नrish

HEALTH ECONOMICS PROJECT

GROUP NO 9 SUBIMTTED TO:

Aashni Chandran (1811076) PROF. ARNAB MUKHERJEE

Nisha Sharma (1811131)

Bizza Srilatha (1811137)
Dhruv Batra (1811231)
Ananya Chaudhury (1811389)

[Date]
Executive summary
There is enough evidence in academic literature demonstrating the importance of household
nutrition practices in reducing the risk of maternal and child mortality, morbidity, and under-
nutrition. Infants born with low birth weight caused due to improper nutrition of mothers are
at a significantly higher risk of mortality and morbidity in infancy and early childhood.
Undernourished pregnant females are also at a substantially higher risk of succumbing to
complications during childbirth. A third of women of reproductive age in India are
undernourished, with a body mass index (BMI) of less than 18.5 kg/m2. The existing public
system of providing rations to pregnant and lactating mothers and children has significant gaps
and has come under scrutiny for poor quality and supplies being low in nutritive value.
Our objective is to improve overall maternal health through nutrition interventions thereby
preventing miscarriages and complications during pregnancy. We aim to reduce risks of
maternal mortality aggravated by anemia and malnutrition, and consequently also decrease
risks of infant mortality by ensuring that healthy babies being born. In this endeavor we have
conceptualized “नrish”- a last mile nutritional food supply service for pregnant and lactating
women. The nutritional requirements of a pregnant female vary with geography, according to
the nutrients present in the type of food naturally available to them. Also, as the foetus grows
during the gestation period, and later as the baby exclusively feeds on breastmilk, the dietary
need of women increases. We aim to provide pregnant and lactating women customised food
baskets by monitoring their entire gestation period in trimesters, analysing the area-wise PHC
data, co-relating it with the current nutrition available to them through local produce and
curating a phase-wise food basket as per recommended dietary standards.

Our business model shall target two different markets – rural and urban. We plan to cross-
subsidize the rural market through the urban market. We shall curate a basic food basket for
our rural market and a premium basket for the urban market. We plan to source fortified cereals/
pulses/ oil /milk through centralized procurement and vegetables/ fruits/poultry through local
procurement. The logistics would include transportation and warehousing. For warehousing,
we plan to rent private space or utilize existing public infrastructure, while primary distribution
of supplies would be done through an owned fleet of vehicles. For secondary distribution in
rural areas we plan to employ the services of an SHG or the ASHA/ Aanganwadi Workers
network.
The primary revenue stream would be through upfront payment by consumers for supplies.
The urban baskets would be sold at a premium to cross-subsidize rural operations. A
subscription model for urban areas, along with the development of an app, will help secure
steady demand while providing urban customers the option to curate the basket according to
individual tastes. Additional sources of revenue could include advertisements on delivery vans,
commission from food product companies for facilitating demand estimation and distribution
of supplementary packaged food, tie-up with payment platforms or credit cards companies on
orders from the app and leasing out delivery fleet when not in use.
In the long term “नrish” will help reduce the existing huge gaps in nutrition in the country, thus
helping bring down maternal and infant mortality and morbidity rates.
Overview
India’s maternal mortality contributes to 20% of the global deaths occurring due to preventable
causes in pregnancy and childbirthi. Though India has reduced the maternal mortality rates
from 212 per 100,000 live births in 2007 to 130 in 2013-15, attaining the sustainable
development goal target of reducing the maternal mortality rate to 70 per 100,000 live births is
still a long way to go.

Despite the well-known fact that

anaemia is a significant underlying
factor in maternal mortality, 53%
Indian women continue to suffer
from anaemia.

Spatial data sourced

from: https://github.com/datameet/maps/tree/
master/parliamentary-constituencies

A mere 31% women visit ANC at

least three times for healthcare
recommendations.

Spatial data sourced

from: https://github.com/datameet/maps/tree/
master/parliamentary-constituencies
There is a lack of knowledge in pregnant women and their caregivers concerning the nutritional
needs of women during and after pregnancy. This lack of information includes the type,
frequency and the quantity of food. Typically, married women eat last and a lesser number of
times per day. While pregnant females have much greater needs in terms of quantity and variety
of meals, the intake remains suboptimal. To address this gap, several government programs
targeting nutrition currently exist, which include the following:
1. Facility-based ANC packages and outreach activities for pregnant women. Village
Health Nutrition Days (VHNDs) every month at Anganwadi centres (AWCs), where
micronutrient supplements such as IFA and calcium are distributed to pregnant women.
2. The Supplementary Nutrition Programme for Pregnant and Lactating Women (part of
the Integrated Child Development Services scheme).
3. The Janani Shishu Suraksha Karyakaram (JSSK) has some allocated budget for
nutrition.
4. The Supplementary Nutrition is one of the six services provided under the Integrated
Child Development Services (ICDS).

