74.3%), Hafizabad (71.3%), Peshawar (70.8%) and Rahim Yar Khan (70.4%). Karachi, on the other hand, appeared to be the most aware with 49% respondents claiming to have been exposed to at least some level of fortified wheat flour related promotions. Rawalpindi and Gujranwala followed with 35.3% and 35%, respectively, having seen or heard at least some related promotion. It appears that there has been some level of promotional activity in all districts based on the responses indicating exposure to at least some such promotions (whether often, occasionally, or sometimes) either from FFP itself or product marketing companies, government agencies or other actors in the ecosystem.

Figure 4.4: Extent of Exposure to Promotion on Fortified Wheat Flour (CM1) - Retail Users

The most frequently cited communication channels by the respondents, through which they had seen or heard the promotion about wheat flour fortification, were word of mouth (35.8%) and TV (35.2%). This appears to be consistent with the early findings in the Awareness section where Retail Users have indicated word of mouth and TV as primary sources for their information on food fortification.

Figure 4.5: Communication Channels for Fortification Information (CM2) Retail Users

From the above figure it may be inferred that in the Early Districts TV was the most frequently used channel for information about fortification, however in Karachi and Rahim Yar Khan, ‘word of mouth’ was the most important communication source. Interestingly, in Peshawar all key mediums, namely TV, newspaper, shopkeeper and word of mouth, all received more or less equal significance.

Another question seeking to assess the extent of influence exerted by communication and promotions on the respondents’ purchase decision was put up to the Retail Users (findings provided in Figure 4.6 below). About 60.2% of all the respondents reported that their purchase decision could be prompted (i.e. moderately or strongly influenced) by the promotions they saw or heard. It appears that the Retail Users in Narowal were by far the most strongly influenced by promotional activity with 80.9% considering their purchase decisions to be significantly motivated by such promotions and another 4.6% moderately influenced (or 85.5% positively influenced overall). Respondents from Hafizabad (72.7%), Karachi (70.3%) and Rahim Yar Khan (68.4%) also indicated a significant level of influence. Peshawar respondents reported to be the least moved by promotional campaigns with 46.1% indicating no or little influence, followed closely by Rawalpindi (41.3%). More urban respondents remained neutral on the fence than rural.

Figure 4.6: Influence of Promotion on Purchase Decision of Retail User (CM3)

5. MIDTERM SURVEY FINDINGS – RETAIL SUPPLIERS

This section of the Report covers the Midterm Survey findings of the Retail Supplier module, presented under the following heads:

 Awareness about Food Fortification

 Availability of Wheat Flour and Oil/ Ghee

 Price Perception and Consumer Sensitivity towards Fortified Wheat Flour and Oil/ Ghee

A total of 1,234 Retail Suppliers were surveyed in eight districts, namely Lahore, Rawalpindi, Hafizabad, Gujranwala, Karachi, Rahim Yar Khan, Peshawar and Narowal. Of the 1,234 retailers, 822 sold wheat flour and 1,184 sold Ghee/cooking oil with 772 retailers selling both the products. Out of 822 retailers selling wheat flour, 780 had the product in stock at the time of the interview, and 1,162 of the 1,184 retailers selling cooking oil/ Ghee had the product in store.

5.1 Awareness about Food Fortification

Screened retailers selling wheat flour or Ghee/cooking oil in all districts surveyed were asked questions (A1 and A3) to assess their top of mind awareness regarding fortified food products, without giving any explanation or information on what ‘food fortification’ meant. On being asked what single food item came to mind when ‘food fortification’ was mentioned, a diverse variety of foods and food products were mentioned. The highest overall mention was Flour28 (33.2%), followed by Roti (15%), Milk (6.6%) and Ghee (4%). ‘Cooking Oil’ was mentioned by 3% of the respondents. About 2% of all respondents did not or could not respond (see Table 5.1 below).

Table 5.1: First Food Item to Come to Mind when ‘Food Fortification’ was mentioned (A1, Unaided)

Midterm Report: Round-2 Survey FFP Rolling District Study

The Retail Suppliers were also asked to indicate if they thought the selected six food products, namely Kulcha/Naan29 , Roti30, Bread Slice, Khatai31/Biscuits, Afghani Naan and Paratha32, were fortified or not. A vast majority (91%) perceived Roti to be fortified, followed by Paratha (64%).

