|Food and Nutrition Bulletin Volume 02, Number 2, 1980 (UNU, 1980, 40 p.)|
|Food and nutrition policy|
|A look at the Incaparina experience in Guatemala|
Nevin S. Scrimshaw
Senior Adviser, World Hunger Programme
Ever since Incaparina was introduced by the Institute of Nutrition of Central America and Panama (INCAP) more than twenty years ago, it has received widespread recognition, but it has also been subject to much misunderstanding concerning its origins, nature, purpose, and degree of success.
The article by Robert Wise that follows is the first systematic study of Incaparina distribution and utilization, and provides some clues as to both the limitations of such a programme and how the success of a project of this type might be enhanced.
Incaparina was always a generic concept, not a specific formula. As described in the registration of its name as a trade mark in a number of countries, it is ". . .a mixture of predominantly vegetable protein origin having a nutritional value similar to that of milk and suitable for the mixed feeding of infants and young children." After experimentation with various formulas, the first one tested in children was " Mixture 8" (1), made with entirely indigenous materials: lime-treated corn flour (50%), sesame meal (35%), cottonseed meal (9%), torula yeast (3%), and powdered kikuyu leaf (3%). It was subsequently recognized that it could be cheaper and more practical to supply vitamin A in synthetic form and that the additional foreign exchange cost of doing so would be negligible. The first mixture recommended for commercial production was "Mixture 9" (2), made of corn flour (29%), sorghum (29%), cottonseed flour (38%), torula yeast (3%), and CaCO3 (1%). 4,500 IU of vitamin A (500,000 USP units per gram, Hoffman-LaRoche Inc., Nutley, N.J.) were added to each 100 grams of the dry product.
Alternate formulas were developed with soy, peanut, and sesame as alternate vegetable protein sources and with rice as the cereal component to permit adjustment of the formula to local ingredient costs and taste preferences. There was no attempt to patent any of these formulas, but rather to stimulate the production of similar mixtures to suit local communities in other developing countries, utilizing local names. The name Incaparina was registered as a trade mark to ensure INCAP's control of quality and price policy, and to prevent exploitation of its name.
INCAP's hope was that the principle would be widely copied and that its own research would facilitate the development of locally appropriate formulas for developing countries in other areas and regions.
There was never any claim or expectation that a commercially produced and marketed vegetable mixture could "solve" the problem of protein-calorie malnutrition in Guatemala or any other country. This could only be realized through an increase in income among the groups in need, or by effective programmes of subsidized distribution. There was, however, a need for a weaning food that could be recommended for malnourished mothers and children in a country where milk was too costly and in short supply. It was considered that, given the role of cow's milk in child nutrition in the US and most other industrialized countries, it would be the height of arrogance to deny developing countries the benefits of a nutritionally comparable food at the lowest practical cost. The objective, then, was to provide a beverage with the nutritional equivalent of milk in a culturally acceptable form at as low a cost as) possible for the benefit of a sector of the population with modest purchasing power, leaving to other programmes the problem of reaching that part of the population unable to purchase weaning foods.
In the 1960s, several reports described Incaparina as failing and about to disappear, but the fact is that commercial sales have increased each year in Guatemala, to the point where a modern factory produces an average of 500,000 to 600,000 pounds per month. Incaparina was sold in Colombia from 1962 to 1971 and was discontinued by the US company producing it only when two locally named equivalents, one of them Colombiharina developed by the National Institute of Nutrition, became available and reduced the profitability of the Incaparina product. Initially, however, Incaparina was available in Colombia at one-fifth the cost of an equivalent amount of milk.
The most striking success of Incaparina-type weaning food is in India, where a formula utilizing the Incaparina principle and named Bal-Ahar (literally "nutritious child food") has played an important role in Government nutrition programmes. It is produced today in plants in several different parts of India. It is noteworthy that Bal-Ahar is provided by the Government of India without cost to the consumer, whereas Incaparina in Guatemala has received no Government subsidy and only sporadic Government purchases. Bal-Amul, a pre-cooked version at a higher price, has been commercially successful and largely displaced imported weaning foods sold by foreign companies.
There are also doubts expressed regarding the palatability and physical consistency of Incaparina, particularly in the board rooms of multi-national companies originally contemplating its production Incaparina in its present form was based on anthropological studies in Guatemala; these provided information about local customs of preparing gruels with corn or other cereals known as "atoles" that could not be expected to be palatable to either upper socio-economic groups that had lost their taste for such preparations or in countries other than those such as rural Mexico and El Salvador with a similar tradition. Incaparina could have been made thinner by the addition of amylase, an enzyme that liquifies the carbohydrates during cooking, or marketed precooked, but this would have cost more and departed from traditional practices. It might also have encouraged its feeding by bottle which would have introduced problems of contamination and displacement of breast milk.
It is a fact that Incaparina has been of very limited benefit to the large Mayan Indian population largely living at a subsistence level. Without it, however, the nutritional situation in Guatemala would almost surely be perceptibly worse.
It is also a fact that Incaparina has not taken hold in other countries of Central America for a variety of reasons that have more to do with politics and the high returns expected by local industries than with its potential value or acceptance. It is noteworthy that pilot studies in Mexico and in Cuba were highly successful, but their continuation was blocked by the stated political decision of these governments to provide their people with animal protein rather than with what they deemed to be an inferior substitute.
As the following article suggests, the Government of Guatemala has failed to capitalize on the potential of Incaparina for contributing to the prevention of protein-calorie malnutrition in Guatemala. This has been due, in part, to the ease of obtaining free donations of dried skim milk, CSM (corn-soy milk), and WSB (wheat-soy blend), which relieved the Government of the obligation to meet the problem of this malnutrition by using indigenous resources.
Currently the Incaparina factory is working three eight hour shifts daily and is unable to meet the demand. However, investment in additional facilities will not occur unless INCAP allows price increases that reflect rising ingredient and other costs. The awarding of rights to a single producer has been criticized, but INCAP had enormous difficulties in persuading any producer to invest in a product whose price was to be kept low and which was designed to appeal to the poor. Even today with "commercial success'' it is highly unlikely that more than one producer could be attracted in Guatemala. The co-operative movement is probably too weak to take on the production of Incaparina and health centres are certainly not able to do so.
Incaparina can thus be considered a success if viewed as a concept that has proved to be reliable, acceptable, and nutritionally sound. If judged by its effect on protein-calorie malnutrition without either governmental or other subsidy, or improvements in social equity, it is not, could not have been, and was never projected to be the answer. Only political and economic policies that improve the purchasing power of the lowest income groups will enable Incaparina or any other food to make a truly significant contribution to this aim.
1. N.S. Scrimshaw, R.L. Squibb, R. Bressani, M. Behar, F.E. Viteri, and G. Arroyave, "Vegetable Protein Mixtures for the Feeding of Infants and Young Children," in W.H. Cole, ea., Amino Acid Malnutrition, XlIl Annual Protein Conference, New Brunswick, New Jersey I Rutgers University Press, Rutgers, New Jersey, 1957), pp 28-46.
2. J.E. graham, R. Bressani, S. de Zaghi, and M. Flores, "Supplementary Value of INCAP Vegetable Mixture 9 for the Diets of Average School Children in Rural Guatemala." Agric. Food Chem., 13 (6): pp. 594597, 1965.