However, the existing public system of providing rations to pregnant and lactating mothers and
children has significant gaps and has come under scrutiny for supplies being of poor quality
and low in nutritive value.
Bihar has the worst maternal nutritional indicators in India. 30% of women have low BMI, and
60 % suffer from severe anaemia (11.9gm/ dl)ii. With wide state disparity, Purnea district is
one of the worst-hit districts in Bihar. Approximately 72% of pregnant women are anaemic,
and 39% have below healthy BMI. Only 33% of women registered during the first trimester of
their pregnancy and only 4.6% received full antenatal care (ANC)iii. Few reasons for the
abysmal health status of Purnea could be the following:
1. Budget allocation and fund utilisation: It has been observed that the funds allocated
for maternal interventions through NHM have been declining continuously from 2014
to 2017. Also, there has been an underutilization of the funds.
2. Insufficiency of healthcare centres: The HSC and PHC in Purnea district were much
below the stated national standards. Each HSC was catering to 9000 people instead of
5000. While each PHC provides to 62,000 people against 30,000, they are also grossly
understaffed.
3. Shortage of health professionals: Each of the health centres are understaffed. There
is a shortage of employees against the no. of vacancies sanctioned for various health
posts.
4. Gaps in the planning and budgeting process: The national health mission program
follows a bottom-up approach. Ideally, inputs from the district level are presented to
the state government, which in turn demands funds or state program implementation
program. But, to the dismay, it has been observed that the inputs from the grassroots
level are not considered leading to faulty budget allocation, sub-optimal facilities and
poor service delivery.
Proposed Solution
To tackle the problem of maternal deaths due to anaemia and neonatal deaths due to low birth
weight, we propose to provide complete nutrition to pregnant women by offering food baskets
designed especially for all three trimesters. The food baskets will be delivered at the place of
the consumer twice a week. The food baskets will be customized to each pregnant woman by
taking into consideration their health vitals every trimester.

The baskets will contain Vegetarian and Non-vegetarian (to suit Indian preferences) foods like
cereals, pulses, oils, fruits, vegetables, eggs and meat. We propose to have different food
baskets for urban and rural population. The urban baskets will also contain superfoods iv
(nutritionally rich foods) like Salmon, Kale, Avocadoes, Quinoa and Blueberries etc., which
are costlier and can be afforded by higher income groups.

The health status of the women will be taken every trimester (from PHCs/medical records) and
accordingly changes to the food basket will be made by a nutritionist who will connect with
the pregnant women over phone. For example, if vitamin D levels are lesser than
recommended, we will provide vitamin D sachets, cheese, fatty fish, cod-liver oil, egg yolkv
etc which contain vitamin D. This will help us provide customized food baskets to every
woman according to their requirements and help us ensure better health. The cost of the food
basket will change accordingly. We will provide a daily recommended diet plan (attached in
Appendix) which will help women eat at proper times. To keep track of pregnant women’s
health status we will maintain a village wise data sheet trimester wise.

Nutrition Plan
The food basket will be changed every trimester according to the needs of pregnant females
(Detailed plans in Appendix)

1st trimester
In the first trimester, nutrients like folic acid, iron, calcium and Vitamin Dvi are important. So
foods rich in these nutrients like spinach, broccoli, pulses, oranges, ragi, bajra, eggs, milk,
soybean, cereals and fish liver oil will be included.

2nd trimester
Foods rich in vitamin C, Omega 3 and magnesium are required in the 2nd trimester. The food
basket will include items like bananas, raisins, nuts, pumpkin seeds, oatmeal, fish, omega 3
rich foods like soybean oilvii, fortified milk, citrus fruits, kiwis, guavas etc.

3rd trimester
In the 3rd trimester, pregnant women need around 200-250 caloriesviii more than in their second
trimester. Protein intake is important in this trimester. So more pulses, milk, meat, cheese will
be included.

Superfoods included in Urban basket

We plan to include the following superfoods in our urban basket:

Berriesix - rich in Vitamin C

Salmon, Tuna – rich in Omega 3 fatty acids
Prunes, dried apricots, dried cranberries – Rich in Iron and Calcium
Broccoli – rich in folic acid
Avocado – rich in Vitamin C, K, E, Folate, potassium
Quinoa – high in protein, gluten free, contains all 9 amino acids

Including these foods will give more value to the urban consumer and hence willingness to
pay is expected to increase.

MARKET CHARACTERISTICS
For our pilot project we have chosen to work at a block level. We are aiming to provide our
services in Srinagar block, Purnia district in Bihar.

Bihar has a population of 104 million with 49 million women. Bihar is one among the states
that have high MMR and IMR indicators. Though the numbers have reduced over years, they
are still higher than the national average. Purnia district is the 5th largest populated district in
Bihar. It has the second lowest literacy rate of 74.04% in Bihar. 90% of the district comes under
rural areas. It also has very low health indicators. The district has 4 sub-divisions, 14 blocks
and 1226 villages. For our pilot project we chose Srinagar block in Damdaha sub-division of
Purnia district.

