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OPPORTUNITIES AND CHALLENGES IN

SCALING-UP MILK FORTIFICATION

DEEPTI GULATIHEAD OF PROGRAMS

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WHY GOOD NUTRITION IS IMPORTANT

2

NUTRITION IS THE CORNERSTONE THAT

DEFINES HEALTH AND IS CENTRAL TO

GROWTH AND DEVELOPMENT

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Delhi

70-94%

Tirupati

45-82%

Lucknow

75-90%

Hyderabad

34-52%

Punjab

50%

J & K

53-83%

Mumbai

88%

Kolkata

92%

States

Vitamin A

deficiency

at blood

level (< 20

g/dL)

% population

eating < 50% of

required amount

of Vit. A rich

foods

Kerala 79.4 91.8

Tamil Nadu 48.8 81.9

Karnataka 52.1 90.4

AP /Telangana 61.5 92.9

Maharashtra 54.7 88.8

MP 88.0 87.4

Orissa 57.7 77.5

West Bengal 61.2 80.6

Pooled 61.8 86.3

India has a very high burden of vitamin A & D deficiencies, impacting all

Vitamin D Deficiency in India

Vitamin A Deficiency in

India

VITAMIN A & D DEFICIENCY IN INDIA: NIN

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WE KNOW…..

Burden of vitamin A and D deficiencies is very high

MILK FORTIFICATION is an excellent cost-effective

complementary strategy to combat vitamin A and D deficiencies

Milk Fortification bridges the nutritional gap between the body’s

requirement and consumption through diet

It is a safe method of improving nutrition among people.

It does not require any behaviour changes in eating patterns

It does not alter the taste, colour, smell or the texture of milk

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*Reach= [(Fortified tonnage in MT/annum)/ per capita consumption of edible oil per person per annum]

Per capita consumption of edible oil per person per day = 25 g

Per capita consumption of edible oil per person per annum= 25g*365 days= 9125g or 9.125kg or 0.0091 M

** Reach= [(Fortified tonnage in Litre Per annum)/ per capita consumption of milk per person per annum (in

Litres)]

Per capita consumption of milk per person per annum (in Litres) = 200ml/1000 g= 0.2*365=73 litres

***As reported by Department of Food & Civil Supplies and other relevant officials

KA

KL

TN

OR

BR

HP

UP

AP

TS

MH

MP

RJ

GJ

PB

HR

AM

S.No States

Edible Oil Milk Wheat Flour

Total Fortified Tonnage

(MT/annum)

*Persons reached@

consumption level of 25g/

day

Total Fortified Tonnage(Litre Per Annum)

**Persons reached@

consumption level of

200 ml/ day

Total Fortified Tonnage (MT per annum)

***Persons reached

Persons reach

through fortified

wheat flour (Open

Market)****

1 Rajasthan 369,999 41,111,000 1,767,714 8,838,570 - -

2 Haryana 59,182 6,575,778 250,626 1,253,130

3 Punjab 185,970 20,663,333 220,256 1,101,280 355 - 4,863

4 M.P 687,495 76,388,333 37,000 185,000 - -

5 Gujarat 2,656,450 295,161,111 --

- -

6 Maharashtra 533,200 63,688,889 248,000 1,240,000 - -

7 Telangana 89,400 9,933,333 510,236 2,551,180

8 A.P 729,374 81,041,556 210,183 1,050,915 18,250 - 250,000

9 Odisha 96,600 10,733,333 --

10 Delhi -

115,000 575,000 5400 73,973

11 U.P 863,184 95,909,333 444,000 2,220,000 720 99,081

12 Bihar 1,300 144,444 - - - -

13 Karnataka 102,400 11,377,778 97,507 487,535

14 Kerala 69,360 7,706,667 10,000 50,000 60,100 20,033,333

15 Tamilnadu 1,479,750 164,416,667 428,535 2,142,675 - -

16 Himachal - -

--

325,992 7,337,828

Total 7,923,664 884,851,556 4,339,057 21,695,285410,817

27,470,242 328,836

GAIN’S LARGE SCALE FOOD

FORTIFICATION REACH (March 2021)

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Group (All

Subjects)N

S.25 (OH) D

level at baseline

S.25 (OH) D

following

fortification

Group A 237 11.74±5.23 10.83±5.24

Group B 243 11.42±5.24 22.87±6.75*

Group C 233 11.94±5.62 27.67±8.47*

Total 713 11.69±5.36 20.44±9.88*

Serum 25 (OH)D levels before and after vitamin

D fortified milk in Delhi children

Group A—no fortification, group B—received milk

fortified with 600 IU, group C—received milk fortified with

1,000 IU

R. Khadgawat ; Osteoporos Int; 2013

Prevalence of Vitamin A Deficiency %

Age-Group All India Rajasthan

Children 5-9 years

(CNNS)

21.5 1.0

Children 10-19 years

(CNNS)

15.6 1.9

Fortification of edible oil and milk since 2012, MAY HAVE

brought down the levels of vitamin A deficiency in

children (CNNS 2016-17) in Rajasthan.

