Large Scale Food Fortification /
What is large scale food fortification?
In an ideal world we would all have access to a wide variety of nutrient rich foods which provide all the vitamins and minerals we need. Unfortunately, for many people, especially in poorer countries, this is often not feasible or affordable. Fortified foods include vegetable oil with vitamin A and D; wheat and maize flour with iron, folic acid, other B vitamins and zinc; sauces and condiments such as soy sauce with iron; and salt with iodine. Food fortification forms an important part of our work at GAIN. It is one of the most scalable, sustainable, and cost-effective tools we have to reduce malnutrition, enabling people to increase their nutrient intake consistently and safely. Once an initial capital investment is made, continuing costs are only a few US cents per person per year. Food fortification also helps economies by reducing malnutrition, preventing estimated losses to the economy of as much as 2.65% of GDP according to the World Bank. Watch our short video about Food Fortification
Our Work in Food Fortification /
Our food fortification programs have reached 800 million people in more than 30 countries Fortified foods include vegetable oil with vitamin A and D; wheat and maize flour with iron, folic acid, other B vitamins and zinc; sauces and condiments such as soy sauce with iron; and salt with iodine. GAIN and its partners have supported large scale food fortification through:
- Brokering sustainable public private partnerships such as National Fortification Alliances
- Ensuring sustainable supply of micronutrient premix
- Improved regulatory monitoring and quality assurance and control systems
- Enhanced production capacity and integration of fortification into national nutrition policy
- We work with a range of partners to support national universal salt iodization programs to become sustainable and effective in improving iodine nutrition in numerous countries around the globe
- In Senegal, the majority of women of reproductive age are now consuming fortified flour and oil – reducing deficiencies including of iron, folic acid and vitamin A
- In South Africa, flour fortification has contributed to a more than 30 percent decline in neural tube defects in babies, including a 41% decline in the prevalence of spina bifida
- GAIN’s financial and technical support has helped mandatory food fortification legislation to be passed in Bangladesh, Cote d’Ivoire, Egypt, Ghana, Indonesia, Kenya, Morocco, Senegal, Tanzania, Uganda, and Ethiopia
GAIN’s Fortification Quality Support (FoQuS) Program
Our FoQuS program helps to ensure that fortification meets national standards and regulations. We work with a variety of stakeholders to build effective quality assurance and quality control (QA/QC) systems and to establish global platforms that support compliance
GAIN Premix Facility
Premix is a commercially prepared blend of vitamins and minerals used to fortify staple foods. Government and industry partners face many challenges in procuring premix for food fortification programs including high costs and lack of systems to ensure the product’s quality. To address these barriers, GAIN has established the GAIN premix facility which started procuring premix on behalf of its customers in July 2009.
GAIN’s Fortification Assessment Coverage Tool (FACT)
We developed our Fortification Assessment Coverage Tool (FACT) to evaluate the effectiveness of large-scale food fortification programs. It aims to understand whether women of reproductive age, especially those at high risk of micronutrient deficiency, receive a meaningful micronutrient contribution from fortified foods. It specifically classifies at-risk population sub groups, to better determine if programs are reaching those who need it most.
Fighting Malnutrition through Sustainable National Partnerships
GAIN supports coalitions of governments, businesses, international organisations and civil society in numerous countries. These National Fortification Alliances (NFAs) collaborate to strengthen policy, legislation and regulation around fortification. They also provide strategic guidance for national fortification programs and act as governance bodies for projects supported by GAIN. Together we are committed to identifying sustainable market-based solutions to malnutrition that continue after projects and programs end. Over the last decade, GAIN and its partners have worked in 30 countries with an estimated 1,194 private sector food processors in fortification including oil producers, flour millers, salt producers and premix manufacturers. This includes 517 private sector partners in Africa and 675 in Asia. GAIN’s current work with industry focuses on improving knowledge of fortification processes and access to quality inputs.
Global tracking /
GAIN collaborates with its partners to collect and publish national data and track fortification efforts globally. While GAIN is tracking information on oil and condiments as fortified vehicles, the Food Fortification Initiative takes the lead on tracking progress on cereal grains, and the Iodine Global Network tracks salt.