2011 Census Bihar Purnia Srinagar

Population 1041 Lakhs 32.64 Lakhs 1.10 Lakhs

No: of females 498 Lakhs 15.65 Lakhs 0.52 Lakhs
No: of Pregnant Women 39 Lakhs 1.23 Lakhsx 0.042 Lakhs
registered
No: of 38 districts 14 Blocks (90% rural area) 27 Villages
Districts/Blocks/Villages
MMR 208 377 -
IMR 38 62 -
Target market
The number of pregnant women registered for Ante Natal Care in Bihar is 39 lakhs out of
which 1.23 lakh women are from Purnia district. The number of pregnant women registered
in Srinagar block according to 2011 census is 4297. In our first year, we aim to target 20% of
the 4297 pregnant women in Srinagar block which comes to around 800 women.

OPERATIONS:

Sourcing of food supplies is planned to be done through multiple channels depending upon the
food category.
We aim to provide fortified supplies in the following food categories: wheat flour and rice
(fortified with iron, vitamin B12 and folic acid), milk and edible oil (with Vitamins A and D)
and double fortified salt (with iodine and iron). Since milk is a highly perishable product with
a shelf life of less than a day, we plan to provide Ultra High Temperature (UHT) treated
fortified milk packages to increase shelf life for poor rural households and for it to be
compatible with our weekly/bi-weekly delivery frequencies. There are quite a few private and
state players in Bihar who are supplying fortified supplies in the above categories with support
from food fortification initiatives led by FSSAI. We plan to tie up with such suppliers to
provide these food categories in our basket for pregnant and lactating women.
For fruits and vegetables, we plan to start out operations by procuring these supplies from the
local wholesale mandis. Going forward, for locally grown fruits and vegetables, we will
gradually shift to direct procurement from farmers by setting up collection centres at the village
level. Farmers shall bring their produce to these collection centres where the produce will be
sorted and graded. The prices offered shall be benchmarked with daily wholesale prices at the
local mandi. Supply deficit, if any, will be met by wholesale procurement from the mandi. This
direct sourcing from farmers will help increase margins for us as well as farmers by eliminating
the middlemen, i.e. commission agents and traders, from the traditional food and vegetables
market supply chain. It will also help reduce damages and waste by minimizing the levels at
which produce is transported and handled. Procurement of commoditized supplies like potatoes
and onions, and food items not grown locally shall continue to be done through wholesale
markets. For premium food items that we plan to provide to our urban customers, we shall tie-
up with specialized vendors who offer these supplies.
Initially, we shall start out with a Just-in-Time approach to sourcing and distribution of food
baskets, gradually moving to an inventory-led model once we have established a steady and
reliable network of suppliers. Under the inventory-led model, storage space shall be obtained
on rent from existing facilities close to the delivery area. We plan to rent the required cold
storage space in a local cold storage facility for perishables, and warehousing space for non-
perishables.
Delivery of supplies to households in two frequencies – items like cereals, pulses, oil etc. shall
be supplied monthly while perishables like fruits, vegetables and milk shall be supplied weekly/
bi-weekly. We shall invest in a fleet of vehicles for the primary distribution of supplies from
cold storage and warehouses to a central distribution center in or near an existing public facility.
For basketing and secondary distribution, we plan to employ the services of a local SHG
operating in the area.

COSTING:

Zero Based Costing & Budgeting

For the initial phase of our project, we have considered Srinigar block in Purnia district of
Bihar. According to the 2011 census, Srinagar has a female population of around 52,000.
Srinagar block has 27 villages with an average 148 women pregnant in each of the villages at
a given point of time. The cost of a day’s food supply comes out to be Rs. 85.87 taking the
average amount of both veg. and non-veg. meals for the three different trimesters.
Simultaneously, we will also be operating a similar business model in the urban areas, for
which we have considered Patna for our pilot phase. Patna has 26.6 lakh female population out
of which 1.64 lakh women are pregnant at a given point of time, according to census 2011. The
food package for urban areas has better food offerings since urban area has a better lifestyle
and more spending capacity. The average cost for a day’s food supply for Patna comes out to
be Rs. 210. The higher cost for Patna as compared to Srinagar is on account of more premium
constituents in the food basket. Since this is for the pilot phase, we have considered 20% of the
pregnant women opt for our product offering both in urban and rural areas.
Zero based budgeting was done considering and analysing every function involved in our
business process, namely running cost of the delivery truck, area to be catered, carriage and
payload capacity of the delivery vehicle, the volume of food packages a vehicle can carry,
labour cost and rental cost of the distribution centre. The delivery truck chosen for the delivery
purpose is Tata Ace XL, as it offers maximum carriage capacity per unit cost. Based on the
traffic density and the number of boxes that fit into a van, we have reached to a conclusion of
deploying 2 delivery vans for Srinagar block and 12 for Patna. All the technicalities and running
cost of the delivery vehicle has been calculated using https://droom.in. We plan to buy the
vehicles at 100% debt and repay it in 5 years which is also the life of the vehicle. After that,
the maintenance cost of the vehicle goes so high that it is not feasible to own it after 5 years.
The loan amount and the interest to be paid has been calculated using loan calculator
https://www.iifl.com. On the other hand, we plan to rent out warehousing and cold storage
space which will act as hubs for the storage and delivery purposes catering to a specific area.
For the Srinagar, the cost of weekly supply delivered twice a week comes out to be Rs.606
while the cost of weekly supply for Patna delivered twice a week comes to be Rs. 1112. We
will be providing the food supplies to the rural pregnant women at a nominal token amount of
Rs.200 per week. On the contrary, we plan to sell the food supplies at a premium price of Rs.
1800 per week in the urban areas which will help us sustain our business in the rural part by
cross subsidization.
We will be providing a subsidy of 67% in the rural areas of Purnia while charge a premium of
62% in the urban areas of Patna. Going by the initial study, we will be able to cater 2.26 villages
like Purnia by providing a subsidy funded by the profits from Patna. As our business grows,
the per unit cost of rent, supply, labour and fuel will come down and we will be able to reduce
the subsidy as well as raise the profits.

