Presentation to NFA Georgia July, 2005Presentation to NFA Georgia July, 2005
International Activities on Food International Activities on Food FortificationFortification
Quentin Johnson, Quentin Johnson, Fortification Consultant Fortification Consultant
GAINGAIN
Successful Fortification Programmes
1920’s Switzerland Salt Iodization 1930’s N. Europe Vitamin D in dairy 1930’s Denmark Vitamin A in margarine 1940’s N America Vit B, Iron in flour 1974 Guatemala Vitamin A in sugar 1992 Universal Salt Iodization
Successful Fortification Programmes
1996 N America Folic Acid in Flour 1996 Venezuela Vit A,B’s Iron in Flour 1998 Philippines Vitamin A in flour 1999 Zambia Vitamin A in sugar 1999 Indonesia Iron Folic Acid Zinc in flour 1999 Egypt Iron in Biscuit flour 2000 Mexico Addition of Zinc to fortified flour 2002 Jordan, Kuwait, Qatar Iron Folic Acid 2002 South Africa Wheat and Maize flour 2002 CARK Region
Conditions For Successful Fortification Programs
Political Support Industry Support Adequate Legislation Consumer Acceptance No Cultural or other Objection Availability of Micronutrients Economically sustainable
Which countries fortify flour with iron?
Sources: MI, UNICEF & WHO
In Place (31 countries)In Process (20plus countries)
Note: India project basis only
Micronutrient Fortification of Cereal Flours: An Important
Global Strategy USA/Canada:mandatory and
ongoing since 1940s. Latin America: 14 out of 24
countries have mandatory fortification. Significant impact in Chile/Venezuela.
Asia: 35% of flour in Philippines is fortified;All flour in Indonesia fortified.
Africa:South Africa ready to launch national corn meal fortification.Permitted in Kenya/Uganda.
Middle East and North Africa: Mandatory in 6 countries. Partial fortification in Egypt/Morocco.
Fortification Activities around the World: Current Status
SUB-SAHARAN AFRICA– Cereal (Maize, Wheat) Fortification with
multiple micronutrients– Voluntary fortification in Angola, Congo, Kenya,
Lesotho, Malawi, Tanzania, Uganda, – Mandatory fortification in
Nigeria for wheat flour South Africa for wheat flour maize meal
– Mandatory fortification of Sugar in Zambia
Current Activities: ASIA
India - Projects in West Bengal small scale fortification, bioavailability studies, some private roller mills fortifying flour
Bangladesh - Fortification of flour from donated wheat USAID with WFP
Nepal - National fortification of wheat flour proposed – start date October 2005
Current Activities: Asia
Afghanistan - WFP flour fortified with assistance from WHO MI – SSF in Kabul and Badakhshan
Indonesia - Mandatory Fortification of wheat flour
Pakistan - Chakki mill and Roller mill fortification projects supported by GAIN, MI WHO
Thailand - Instant Noodle fortification of spice packet with Iodine, Iron and Vitamin A
Current Activities: ASIA
Central Asia - Development of Regional standard for flour fortification in 6 CARK nations with assistance from ADB
China - Western China flour fortification with Fe Na EDTA
South and South East Asia - ADB RETA project for China, India, Indonesia, Pakistan, Thailand and Vietnam - flour and vegetable oil
Current Activities: Middle EastFlour
Regional Workshops- Iran 1995, Oman 1996, Beirut 1998
International Agency Partners MI, WHO. UNICEF
Regional Standard recommended by WHO– *60 ppm Iron, electrolytic or 30 ppm as FeSO4– 1.5 ppm Folic Acid
•Proposed fortification standard for Georgia 60 ppm •Electrolytic iron and Folic Acid
Current Activities: Middle East
Countries fortifying as of July 2005 - Bahrain, Jordan, Kuwait, Oman, Qatar, Saudi Arabia, Egypt (school children biscuit flour with Iron)
Projects underway - Egypt, Iran, Syria Morocco - National programme to start November 2005 Legislation - Libya (flour) and Yemen (flour and oil) GCC - Adoption of Fortified Wheat flour standard UAE - Voluntary fortification with Iron and Folic Acid
Common Challenges
Cost of fortification - can represent more than profit margin for mills in Jordan or 10% increase in SSF milling fee