Table 5.2: Selected Wheat Flour Based Food Products Perceived to be Fortified (A3 Aided)

5.2 Early District Comparison on Awareness – Round-1 vs Round-2

A direct comparison of this section cannot be drawn between Round-1 and Round-2 due to major changes in the approach and structure of the questions. Firstly, and most importantly, in Round-1 an explanatory brief on food fortification was read out to the respondents by the enumerators before the questions were posed, acquainting them about the concept of food fortification. In the second round, the first question was aimed at gauging respondents’ top-of-mind awareness. Furthermore, the number of questions and responses sought were also not similar (multiple vs single responses). Nevertheless, it is interesting to note that both ‘Flour’ and ‘Ghee’ were among the top 5 mentions in both rounds in the Early Districts overall. The significance of ‘Flour’ is important in Round-2 because of the unprompted structure of the question as well as the number of mentions by respondents (41% in Round-2 as compared to 20.7% in Round-1. In addition, ‘Roti’, generally made out of wheat flour, is also mentioned among the top 5 in Round-2 taking the total to 48.9%. ‘Ghee’, however, lost its standing significantly over the year from 23.7% in Round-1 to only 6.2% in Round-2.

29 Kulcha and Naan are types of native bread made usually out of refined wheat flour and baked in clay ovens indigenous to Pakistan.

30 Roti is a type of native bread made with wheat flour.

31 Khatai is an indigenous type of biscuit made out of refined wheat flour

32 Paratha is a type of local bread made out of wheat flour and fried in Ghee/ cooking oil

Figure 5.1: Top 5 Food Mentions against ‘Food Fortification’ - Early District (Round-1 vs Round-2) (A1)

5.3 Wheat Flour

5.3.1. Availability and Visibility of Wheat Flour

A total of about 243 brands of wheat flour were reported to be in stock at the Retail Suppliers surveyed across the eight districts during Round-2. Wheat flour in loose form was available at 423 (54%) retail outlets out of the 780 having wheat flour in stock. The wheat flour market appears to be highly fragmented with a large unorganized segment, however some large brands like Punjab, Classic, Islamabad, Zameendar and OK/OK were found to be the top five brands in stock overall, albeit with relatively minor shares of retail shelf space. Some major brands also appear repeatedly among the top 5 across the surveyed districts as well (see Table 5.3). Most of the top brands stocked at the retailers were also cited by Households as top brands in use

Table 5.3: Top Brands in Stock and Share of Shelf - Wheat Flour (WF1)

The findings show that the top brands in stock (with the exception of ‘Punjab’) were not necessarily the brands enjoying high visibility. A bias towards smaller, highly localized brands may be seen among the retailers.

5.3.2. Wheat Flour Package Sizes

Wheat flour was available in a variety of package sizes ranging from 1kg, 5kg, 10kg, 20kg to bulk packs of 40kg, 50kg and 80kg - in addition to being sold in loose form in the quantity required by the customer.

5.3.3. Retail Prices of Wheat Flour

Rates ranged from PKR 32 to PKR 57 per kg (excluding outliers), depending on the size of the package and brand, with an average of PKR 39.45 and a modal rate of PKR 40 per kg. Rates of the top brands listed above were more or less consistent across markets, and available at the following average rates:

 Punjab PKR 40.86/ kg

 Classic PKR 38.15/ kg

 Islamabad PKR 43.03/ kg

 OK/OK PKR 39.85/ kg

 Zamindaar PKR 37.33/ kg

5.4 Early District Comparison on Availability of Wheat Flour – Round-1 vs Round-2

On comparative analysis of findings in Round-1 and Round-2 across Early Districts, we make the following observations:

5.4.1. Wheat Flour Brands

In Round-2 a total of 139 different brands of wheat flour were identified in stock in the Early Districts, as compared to 85 brands in Round-1. A majority of the brands were less known, local brands sold in narrow geographic locales. A key reason for this significant jump may be attributable to the additional instructions to enumerators to check the manufacturing source of the wheat flour brands available at the retail outlets (i.e. the flour mill or Chakki where it was produced) not sufficing with the primary brand on the label. For example ‘Fine’ alone was not accepted as a brand without cross referencing it with the package label and/or identifying the flour mill where it had been produced. This addition was made because in Round-1 it was discovered that ‘Fine’ wheat flour was distributed as both a brand as well as a category - a more refined, whiter version of wheat flour. An effort was made during Round-2 to report the brands as accurately as possible.