Challenges:
Nourish addresses the nutrition of around 1.23 lakh pregnant women in Purnia district in Bihar
alone. With expansion of Nourish, there would be many pregnant women who would be
benefitting from Nourish leading to reduced mortality rates, reduced health issues related to
malnutrition and heathy mother and infant after the delivery. But Nourish would have to deal
with the following key challenges:

1. Economic constraints:

Nourish is provided in rural areas as well as urban areas. In rural areas, it is provided in
subsidized price and in urban areas in premium price. But the average income of a rural Indian
is Rs 8931 per month, out of which Rs 500 to 600 must be paid for one month of supplies. The
pregnant ladies or their families must pay upfront for the week for the customized food
supplements, even though it is provided at subsidized price. Hence, there might be a reluctance
towards registering for the supplements initially. But once the benefit and the subsidized price
is being explained to the rural pregnant women, they would understand the advantage and start
consuming these supplies. For this, we would be promoting nourish through direct approach,
through doctors in government hospital in the locality, making announcements and distributing
pamphlets in the mini trucks used for carrying supplements.

2. Trust and Reach:

The concept of food nourishment to pregnant women is completely new and would take time
to accept it. Even though price is low, there is a chance of doubting the quality of the food
provided. As we would be explaining about nourish through doctors, rural pregnant women,
who continuously go to check up to the same doctor, would develop trust in our service. And
also, most of the food supplements in the basket like vegetables, fruits, egg, milk are locally
procured at subsidized price. Hence, it would be a local supplier, whose quality of products are
well known among the villagers.

3. Reluctance from family:

In rural villages, in most of the family, they would be receiving only one income, either from
farming or other works in the village itself. Hence to procure food separately through Nourish
food basket system, the families would be hesitant even though it is for the wellbeing of the
pregnant women under subsidized price. We can convince the family by making them
understand the various vitamin, protein and mineral required for the pregnant women. Nourish
also customizes the food basket according to the health condition and requirement of the
pregnant women. The health condition is known, by partnering with the local hospitals and
referring to the test reports taken in the third morn of pregnancy with the permission of the
doctor and the pregnant women.

4. Cultural belief:

India with varied culture, there are varied beliefs in each culture. For instance, few believe that
pregnant women should not eat non-vegetarian food after few months of pregnancy. But meat
as such is a very good source of protein and easily increase the health condition on regular
consumption, even in smaller quantity. This lack of information and misleading beliefs also
prevent families and pregnant women from buying nourish food basket. This prevents the
mother from taking proper nutrition. It is a challenge to convince the entire community about
these misconceptions and is a time-consuming process. This awareness must be created through
continuous promotion not only by nourish but also government schemes and slogans.

5. Proper intake of food and its impact:

Nourish delivers the food supplements to the pregnant women doorstep. This way it is
convenient for the pregnant women and easy to keep a track of their consumption. But it would
be a challenge to analyze if the food is consumed only by the pregnant women or the other
members of family or if it is getting wasted due to other circumstances. The wastage can be
prevented by labelling all the supplements with dates, within which it must be consumed.
Hence the pregnant women would use those supplements and plan their meal accordingly. But
in case of supplements been used for the entire family, it is the sole responsibility of the family.
Even though in long term, we can still detect it through tests in the later months. But knowing
it through test results in later stage of pregnancy will be of less use.

IMPACT:

1.Impact on health of infant:

The health of the new born child is considered very important in any situaton. But
unavailability or less consumption of food during pregnancy due to several reasons like
economic constraints or availability can lead to maternal malnutrition which in turn can affect
the health of the child. Some health problems that are generally faced due to maternal
malnutrition are low birth weight, feat intrauterine growth retardation, weak immune system.
These can be prevented with the initiative of Nourish.
2.Impact on maternal malnutrition

Malnutrition doesn’t affect only the health of the infant, but also causes difficulties to the
mother during the pregnancy period. It leads to several problems like gestational anaemia,
hypertension, etc. With regular intake of food, the malnutrition and the effects can be reduced.
Implementation of nourish facilities this regular intake of food in proper quantity. And, due to
malnutrition, there is a high chance of miscarriage. Hence, regular intake of food starting from
the first or second month of pregnancy is very important. Pregnant women or families should
not delay further.