CNNS-2016-17 Factsheet Data

IMPACT OF MILK FORTIFICATION

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1. Well-Designed Program with a Clear Focus on Interventions that Work

2. Strong Engagement, Good Coordination & Collaboration between All Stakeholders

3. Stable Funding by the Government, Industry and Other Partners

4. Strong Government Leadership & Champions

5. Effective Capacity Building of Food Industry to Adopt and Scale-up Fortification

6. Strong Monitoring System for Quality and Quantity

7. Assessment of Coverage and Regulatory Compliance by the Industry

8. Rigorous Assessment of Efficacy and Effectiveness

SUCCESS FACTORS

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WHAT IS AN OPPORTUNITY AND A CHALLENGE

OPPORTUNITY:

Cambridge Dictionary: a chance to do something that you would like to do;

a situation or a time in which it is possible to do something that you would

like to do

Webster: a good chance / situation for advancement or progress

CHALLENGE:

Cambridge Dictionary: something that by its nature or character serves as a

call to battle, contest, or put in special skill, effort, etc.

Webster: A situation that needs great mental / physical effort, in order to

be done successfully, thereby testing the person’s ability

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OPPORTUNITIES

Constitutional Provision: “State shall regard the raising of the level of nutrition

and the standard of living of its people and the improvement of public health as

among its primary duties … ” – Article 47. Constitution of India

Political Commitment at the Highest Level: “There is immense potential for food

processing and value addition, especially in niche areas such as organic and

fortified foods” said by Prime Minister Shri Narendra Modi.

Food Fortification is an Accepted Strategy in National Nutrition Mission (POSHAN

ABHIYAAN)

Fortified Staples Recommended as Mandatory in the Social Food Safety-Net

Programmes: ICDS, MDM and PDS

Endorsement of Cost-effectiveness by the UN Agencies and Global Development

Sector Partners: “Annually, India loses over US$12 billion in GDP to vitamin and

mineral deficiencies. Scaling up core micronutrient interventions would cost less

than US$574 million per year” – UNICEF and Initiative. 2004 and World Bank. 2009

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India’s salt iodisation story has shown the way, benefitting all at population

level, especially the children and the other vulnerable population groups

WHO showcases positive consequences: Global mapping study (2016) of

food fortification in many countries (Indonesia, Venezuela, Morocco etc)

High Benefit to Cost Ratio: Investment on equipment and the vitamin and

mineral premix, is extremely low: just 1-2%, which is less than the normal

price variation.

FSSAI has set the standards for Milk Fortification of Milk and other Staples

FSSAI has provisioned a Logo

…… OPPORTUNITIES

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1. Even though cost is very low, fortification is considered as financial burden by

industries

2. Reaching target populations may be difficult, as dairy sector (milk processing) is

fragmented

3. Ensuring quality assured premixes to all the milk processing dairy plants

4. Monitoring intake of fortified milk and its associating it with improved nutritional

status at population level may not always be easy to corroborate

5. Social marketing not rigorous enough to create mass awareness about the

benefits of fortified milk leading to

6. Competitive Business Environment

7. Demand and Supply Situation

8. Milk Fortification is Not yet Mandatory

CHALLENGES TO SCALE-UP MILK FORTIFICATION

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WHAT NEEDS TO BE DONE

1. Strengthen Dairy sector’s capacity to undertake fortification and its

quality assurance

2. Set-in proper processes for procurement of vitamin premix

3. Build the capacity nationally and within States for regulatory

monitoring

4. Nation-wide social marketing about the advantages of Milk

Fortification

5. Mandatory Fortification of Milk

Milk fortification would be an easy win as it has significant potential for

becoming an industry-led and government supported food fortification

initiative across India

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1. Providing extensive training on:

• appropriate fortification method and processes; and

• enhanced internal quality assurance and external quality control among

participating milk dairies

2. Supporting procurement of quality assured premix for fortification

3. Developing protocols for appropriate handling and storage of micronutrient

premix, sampling of the fortified milk; and initiating actions in case of over or

under fortification;

4. Linking the dairies to laboratories accredited by National Accreditation Board

Laboratories (NABL) for quality assurance and regulatory activities;

5. Providing “Spot testing” kits for the qualitative testing for the added vitamin A

6. Supporting the systems for documentation and regular reporting

HOW GAIN SUPPORTS

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Investing in Milk

Fortification is

Good Ethics

and

Good Economics

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Let's Drink Right … Lets Drink Milk

That is Fortified

Thank you !!

Let’s join hands to provide good health

& improved quality of life to all !