The wheat flour market appears to be highly fragmented with a large unorganized segment, with a large majority of the brands identified at the retailers sold in narrow geographic locales and stocked by only a few retailers in the area pushing the brand.

However, some large brands in the organized sector do spread across geographic boundaries. The top brands reported in both rounds to be stocked by retail outlets in the Early Districts are provided in the table below. The top-5 composition changed across the four districts over the two rounds however, Punjab, Zamindar and Yadgaar brands remained among the top 5 most stocked brands overall in both rounds (see table below).

Table 5.4: Top Brands Stocked for Wheat Flour – Early Districts (Round-1 vs Round-2) (WF1)

5.4.2. Wheat Flour Package Sizes

Wheat flour was available in a variety of package sizes in addition to being sold in loose form as per customer’s requirement. In both rounds, packaged wheat flour was found available in sizes ranging from 1 kg, 5 kg, 10 kg, 20 kg, 40 kg to 50 kg. However, additional bulk size of 80 kg was also found in stock in Lahore during Round-2.

5.4.3.

Price varied from brand to brand and with the quantity purchased or size of package, in a range of PKR 32-65 per kg in Round-2 as compared to PKR 30-56 in Round-1. Interestingly, the retail rates of wheat flour brands in stock have actually declined in the second round, with the modal rate declining to PKR 37.5 from PKR 40, and the average rate also down to PKR 39.50 from 39.80 per kg. This may be pointing towards an increasing tendency among retailers to stock a larger proportion of cheaper brands –also corroborated by a significantly larger number of brands identified in stock during Round-2.

Table 5.5: Unit Rate of Wheat Flour – Early Districts (Round-1 vs Round-2) (WF4)

Note: As per PBS average price per kg in the country for wheat flour was PKR 38.86 per kg as at end of April 2019. On a YoY basis, PBS has reported a 3.24% increase in wheat flour prices (data July – Apr 2019).

5.5 Ghee

5.5.1. Availability and Visibility of Ghee

A total of about 111 different brands of Ghee were identified to be in stock with the Retail Suppliers interviewed across the eight districts in Round-2. Ghee was also available in loose form at 116 retailers out of 1,162 (10%) having Ghee/cooking oil in store at the time. Ghee market is relatively less fragmented than wheat flour and major brands in the organized sector appear to enjoy significant share of the market, and retail shelf space as well as some retail visibility. Sufi, Dalda, Kiran, Sadiq and Kashmir were the top

Retail Prices of Wheat Flour

Midterm Report: Round-2 Survey FFP Rolling District Study

five Ghee brands in stock overall (see Table 5.6). Dalda is ubiquitous in that it found a place among top five across all geographies barring Hafizabad. Most of the other major brands as highlighted in the table below also transcend geographic boundaries and are widely supplied in various districts across the three provinces covered during Round-2 (Punjab, Sindh and Khyber Pakhtunkhwa).

Table 5.6: Top Brands in Stock and Share of Shelf - Ghee(G1)

5.5.2. GheePackage Sizes

A large variety of package sizes was available for Ghee but the most common sizes ranged from 250g, 500g, 1kg, 2.5kg, 5kg to bulk sizes of 10kg, 12kg, 15kg and 16kg. However, some brands were available in as small a size as 100g and 125g.