3.Decrease in mortality rate:

With increasing mortality rate, Maternal mortality rate is 130 per 1000 population and infant
mortality rate of 44 per 1000 population, the need for increased nutrition of mother is required.
Nourish by providing customized food supplements to pregnant women starting from the early
stage of pregnancy and even after pregnancy benefits both the mother and the child. And hence,
can reduce both maternal and infant mortality rate

4.Reduced difficulties during labour:

There are not only after delivery consequences, but during delivery too there are many
difficulties faced by the mother due to the under nourished condition. Pre-term delivery leading
to consequences in new born development and blood clotting which presents particular risks
during pregnancy when there is substantial loss of blood which could be avoided with Nourish

FUTURE EXPANSION:
The image represents the color-coded state wise division of India based on mortality rate. States
indicated by red are the one with mortality rate more than 30 per 1000 live births and states
indicated by green are the one with mortality rate less than 10. The states with the highest
mortality rates include Rajasthan, Madhya Pradesh, Uttar Pradesh, Chhattisgarh, Orissa and
Bihar.

PHASE1:

For phase 1 analysis, to test the viability of Nourish, we plan to cover a block of a district in
Bihar. The pilot plan would be implemented in Srinagar, a block in the district of Purnia. Purnia
consists of totally 14 blocks and 1450 villages among the blocks. The pilot program, as
mentioned in the cost analysis and implementation plan, would be implemented at a cost of
Rs34000/week. It would benefit around 123771 pregnant women.

PHASE 2:

In the second phase, we plan to cover Purnia, the entire 1450 villages. We would be establishing
distribution centers in all districts of Bihar making it easier for distribution of food supplies.
We plan to cover the entire state of Bihar in the next five years. We would follow the same
revenue model in all districts and would break even in the third year.

PHASE 3:

Apart from Bihar, there are 6 more states, which have high mortality rate and all of them are
majorly situated in the central region of India. We would be covering these states in phase 3.
As this is on a much larger scale, we would be partnering with corporates as well as
government.
 APPENDIX

Daily sheet

Time Diet Plan

7:00 AM
Glass of milk/Dry fruits(Almonds)/Apple or Tomato juice
Pohaxi/ Upma/Parathas/Whole wheat
9:00 AM bread/Oats/Sandwiches with
veggies/Guacamole/Boiled eggs
11:00 AM Soups/Fruits
Saladxii, Khichdi/Roti/Parathas/Rice with dal/Chicken
1:30 PM
curry/Fish curry, 1 cup Curd
Milk/Sprouts/Boiled eggs/Boiled Chickpeas/Roasted
4:00 PM
Peanuts/Dry fruits

7:30 PM Roti/Rice with Dal/Khichdi/Parathas with curries,

Yoghurt/Buttermilk, Salad, Fish
10pm/before
sleeping Glass of milk/Dates/Fruit
Nutrition planxiii

Vegetarian Plan
1st trimester

Rural Basket Urban Basket

Average Average
Recommended Price per Price per
Total No. of grams kg Item Price per day (Rs) kg Item Price per day (Rs)
Nutriets
needeed Pregnant Lactating Pregnant Lactating Pregnant Lactating

Quinoa/
Cereals 360 390 24.78 Rice/Wheat/Rava 8.9208 9.6642 49.56 Buckwheat/ Bulgur 17.8416 19.3284
Black-eyes peas/
Pulses 105 165 68.04 Arhar Dal/ Rajma 7.1442 11.2266 136.08 Kidney beans 14.2884 22.4532
Fat/Oil 40 40 70 Groundnut Oil 2.8 2.8 140 Olive Oil 5.6 5.6
Soy Milk/ Almond
Milk 600 600 40 Milk 24 24 80 Milk 48 48

Apple/Banana/ Avocado/
Fruit 300 300 35 Orange/guava 10.5 10.5 70 Blackberries 21 21
Green Leafy Kale/ Lettuce/ Red
Vegetables 350 350 25 Spinach/ Methi 8.75 8.75 50 Cabbage 17.5 17.5
Roots & Sweet Potatoes/
Tubers 300 300 10 Potatoes/Radish 3 3 20 Carrots 6 6
Other Brinjal/ Bottle
Vegetables/ Gourd/ Brocolli/ Bell
nuts 300 300 20 Cauliflower 6 6 40 Pepper 12 12
Sugar 35 35 35.7 Sugar 1.2495 1.2495 71.4 Sugar 2.499 2.499
Total daily cost 72.3645 77.1903 Total daily cost 144.729 154.3806