Lack of dietary diversification - presence of natural inhibitors ie phytates and tannins
Disease and Poor Health - AIDS, Malaria, Intestinal parasites
Low Utilization rates in Large Mills - Bangladesh, India, Pakistan
Common Challenges
Fortification form of birth control, Religious and Cultural objections to adding
something to foods Consumption of inhibitors i.e. tea Regulatory barriers i.e. Pure Food Act Lack of Technology
Addressing Challenges
Disease and Public Health– Concurrent programmes of fortification and
Public Health to control Malaria and Intestinal problems
– AIDS significant issue in Africa and now in Asia
Misinformation– Strong IEC and Social Marketing Campaigns
Addressing challenges: Examples
Morocco - Millers pay for premix and feeders Government pays for Social Marketing and advertising campaigns
Jordan - MOH included premix cost as budget line item. Feeder costs covered by WHO/MI/UNICEF fund
Bahrain - Premix cost covered by MOH and Ministry of Commerce
Addressing Challenges:Examples
Qatar - Inspection Fee for wheat imports eliminated to pay for premix and feeders
Moldova - 0.25% Customs Service Fee identified to be eliminated to cover cost of premix
Addressing Challenges:Examples
Fortification costs are being covered by adjustment of existing government fees and reduction in import duties for equipment and premix
Wheat price variations more significant than cost of fortifications: (Note due to drought in North America wheat prices in 2002 up by 35-50%)
All parts of national budgets to be looked at for potential sources of funding
Global Alliance for Improved Nutrition, GAIN
Sponsored by Bill and Melinda Gates Foundation, CIDA, USAID
Assistance Grants for National Fortification Programmes
15 Countries received grants to date including Burkina Faso, China, Cote d’Ivoire, Dominican Republic, Ghana, Mali, Morocco, Nigeria, Pakistan, South Africa
GAIN Proposal Requirements
National Fortification Alliance – must be multisectoral partnership - Industry, Government, Civil Society, NGOs
National programme must be sustainable once started and after GAIN funding stops
GAIN funds for only 3 years but proposal 5 years Proposal: RFP documents and budget document Maximum from GAIN $3 million
GAIN Proposal Documents
RFP Document must cover overall objective and 5 Components– Production and Distribution– Safety and Quality of Fortified food– Social Marketing and Communications– Monitoring, Evaluation and Impact– Programme Management
RFP Budget– Covers Costs– Sources of funding
GAIN GrantsSuccessful Proposals
Strong Political Support Demonstrated strong partnerships between
government, industry and civil society Demonstrated commitment to long term
sustainability Balanced funding sources from GAIN,
government (in-kind), civil society, and industry Realistic
Wheat Export BoardsCommodity Companies
Milling AssociationsMilling Companies
Food Companies & Bakers
GovernmentsRegional Bodies
Trade OrganizationsConsumer Groups
Consumers
MI, CDCUN Organizations
GAINOther International Organizations
Flour Fortification: The importance of engaging all Stakeholders
What are the costs for the premixes?
Niacin
Iron
Vit A
Folic Acid
Vit B6
Thiamin
RiboflavinZinc Fe 60 ppm: Fe 60 ppm: $.33/MT$.33/MT
FE + Folic : FE + Folic : $.50/MT$.50/MT FE, Folic Acid + B FE, Folic Acid + B
Vitamins: Vitamins: $1.10/MT*$1.10/MT* Multi-Nutrient Mix Multi-Nutrient Mix
w/Vitamin A w/Vitamin A $2.35/MT$2.35/MT For 100 kg Annual Cost: For 100 kg Annual Cost:
$0.03- $.24/pp/yr$0.03- $.24/pp/yr
Relative Premix CostsRelative Premix CostsSouth AfricaSouth Africa
Source: Jack Bagriansky
* 0.5% of flour price
Wheat & Maize FlourMap of countries shows the potential contribution to Iron RDI from wheat & maize flour consumed (gm/day) if 30 ppm of iron were absorbed from the flour
% US RDI<25%25-49%50-74%>75%
Data source: FAO 1997
Data notpresented
Data notpresented
Universal flour fortification could make a very large impact
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