5.5.3. Retail Prices of Ghee

Rates ranged from about PKR 100 to PKR 260 per kg (excluding outliers), depending on the size of the package and brand, with an average of PKR 157.27 and a modal rate of PKR 160 per kg. For the major five brands listed above with the highest share of shelf overall, the prices were more or less consistent across markets. Their average prices were recorded as:

 Sufi PKR 168.02/ kg

 Dalda PKR 184.72/ kg

 Kiran PKR 159.39/ kg

 Sadiq PKR 151.36/ kg

 Kashmir PKR 171.88/ kg

5.6 Early District Comparison on Availability of Ghee– Round-1 vs Round-2

Based on comparative analysis of findings from Round-1 and Round-2 across Early Districts, our observations are as follows:

5.6.1. GheeBrands

In Round-2 a total of 57 brands of Ghee were identified to be stocked at the retail outlets surveyed, as compared to 46 in Round-1. Ghee in loose form was available at 22 out of 589 retailers with Ghee/cooking oil in stock (slightly over 3%). Most popular brands among the Retail Suppliers are provided in the table below. The top-5 composition has remained more or less similar in the two rounds across the Early Districts with the change mainly seen in the rankings.

Midterm Report: Round-2 Survey

FFP Rolling District Study

While not as widely fragmented as the wheat flour market, the Ghee market also has a large unorganized segment. With the exception of 25 to 30 brands identified in both rounds of the survey, the remaining brands appear highly localized and pushed by a limited number of retailers within a narrow geography.

In terms of retail visibility enjoyed by the brands, a significant change is observed in Round-2 from the first round. Major brands like Dalda and Sufi which were among the most visible brands in Round-1 seem to have lost favour with the retailers who appear to be either giving better shelf space to other brands or using prime space for other products. Furthermore, Sufi and Dalda which were stocked by 65% and 35% of the retailers in Round-1, respectively, were in stock with only 30% of retailers collectively in Round-2.

Table 5.7: Top Brands Stocked for Ghee– Early Districts (Round-1 vs Round-2) (G1)

5.6.2. GheePackage Sizes

Most of the sizes for packaged Ghee available at retail outlets (250g, 500g, 1kg, 2.5kg, and 5kg to bulk sizes of 10kg, 12kg and 16kg) were identified in both rounds. However, in Round-2 the product was also found to be available in as small a size as 125g.

5.6.3. Retail Prices of Ghee

A slight increase in average retail price was recorded over the period among the Early Districts, with the average rate per kg of Ghee being PKR 161.42 in Round-2 as compared to PKR 161 in Round-1. An increasing trend in both mean and modal rates was seen across all districts except Hafizabad, where the average rate per unit declined significantly, diluting the total average down for all Early Districts.

Note: According to PBS, the average price of vegetable Ghee (loose) as of April 2019 was recorded at PKR 160.41.

Table 5.8: Unit Rate of Gheein Early Districts – Early Districts (Round-1 vs Round-2) (G4)

5.7 Cooking Oil

5.7.1. Availability and Visibility of Cooking Oil

During the Round-2 survey in eight districts, 81 brands of cooking oil were identified to be in stock at the retail outlets. Oil was also sold in loose form at 94 (8%) of the 1,162 retailers interviewed who had Ghee/cooking oil in store at the time. The edible oil market appears to be less fragmented and more organized than Ghee market with relatively greater concentration of market share and shelf space. Much like the Ghee market, in the cooking oil segment too, Dalda extends its presence beyond boundaries to all territories surveyed with 22% of the Retailer Suppliers interviewed stocking Dalda cooking oil. Sufi comes second with 19% outlets storing the brand followed by Meezan with 6%. The top five brands overall with the highest share of retailer shelf space include Dalda, Sufi, Meezan, Kiran and Shaan.

Table 5.9: Top Brands in Stock and Share of Shelf - Cooking Oil (O1)

5.7.2. Cooking Oil Packaging Size

A variety of package sizes for cooking oil was available at the Retail Suppliers commonly ranging from 500ml, 1 liter, 2.5 liters, 3 liters, 4.5 liters, 5 liters and bulk sizes of 10 liters, 12 liters, 15 liters and 16 liters. Minipacks of 100ml and 250ml were also stocked by a few retailers.

