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