2nd trimester

Rural Basket Urban Basket

Average Average
Recommended Price per Price per
Total No. of grams kg Item Price per day kg Item Price per day
Nutriets
needeed Pregnant Lactating Pregnant Lactating Pregnant Lactating
Quinoa/ Buckwheat/
Cereals 360 390 24.78 Rice/Wheat/Rava 8.9208 9.6642 49.56 Bulgur 17.8416 19.3284
Black-eyes peas/
Pulses 105 165 68.04 Arhar Dal/ Rajma 7.1442 11.2266 136.08 Kidney beans 14.2884 22.4532
Fat/Oil 45 45 70 Groundnut Oil 3.15 3.15 140 Olive Oil 6.3 6.3
Milk/ fortified Soy Milk/ Almond
milk 650 650 40 Milk 26 26 80 Milk 52 52
Fruit/ dry Apple/Banana/ Avocado/
fruits 350 350 35 Orange/guava 12.25 12.25 70 Blackberries 24.5 24.5
Green Leafy Kale/ Lettuce/ Red
Vegetables 350 350 25 Spinach/ Methi 8.75 8.75 50 Cabbage 17.5 17.5
Roots & Sweet Potatoes/
Tubers 300 300 10 Potatoes/Radish 3 3 20 Carrots 6 6
Other Brinjal/ Bottle
Vegetables/ Gourd/
nuts 300 300 20 Cauliflower 6 6 40 Brocolli/ Bell Pepper 12 12
Sugar 35 35 35.7 Sugar 1.2495 1.2495 71.4 Sugar 2.499 2.499
Total daily cost 76.4645 81.2903 Total daily cost 152.929 162.5806
3rd trimester

Rural Basket Urban Basket

Average Average
Recommended Price per Price per
Total No. of grams kg Item Price per day (Rs) kg Item Price per day (Rs)
Nutriets
needeed Pregnant Lactating Pregnant Lactating Pregnant Lactating
Quinoa/
Cereals 360 390 24.78 Rice/Wheat/Rava 8.9208 9.6642 49.56 Buckwheat/ Bulgur 17.8416 19.3284
Black-eyes peas/
Pulses 165 225 68.04 Arhar Dal/ Rajma 11.2266 15.309 136.08 Kidney beans 22.4532 30.618
Fat/Oil 45 45 70 Groundnut Oil 3.15 3.15 140 Olive Oil 6.3 6.3
Milk/
fortified Soy Milk/ Almond
milk 700 700 40 Milk 28 28 80 Milk 56 56
Fruit/ Dry Apple/Banana/ Avocado/
fruits 350 350 35 Orange/guava 12.25 12.25 70 Blackberries 24.5 24.5
Green Leafy Kale/ Lettuce/ Red
Vegetables 350 350 25 Spinach/ Methi 8.75 8.75 50 Cabbage 17.5 17.5
Roots & Sweet Potatoes/
Tubers 300 300 10 Potatoes/Radish 3 3 20 Carrots 6 6
Other Brinjal/ Bottle
Vegetables/ Gourd/ Brocolli/ Bell
nuts 300 300 20 Cauliflower 6 6 40 Pepper 12 12
Sugar 35 35 35.7 Sugar 1.2495 1.2495 71.4 Sugar 2.499 2.499
Total daily cost 82.5469 87.3727 Total daily cost 165.0938 174.7454

Non-Vegetarian Plan

1st trimester

Rural Basket Urban Basket

Average Average
Recommended Price per Price per
Total No. of grams kg Item Price per day kg Item Price per day
Nutriets
needeed Pregnant Lactating Pregnant Lactating Pregnant Lactating
Quinoa/ Buckwheat/
Cereals 360 390 24.78 Rice/Wheat/Rava 8.9208 9.6642 49.56 Bulgur 17.8416 19.3284
Black-eyes peas/
Pulses 105 165 68.04 Arhar Dal/ Rajma 7.1442 11.2266 136.08 Kidney beans 14.2884 22.4532
Fat/Oil 40 40 70 Groundnut Oil 2.8 2.8 140 Olive Oil 5.6 5.6
Soy Milk/ Almond
Milk 600 600 40 Milk 24 24 80 Milk 48 48
Apple/Banana/
Fruit 300 300 35 Orange/guava 10.5 10.5 70 Avocado/ Blackberries 21 21
Green Leafy Kale/ Lettuce/ Red
Vegetables 250 250 25 Spinach/ Methi 6.25 6.25 50 Cabbage 12.5 12.5
Roots & Sweet Potatoes/
Tubers 300 300 10 Potatoes/Radish 3 3 20 Carrots 6 6
Brinjal/ Bottle
Other Gourd/
Vegetables 300 300 20 Cauliflower 6 6 40 Brocolli/ Bell Pepper 12 12
Meat/Chicken
/Fish 50 50 150 Chicken 7.5 7.5 300 Chicken 15 15
Egg 50 50 120 Egg 6 6 240 Egg 12 12
Sugar 35 35 35.7 Sugar 1.2495 1.2495 71.4 Sugar 2.499 2.499
Total daily cost 83.3645 88.1903 Total daily cost 166.729 176.3806
2nd trimester

Rural Basket Urban Basket

Average Average
Recommended Price per Price per
Total No. of grams kg Item Price per day kg Item Price per day
Nutriets
needeed Pregnant Lactating Pregnant Lactating Pregnant Lactating