5.7.3. Retail Prices of Cooking Oil

The rate per liter ranged from about PKR 110 to PKR 270 (excluding outliers), depending on the package size and brand, with an average of PKR 176.03 and modal rate of PKR 170 per liter of cooking oil. Major brands with highest share of shelf were available at the following average rates across markets:

 Dalda PKR 199.42/ liter

 Sufi PKR 185.53/ liter

 Meezan PKR 190.01/ liter

 Kiran PKR 169.16/ liter

 Shaan PKR 179.49/ liter

5.8 Early District Comparison on Availability of Cooking Oil – Round-1 vs Round-2

Observations based on the analysis and findings of the two rounds conducted at the Early Districts are provided as follows:

5.8.1. Cooking Oil Brands

A total of 46 different brands of cooking oil were identified in stock at the Retail Suppliers surveyed in Round-2 as compared to 31 brands in the previous round. Unpackaged cooking oil was also sold but

Midterm Report: Round-2 Survey

FFP Rolling District Study

only at an insignificant number of outlets. The most stocked cooking oil brands for both rounds are given in the table below with the top 3 brands being identical i.e. Dalda, followed by Sufi and Shaan.

Table 5.10: Top Brands Stocked for Cooking Oil – Early Districts (Round-1 vs Round-2) (O1)

5.8.2. Cooking Oil Package Sizes

Cooking oil was mostly available in package sizes ranging from 500ml to 5 liters, however in Round-2 additional packaging of 250ml and bulk sizes of 10, 12 and 16 liters were also identified in stock.

5.8.3. Retail Prices of Cooking Oil

Average rate increased significantly in Round-2 from PKR 165.4 per liter to PKR 174.85, a trend observed across all Early Districts. The modal rate for the stocked brands, however, declined hinting perhaps at an increase in inventory of cheaper varieties of cooking oil.

Table 5.11: Unit Rate of Cooking Oil – Early Districts (Round-1 vs Round-2) (O4)

Note: According to PBS, the average price of tinned vegetable oil was recorded at PKR 208 per liter, as of April 2019

5.9 Price Perception and Sensitivity

Nearly 73% of the Retail Suppliers indicated that fortified food products were priced higher than unfortified ones and 18% stated that both alternatives were priced at par, while less than 9% thought that fortified products were cheaper. An overwhelming majority across all segments (84% to 96%) indicated that the fortified products were either more expensive or the same price as the unfortified, with the trend more pronounced in the urban areas. About 11.1% of the rural retailers believed it to be priced lower as compared to 7.1% urban retailers.

Table 5.12: Price Differential between Fortified and Unfortified Products (P1, Single Response)

5.10 Price Sensitivity towards Fortified Wheat Flour

The Retailer Suppliers regarded their customers to be more price sensitive than what the Household respondents have indicated. Only about 60% of the retailers suggested that their customers would be willing to buy fortified wheat flour if priced at PKR 1 per kg higher than the unfortified product. Customer willingness was expected to grow to 70.8% for an incremental price increase of PKR 0.5 per kg, and to 84.5% if it was priced at the same level. A greater proportion of retailers (15.5%) believed that their customers would either be undecided or unwilling to switch to fortified wheat flour as compared to around 8.8% of household respondents. The perception of price sensitivity was greater among rural retailers as compared to urban. Similarly, the proportion of rural retailers suggesting resistance from consumers towards fortified wheat flour was higher among rural territories, with Gujranwala topping the districts with more than 29% indicating that their customers would either remain unwilling or undecided. Districts with greater rural representation have greater and more economic access to direct wheat grain and hence a greater propensity to obtain flour through grinding own grain at local Chakkis rather than buying commercial wheat flour.

Table 5.13: Perceived Price Sensitivity towards Fortified Wheat Flour (P2-P3, Single Response)

5.11 Price Sensitivity Towards Fortified Ghee/Cooking Oil

As in the case of wheat flour, Retailer Suppliers considered their customers to be more price sensitive than the households themselves indicated. Only 63.3% of the retailers indicated that their customers would purchase fortified Ghee/cooking oil even if the product was available at an incremental price of PKR 1 per kg. Consumer willingness to purchase was expected to increase to 73.6% with the price increase reduced to an incremental PKR 0.5 per kg over the unfortified variety, and to 86.7% if the price was kept at par with unfortified Ghee/cooking oil. About 13.3% of retailers indicated that their customers may be unwilling or undecided to make the switch to fortified oil/Ghee, even if it were available at the same price. Consumers’ price sensitivity towards fortified Ghee/cooking oil was expected to be less than wheat flour and the urban-rural split was not significant. Price sensitivity was perceived to be the lowest in Narowal but the ratio of ‘resisters’ was expected to be the lowest in Hafizabad among all districts at only 3.3%. Gujranwala retailers perceived their customers to resist switching to fortified with more than 21.3% - highest among all districts - indicating their customers to remain either undecided or unwilling to switch to fortified cooking oil/ Ghee even if it was available at the same price.