Vegetable oils and fats
Vegetable oils and fats, such as margarine or ghee, are typically fortified with vitamins A and D. While some countries may have legislation covering all types of vegetable oils, the below information is valid if a country mandates at least one type of vegetable oil or fat.
As of October 2016:
- 49 countries mandate fortification of vegetable oils or margarine with vitamin A and 20 of these also include vitamin D in their standards.
- 10 countries allow voluntary fortification with vitamin A and 6 also include vitamin D in their standards.
Condiments and sauces
Condiments and sauces, such as fish sauce, soy sauce, MSG, and bouillon cubes are increasingly being utilized as flavor enhancers for many foods, reducing salt intakes in some cases. Condiments and sauces can be fortified with iodine, iron, vitamin A, or multiple micronutrients depending on the condiment and the population need.
As of October 2016:
- 2 countries mandate fortification of fish and soy sauces (Thailand and Cambodia).
- Vietnam allows for voluntary fortification of fish and soy sauces and China allows for voluntary fortification of soy sauce only.
- 2 countries allow voluntary fortification of MSG (Philippines and Indonesia).
- 7 countries in West Africa are currently within the Nestle Maggi fortified bouillon cubes distribution area.
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Read news and updates about GAIN’s food fortification work
Central Asia Regional Fortification Portal /
The USAID-funded Afghanistan, Pakistan and Central Asia Republics Regional Fortification Initiative aims to build capacity for food fortification with essential vitamins and minerals in order to improve micronutrient intakes across the region, and in particular for Afghanistan. The initiative is forming essential partnerships between governmental bodies, the private sector as well as civil society partners to embed fortification within the regional and national food systems to achieve sustainable fortification which leads to health impact. Key objectives include establishing and strengthening regulations and monitoring, facilitating harmonization of regional fortification standards; and strengthening quality control and enforcement. This portal offers essential USAID-funded technical outputs and information related to food fortification in Afghanistan, Pakistan and the Central Asian Republics.
- GAIN-USAID Central Asia Project Summary (ENG)
- GAIN-USAID Central Asia Project Summary (RUS)
- Factsheet – Industry Assessments Kazakhastan (ENG)
- Factsheet – Industry Assessments Kazakhastan (RUS)
- Factsheet – Trade Flows Kazakhastan (ENG)
- Factsheet – Trade Flows Kazakhastan (RUS)
- Factsheet – Legislation (ENG)
- Factsheet – Legislation (RUS)
- Summary of Lessons Learned in the Central Asia Republics (ENG)
- Summary of Lessons Learned in the Central Asia Republics (RUS)
- Industry Assessment in Kazakhstan and Pakistan (ENG)
- Industry Assessment in Kazakhstan and Pakistan (RUS)
- Analysis of Food Fortification in CAR Afghanistan and Pakistan (ENG)
- Analysis of Food Fortification in CAR Afghanistan and Pakistan (RUS)
- Regional Trade Flow Analysis across the CAR Region (ENG)
- Regional Trade Flow Analysis across the CAR Region (RUS)
- 29 October 2015 Central Asian Trade Forum Panel Report
- 30 October 2015 Regional Meeting Report
- 8 September 2016 Central Asian Trade Forum Panel Report
- Pakistan – Afghanistan Cross Border Trade Meeting on Fortified Wheat Flour and Edible Oils (ENG)
Micronutrient deficiencies including iron, zinc, vitamin D, and vitamin A are widespread in Afghanistan. More than 50% of children under five years are deficient in vitamin A, and 64% are deficient in vitamin D while 14% are iron deficient, all severe public health problems. GAIN and USAID are supporting in-country efforts aimed at creating an enabling environment to increase the availability and access to fortified foods in Afghanistan by strengthening fortification regulations and capacity for monitoring and enforcement, with a special focus on imports of fortified wheat flour and edible oil from neighbouring countries.
- Afghanistan Fortified Wheat Flour Standard
- Afghanistan Fortified Edible Oil and Ghee Standard
- Afghanistan Iodized Salt Standard
Wheat flour is a critical staple food in Central Asia, accounting for between 50-70% of caloric intake. Kazakhstan is among the top wheat flour exporting countries in the world. Neighbouring countries in the region, especially Afghanistan, import part of their wheat flour from Kazakhstan, which, if fortified, would have a significant impact. GAIN and USAID are working with key stakeholders including the Kazakh Academy of Nutrition and the Kazakh Union of Grain Processors, to raise awareness and create an enabling environment for increased production and trade of adequately fortified wheat flour in Kazakhstan and throughout the region, with an emphasis on improving fortification processes, regulations and monitoring.