Quinoa/
Cereals 360 390 24.78 Rice/Wheat/Rava 8.9208 9.6642 49.56 Buckwheat/ Bulgur 17.8416 19.3284
Black-eyes peas/
Pulses 105 165 68.04 Arhar Dal/ Rajma 7.1442 11.2266 136.08 Kidney beans 14.2884 22.4532
Fat/Oil 45 45 70 Groundnut Oil 3.15 3.15 140 Olive Oil 6.3 6.3
Soy Milk/ Almond
Milk 650 650 40 Milk 26 26 80 Milk 52 52
Apple/Banana/ Avocado/
Fruit 350 350 35 Orange/guava 12.25 12.25 70 Blackberries 24.5 24.5
Green Leafy Kale/ Lettuce/ Red
Vegetables 350 350 25 Spinach/ Methi 8.75 8.75 50 Cabbage 17.5 17.5
Roots & Sweet Potatoes/
Tubers 300 300 10 Potatoes/Radish 3 3 20 Carrots 6 6
Brinjal/ Bottle
Other Gourd/ Brocolli/ Bell
Vegetables 300 300 20 Cauliflower 6 6 40 Pepper 12 12
Meat/Chicken
/Fish 50 50 150 Chicken 7.5 7.5 300 Chicken 15 15
Egg 50 50 120 Egg 6 6 240 Egg 12 12
Sugar 35 35 35.7 Sugar 1.2495 1.2495 71.4 Sugar 2.499 2.499
Total daily cost 89.9645 94.7903 Total daily cost 179.929 189.5806

3rd trimesterxiv

Rural Basket Urban Basket

Average Average
Recommended Price per Price per
Total No. of grams kg Item Price per day kg Item Price per day
Nutriets
needeed Pregnant Lactating Pregnant Lactating Pregnant Lactating
Cereals 360 390 24.78 Rice/Wheat/Rava 8.9208 9.6642 49.56 Quinoa/ Buckwheat/ 17.8416 19.3284
Pulses 165 225 68.04 Arhar Dal/ Rajma 11.2266 15.309 136.08 Black-eyes peas/ 22.4532 30.618
Fat/Oil 45 45 70 Groundnut Oil 3.15 3.15 140 Olive Oil 6.3 6.3
Milk 700 700 40 Milk 28 28 80 Soy Milk/ Almond 56 56
Apple/Banana/ Avocado/
Fruit 350 350 35 Orange/guava 12.25 12.25 70 Blackberries 24.5 24.5
Green Leafy Kale/ Lettuce/ Red
Vegetables 350 350 25 Spinach/ Methi 8.75 8.75 50 Cabbage 17.5 17.5
Roots & Sweet Potatoes/
Tubers 300 300 10 Potatoes/Radish 3 3 20 Carrots 6 6
Brinjal/ Bottle
Other Gourd/
Vegetables 300 300 20 Cauliflower 6 6 40 Brocolli/ Bell Pepper 12 12
Meat/Chicken
/Fish 50 50 150 Chicken 7.5 7.5 300 Chicken 15 15
Egg 50 50 120 Egg 6 6 240 Egg 12 12
Sugar 35 35 35.7 Sugar 1.2495 1.2495 71.4 Sugar 2.499 2.499
Total daily cost 96.0469 100.8727 Total daily cost 192.0938 201.7454
 Urban Basket Cost
State Bihar
City Patna
Population 54.15 Lakhs
No. of Females 26.6 Lakhs
No. of Pregnant Females 1.64 Lakhs
Potential market size @20% 0.328 Lakhs
Expected volume of a single package 18000 cc
0.018 cu. m
Volume of Tata ace 4687500 cc
No. of crates that can be carried by 1 vehicle 260
Total no. of crates required per day 0.09 Lakhs
No. of delivery vehicles required 36
Area of Patna 136 sq. km
Diameter of Patna 6.58 Km
Average distance travelled per delivery trip 20 Km
Time per trip 3 Hrs
No of trips possible in a day 3
No. of delivery vehicles required 12

Cost of Delivery Vehicle

Fixed Cost 432,000 Rs.
RTO+Road Tax+Others 62,300 Rs.
Insurance 17,500 Rs.
Estimated 5 year cost to own 796,560 Rs.
Avg. Cost per Km 6.64 Rs.
Loan Tenure 5 Years
Interest Payable @ 9% 106,000 Rs.
Net ownership cost 902,560 Rs.
Total ownership cost 10843944.32 Rs.
Ownership cost per week 3475.62 Rs./Week

Mileage 15 Km/L
Average running per day per vehicle 60
Fuel cost 69.1 Rs./L
Fuel cost incurred per day per vehicle 276.4 Rs./Day
Fuel cost per vehicle per week 1934.80 Rs.
Fuel cost of fleet per week 23245.95 Rs.
Total delivery cost 26721.57 Rs./Week
Delivery cost for a week's supply 1.63 Rs.

Cost of daily supply 158.53 Rs.