Table 5.14: Price Sensitivity towards Fortified Oil/Ghee(P4-P5, Single Response)

5.12 Early District Comparison on Price Perception – Round-1 vs Round-2

On analyzing the findings of Round-1 and Round-2 against retailers’ perception towards the pricing of fortified food products, we make the following observations:

5.12.1. Price Perception of Fortified Food Products

A significant shift is seen in retailers’ perception with respect to pricing of fortified food products viz-aviz their unfortified alternatives. Nearly 74% of the retailers in the Early Districts in Round-2 indicated that fortified products are priced higher than unfortified ones as opposed to only 39% in Round-1. By the same token, less than 10% retailers in the second round indicated that fortified products are priced lower than unfortified, as compared to 21% in the first round. With minor variations the same general trend was observed across all four Early Districts, with the highest ratio of retailers in Gujranwala considering fortified products to be priced lower.

5.12.2. Perceived Price Sensitivity to Wheat Flour

The retailers’ perceived price sensitivity of their customers towards fortified wheat flour was seen to increase significantly in Round-2 of Early Districts survey, as compared to Round-1. This is in contradiction to the decline observed in the price sensitivity of consumers as indicated by the households themselves.

Only about 53% of the retailers thought the consumers would purchase fortified wheat flour if it cost PKR 1/kg more than the unfortified version - as compared to 69.5% in Round-1. About 63% thought they would buy it at an additional PKR 0.5/kg as compared to nearly 80% in the previous round.

 On the other hand, 17.4% of the retailers surveyed in Round-2 opined that the customers may not buy fortified wheat flour even if it was available at the same price, as opposed to 14.9% in the first round, which may be a matter of some concern.

 A comparison of the perceived ‘Resisters’ in both rounds indicates an interesting shift which may need to be studied further for reasons and motives (see Table 5.16). The ratio for fortified wheat flour has significantly grown for Gujranwala from 9% to 29%, while for Hafizabad it has radically declined from almost 31% to 12%.

Table 5.16: Retailers’ Perception of ‘Resisters’ against Fortified Foods - Early Districts (Round-1 vs Round-2)

Table 5.15: Price Sensitivity towards Fortified Wheat Flour (P2-P3) Early Districts (Round-1 vs Round-2)

Note: Green indicates improvement over the year and Red indicates deterioration

5.12.3. Perceived Price Sensitivity to Cooking Oil/ Ghee

The price sensitivity towards Ghee/cooking oil was perceived by the retailers to be lower than that for wheat flour. This is consistent with the findings from household survey.

However, like fortified wheat flour, retailers’ perceived price sensitivity of their customers towards fortified oil/Ghee was also seen to increase in Round-2 from Round-1 – while, interestingly, the households themselves indicated becoming less price sensitive.

Only 59% of the respondents opined that the customers would buy fortified Ghee/cooking oil instead of the unfortified one even if it was more expensive by PKR 1 per liter (or kg), as compared to 70.5% in Round-1. Similarly, about 70.6% as compared to 80.6% of the retailers thought they would buy it at an additional PKR 0.5 per liter/kg.

A more positive indication for oil/Ghee as compared to wheat flour, however, was the decline in customer ratio expected to remain undecided or unwilling to buy fortified oil/Ghee – about 12% in Round-2 as compared to 14% in the first round.

A comparison of the perceived ‘Resisters’ in both rounds (see Table 5.16) indicates an across the board decline in all districts except for Gujranwala where the ratio grew from 8% in Round-1 to more than 21% in Round-2. A major improvement was seen in the perception towards customers in Hafizabad where the unwilling/undecided ratio fell from 10.6% to 3.3%. This shift may need to be examined more closely to study the reasons behind it.