- Public Health and Healthcare System Code of the Republic of Kazakhstan (RUS)
- Food Safety Law of the Republic of Kazakhstan (RUS)
- Kazakhstan Specifications for Fortified Bread and Breadstuffs (RUS)
- Kazakhstan Specifications for KAP Komplex 1 Premix (RUS)
- Wheat standard of the Republic of Kazakhstan (RUS)
- Kazakhstan Food Fortification Rules – Decree of the Ministry of National Economy from February 2015 (RUS)
- 7-8 July 2015 Kazakhstan Regional Flour Fortification Workshop Report (ENG)
- 14-15 March 2016 Regional Technical Meeting on Harmonization of Wheat Flour Fortification Standards in Kazakhstan Report
In Pakistan, most children and women of reproductive age suffer from multiple micronutrient deficiencies. Half of the women and 62% children under five in Pakistan are iron deficient. Vitamin A deficiency is also of concern with 42% of non-pregnant women and 54% of the under-fives with low serum retinol levels. At the same time, Pakistan is a major producer and exporter of both wheat flour and edible oil in the region. More than half of Afghanistan’s wheat flour is imported from Pakistan. Mandatory regulations for the fortification of edible oils with vitamin A are in place, wheat flour fortification is starting. USAID and GAIN are supporting industries to set up the right tools and processes to produce fortified wheat flour and edible oil; supporting strengthening the regulatory monitoring system for compliance; and raising awareness about the economic and health benefits of consuming fortified foods to industries, consumers, and government stakeholders.
Reports and Assessments
- Analysis of Economic Losses due to Micronutrient Deficiencies in Pakistan (ENG)
- Analysis of Economic Losses due to micronutrient deficiencies in Pakistan (RUS)
- Industry and Regulatory Monitoring of Wheat Oil and Salt in Punjab Province (ENG)
- 15 June 2015 Pakistan Consultative Session Report
- Pakistan – Afghanistan Cross Border Trade Meeting on Fortified Wheat Flour and Edible Oils (ENG)
Despite economic progress, micronutrient deficiencies Tajikistan remain high. Iron deficiency anaemia affects an estimated 24% of women of reproductive age and 28% of children under the age of five. Bread is the main staple food, and therefore wheat flour is an ideal vehicle for fortification with iron and folic acid. GAIN and USAID are supporting the Government of Tajikistan in the development of appropriate fortification legislation and policies, and building capacities of food industries and food control authorities for the fortification of wheat flour to improve iron and folate status in the Tajik population.
- GAIN-USAID Tajikistan Project Summary (ENG)
- GAIN-USAID Tajikistan Project Summary (RUS)
- Summary of Scaling Up Nutrition in Tajikistan
- Tajikistan Standard for Bread and Bakery Products made with Fortified Wheat Flour (RUS)
- Tajikistan Standard for Baking using Fortified Wheat Flour (RUS)
- Tajikistan Technical Specifications for Micronutrient Premix (RUS)
- Tajikistan Standard for National Bakery Products (RUS)
- Tajikistan Standard for National Bread (RUS)
Reports and Assessments
- Assessment of Fortification Opportunities in Tajikistan (ENG)
- Tajikistan Laboratory Assessment Report (ENG)
- Wheat Flour Milling Industry Assessment Report (ENG)
- Formative Research on Consumption of Wheat Flour in Khatlon Province 2014 (ENG)
- Formative Research on Consumption of Wheat Flour in Khatlon Province 2014 (RUS)
- Tajikistan Laboratory Assessment Report (RUS)
- 1-2 July 2015 Tajikistan National Workshop on Food Fortification Report
- 10-11 March 2016 Synopsis of the Cost Benefit Analysis of Wheat Flour Fortification in Tajikistan
- Food fortification in Tajikistan: A cost effective strategy for sustainable economic growth (ENG)
- Food fortification in Tajikistan: A cost effective strategy for sustainable economic growth (RUS)
- Food fortification in Tajikistan: A cost effective strategy for sustainable economic growth (TAJ)