Cost of weekly supply 1109.71 Rs.
Rent of distribution centre 20000 Rs./Month
Rent of distribution centre per week 4666.67 Rs./Week
Rent of DC per week per pregnant woman 0.14 Rs./Week/Woman
Labour cost per week (Shopfloor Level) 154200.00 Rs./Week
Labour cost per week (Delivery) 15438.83 Rs./Week
Total Labour Cost 169638.83 Rs./Week
Total Labour Cost per pergnant woman 1.03
Total cost for a week's supply 1112.52 Rs.
 Rural Basket Cost
State Bihar
Distt. Purnia
Block Srinagar
No. of villages in the Block 27
Population 1.1 Lakhs
No. of Females 0.52 Lakhs
No. of Pregnant Females 0.04 Lakhs
Average no. of Pregnant women per village 148
Potential market @20% 29.63

Expected volume of a single package 18000 cc

0.018 cu. m
Volume of Tata ace 4687500
No. of crates that can be carried 260
No. of villages that can be catered by 1 delivery Vehicle 8.79
No. of delivery vehicles required to cater 27 villages twice a week 6
Area of Srinagar 160 sq. km
Dimensions of Srinagar 12 X 13.3 sq. km
Average distance travelled per delivery trip 20 Km
Time per trip 3 Hrs
No of trips possible in a day 3
No. of delivery vehicles required 2

Cost of Delivery Vehicle

Fixed Cost 432,000 Rs.
RTO+Road Tax+Others 62,300 Rs.
Insurance 17,500 Rs.
Estimated 5 year cost to own 796,560 Rs.
Avg. Cost per Km 6.64 Rs.
Loan Tenure 5 Years
Interest Payable @ 9% 106,000 Rs.
Net ownership cost 902,560 Rs.
Total ownership cost 1848442.88 Rs.
Ownership cost per week 592.45 Rs./Week

Mileage 15 Km/L
Average running per day per vehicle 60
Fuel cost 69.1 Rs./L
Fuel cost incurred per day 276.4 Rs./Day
Fuel cost per vehicle per week 1934.80 Rs.
Fuel cost of fleet per week 3962.47 Rs.

Total delivery cost 4554.92 Rs./Week

Delivery cost for a week's supply 2.28 Rs.

Cost of daily supply 85.87 Rs.

Cost of weekly supply 601.09 Rs.
Rent of distribution centre 6000 Rs./Month
Rent of distribution centre per week 1400.00 Rs./Week
Rent of DC per week per pregnant woman 0.35 Rs./Week/Woman
Labour cost per week (Shopfloor Level) 7710.00 Rs./Week
Labour cost per week (Delivery) 2631.68 Rs./Week
Total Labour Cost 10341.68 Rs./Week
Total Labour Cost per pergnant woman 2.59
Total cost for a week's supply 606.30 Rs.
 Break-even Analysis
Patna
Cost price for a weekly supply 1112.52
Estimated SP for a weekly supply 1800
Projected profit 687.48
Female population 26.61
Pregnant women population 1.64
Potential market @20% 0.328

Purnia
Cost price for a weekly supply 606.30
Estimated SP for a weekly supply 200
Projected subsidy to be given -406.30
Female population 15.65
Pregnant women population 1.23
Potential market @20% 0.246

Projected profit in Patna 22549474

Pregnant women that can be catered at break even 55499.17
No. of villages like Purnia that can be catered 2.26

i
https://www.orfonline.org/expert-speak/an-analysis-of-maternal-health-condition-across-parliamentary-
constituencies-in-india50535/
ii
https://www.epw.in/journal/2019/20/perspectives/delivering-nutrition-pregnant-
women.html?0=ip_login_no_cache%3D8e2d277ff8be630e7658b84f1b8ddaa5
iii
https://www.epw.in/journal/2019/20/perspectives/delivering-nutrition-pregnant-
women.html?0=ip_login_no_cache%3D8e2d277ff8be630e7658b84f1b8ddaa5
iv
https://www.livescience.com/34693-superfoods.html
v
https://www.webmd.com/food-recipes/guide/calcium-vitamin-d-foods
vi
https://www.ndtv.com/health/mothers-to-be-take-care-of-these-nutritional-requirements-for-a-
healthy-pregnancy-and-childbirth-2002828
vii
https://ods.od.nih.gov/factsheets/Omega3FattyAcids-Consumer/
viii
https://www.dietinpregnancy.co.uk/pregnancy/trimester-nutrition/
ix
https://www.dietinpregnancy.co.uk/pregnancy/pregnancy-superfoods/
x
https://data.gov.in/resources/performance-key-hmis-indicators-across-sub-districts-purnia-bihar-
financial-year-2017-18

xi
https://parenting.firstcry.com/articles/healthy-indian-diet-during-pregnancy-what-to-eat-what-to-
avoid/

xii
https://www.sitarambhartia.org/blog/maternity/need-know-pregnancy-diet-chart/

xiii
http://ninindia.org/DietaryGuidelinesforNINwebsite.pdf