5.13 Improving Sale of Fortified Food Products

On being asked an open-ended question regarding how the sale of fortified food products may be improved, the Retailer Suppliers gave a wide range of answers with a modal suggestion revolving around communicating health benefits of using fortified foods to the consumers through various promotional activities. Respondents generally spoke about creating awareness and positive messaging about food fortification to the public.

Table 5.17: Price Sensitivity towards Fortified Cooking Oil/ Ghee(P4-P5) - Early Districts (Round-1 vs Round-2)

5.14 Early District Comparison – Round-1 vs Round-2

Generally similar suggestions were made by the retailers in both rounds for improving sale of fortified food items. See table below for five most frequently cited responses.

Table 5.18: Top 5 Suggestion for Improving Sale of Fortified Food Products (P6) Early Districts (Round-1 vs Round-2)

6. PRODUCT SAMPLE TEST RESULTS

6.1 Sample Testing for Wheat Flour

A total of 47 samples for wheat flour could be sent for laboratory testing, against the proposed target of 200 at 25 samples per district. Such a low sample achievement was due to the two-tier testing approach adopted during Round-2 for wheat flour being used by respondents. This two-tier process entailed the following two steps:

i. Spot testing at respondent premises; and

ii. Lab Testing to measure added Iron content

As a first step, onsite testing was conducted using Rapid Test Kits (“RTK”s) at the time of conducting the interview with respondents using commercial wheat flour. Wheat flour obtained from ground wheat grains or purchased from Chakkis was excluded from the testing and only commercial wheat flour in use was tested by enumerators trained in the use of RTKs. RTKs were sourced from the Nuclear Institute of Food and Agriculture in Peshawar as directed by the FFP. The objective of this exercise was to validate whether households which had indicated using commercial wheat flour in the districts were fortified or not.

Only samples validated as fortified through the RTKs were to be sent to Qarshi Laboratories for quantitative analyses to determine added Iron content in the samples. Given the fact that a very small proportion of samples were tested to be fortified (2 out of 3,342 samples), 47 samples which included ambiguous results were sent to the laboratory. The target set for lab testing could still not be met. Out of these only 1 sample indicated an added Iron content of greater than 15. Also 43 samples had added Iron content of less than 15 PPM, but were found to have readings of greater than 1 and therefore determined as ‘Inadequately Fortified’. Only 3 samples reportedly had added Iron content of less than 1 PPM. A course correction was initiated based on Quality Assurance/ Quality Control (“QA/QA”) checks 33 and subsequently only those samples clearly validated to be fortified through RTKs were dispatched for further quantitative analysis at Qarshi Laboratories.

Out of the total 1,451 Households indicating using branded wheat flour bought from the market, 1,190 respondents provided a wheat flour sample for spot testing. Similarly, of the 1,221 Retail Users, 1,152 reportedly used commercial wheat flour and of these 942 provided a sample for spot testing. For Retail Suppliers, a random sample was drawn, as these respondents were not using wheat flour and only selling it.

33 Since a negligible number of wheat flour were tested to be fortified through RTKs, in order to meet the target sample agreed with FFP the enumerators sent the samples with ambiguous RTK readings for lab testing. Subsequently, a Quality Assurance/Quality Control check was performed on 5 samples of commercial wheat flour taken from Lahore, Gujranwala and Rawalpindi with packaging clearly indicating these to be ‘Fortified’ however none of them were found to be fortified. These tests were held at Gallup’s field offices in Lahore on May 17, 2019. Subsequently, all field staff were communicated that no samples must be sent for lab testing unless they are clearly validated as Fortified through RTKs, even if the packaging states that they are fortified. Results of all 47 tests are appended with this Report as Annex 8. Around 44 out of 47 samples had an added iron reading of [>1 PPM] on the ‘Added Iron’ result. According to Qarshi, no unfortified wheat sample should give a reading of ‘Added Iron’ beyond 1 PPM.

