Presentation to NFA Georgia July, 2005 International Activities on Food Fortification

1. Presentation to NFA Georgia July, 2005International Activities on Food Fortification • Quentin Johnson, Fortification Consultant • GAIN

2. 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

3. 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

4. Conditions For Successful Fortification Programs • Political Support • Industry Support • Adequate Legislation • Consumer Acceptance • No Cultural or other Objection • Availability of Micronutrients • Economically sustainable

5. Which countries fortify flour with iron? In Place (31 countries) In Process(20plus countries) Sources: MI, UNICEF & WHO Note: India project basis only

6. 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.

7. 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

8. 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

9. 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

10. 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

11. 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

12. 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

13. 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

14. 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

15. 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

16. 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

17. 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

18. 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

19. 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

20. 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

21. 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

22. 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

23. Wheat Export Boards Commodity Companies Milling Associations Milling Companies Food Companies & Bakers MI, CDC UN Organizations GAIN Other International Organizations Governments Regional Bodies Trade Organizations Consumer Groups Consumers Flour Fortification: The importance of engaging all Stakeholders

24. What are the costs for the premixes? • Fe 60 ppm: $.33/MT • FE + Folic : $.50/MT • FE, Folic Acid + B Vitamins: $1.10/MT* • Multi-Nutrient Mix w/Vitamin A $2.35/MT • For 100 kg Annual Cost: $0.03- $.24/pp/yr * 0.5% of flour price Relative Premix Costs South Africa Source: Jack Bagriansky

25. Wheat & Maize Flour Map 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 not presented Data not presented Data source: FAO 1997 Universal flour fortification could make a very large impact