Table 6.1a: Spot Testing Summary

Midterm Report: Round-2 Survey FFP Rolling District Study

Table 6.1b: Spot Testing Summary by Category of Respondent

Only 1 sample out of 3,342 samples tested in the eight districts was validated as being Adequately Fortified by Qarshi Laboratories. This sample was taken from a Retail Supplier in Rawalpindi district, and the brand tested was Bakhtawar with an added Iron content of 18 PPM which is greater than the benchmark 15 PPM Pakistan National Fortification Standard34 .

6.2 Early District Comparison of Wheat Flour Sample Fortification – Round-1 vs Round-2

A massive decline in the percentage of fortified wheat flour samples was seen over the two annual rounds. In Round-1, 8 out of a total of 62 samples tested through RTKs were found to be fortified or about i.e. about 13% of the samples were found to be fortified. All fortified samples had added Iron content above 15 PPM and ranged between 17 to 27 PPM.

In Round-2, out of the 1,205 samples of wheat flour tested through RTKs from the Early District only 2 were validated as Fortified, and only one sample had an added Iron content of 18 PPM or was deemed as ‘Adequately Fortified’.

34 Source: Study on The Fortification Costing of Wheat Flour and Edible Oil in Pakistan, GAIN/USAID 2017

Midterm Report: Round-2 Survey FFP Rolling District Study

6.3 Sample Testing for Ghee/ Cooking Oil

Like wheat flour, the target sample size was 200, with 25 each to be collected from all eight districts such that 80 are from Households, 80 from Retail Supplier and 40 from Retail Users. A total of 201 samples were collected against the target of 200 and dispatched to the laboratory for testing for vitamin A content. Benchmark specification of 33,000 IU/kg has been used to test the adequacy of vitamin A in the samples of Ghee/cooking oil. The benchmark specification is the current Pakistan Standard Specification of vitamin-A per kilogram of finished edible oil and Ghee products, and this national standard is reflected in the provincial Pure Food Rules, including those for Punjab As of June 1, 2019, results against all 201 of these samples have been received from Qarshi Laboratories, and have been included in this Report. A summary of these results are provided in tables 6.3 and 6.4 below.

According to the lab reports, 82.1% of the samples tested were found to be adequately fortified (see tables below)

Note: Measurement uncertainty is at ± 19% of measured value with 95% confidence level for each analyzed sample as per sample analysis reports from Qarshi Laboratories

Table 6.3: Sample Collection –Ghee/ Cooking Oil

Table 6.4: Sample Test Results Summary – Ghee/ Cooking Oil

6.4 Early District Comparison of Ghee/Oil Sample Fortification – Round-1 vs Round-2

For Round-2, a decline in the adequately fortified samples as compared to Round-1 was also witnessed for Ghee/cooking oil. However, the coverage of fortified products was fairly high in the Early Districts in the second round also. In Round-1, all 102 samples of Ghee/cooking oil tested at the laboratory had vitamin-A content of greater than 33,000 IU/kg, the prescribed Pakistan Standard. For Round-2, out of 101 samples tested across the four Early Districts, a total of 92 (91.1%) were found to have vitamin A levels greater than or equal to the threshold Pakistan Standard.

Midterm Report: Round-2 Survey

FFP Rolling District Study

ANNEXURES

ANNEX 1: RESEARCH DESIGN AND SAMPLING FRAMEWORK – ROUND 2

ANNEX 2: HOUSEHOLD QUESTIONNAIRE USED FOR MIDTERM SURVEY

ANNEX 3: RETAIL USER QUESTIONNAIRE USED FOR MIDTERM SURVEY

ANNEX 4: RETAIL SUPPLIER QUESTIONNAIRE USED FOR MIDTERM SURVEY

ANNEX 5: MS EXCEL SHEET CONTAINING MIDTERM SURVEY RESULTS FOR HOUSEHOLD SURVEY

ANNEX 6: MS EXCEL SHEET CONTAINING MIDTERM SURVEY RESULTS FOR RETAIL USER SURVEY

ANNEX 7: MS EXCEL SHEET CONTAINING MIDTERM SURVEY RESULTS FOR RETAIL SUPPLIER SURVEY

ANNEX 8: WHEAT FLOUR ADDED IRON TEST REPORTS FROM QARSHI

ANNEX 9: COOKING OIL/GHEEVITAMIN A TEST REPORTS FROM QARSHI

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