Human Capacity Building to Monitor Fortified and Nutritious Foods in East, Central, and Southern Africa

With the completion of USAID-sponsored regional fortification programs in East, Central, and Southern Africa (countries include: Burundi, Ethiopia, Kenya, Lesotho, Malawi, Mozambique, Rwanda, South Africa, Swaziland, Tanzania, Uganda, Zambia, and Zimbabwe ) in 2011, regional cooperation and coordination has weakened.

GAIN and partners have been working on a project to build human capacity to improve fortification efforts throughout the whole region, with a focus on regional communication and collaboration.

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Bangladesh Garment Workers

The Garment sector is a major source of employment in Bangladesh, employing approximately 4.4 million people. Employees in this sector are often part of the most undernourished quintile of the population. GAIN is seeking to improve the overall nutritional status and dietary diversity of female garment industry workers and their children under 5 years old and to reduce anemia and increase Body Mass Index (BMI).

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India Integrated Food Fortification

Through the Integrated Food Fortification program, more than 4,500 metric tonnes of wheat flour, 8,900 metric tonnes of oil and 41,000 metric tonnes of milk are being fortified per month reaching about 15 million people.

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Complementary foods in Côte d’Ivoire

GAIN has been working with Protein Kissèe-La (PKL) and Helen Keller International (HKI) in Côte d’Ivoire to address malnutrition among infants and young children in Côte d’Ivoire through the production and promotion of a locally produced fortified complementary food for infants aged six to 24 months.

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Wheat flour and oil fortification in Senegal

Since 2010, GAIN has been providing financial and technical assistance to the CLM to strengthen the capacity of flour millers, oil producers, government regulators and standards bodies to fortify all wheat flour with iron and folic acid and vegetable oil with vitamin A to reach the majority of the population.

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Fortification of soy sauce in China

The purpose of the project was to create a supportive environment to leverage production volume and improve distribution channels as the means to increase availability and accessibility of iron fortified soy sauce in both rural and urban areas in China.

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Fortification of fish sauce and soy sauce

GAIN is providing financial and technical support to the Reproductive and Children’s Health Alliance (RACHA) to initiate fortification of fish and soy sauce with iron in Cambodia.

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UltraRice in Brazil

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Community led Integrated School Nutrition Program

To date, nutritious hot-cooked meals have been served to approximately 18,000 of the most vulnerable primary school children every school day in 45 schools in urban slums in Dhaka and in rural communities in Trishal and Mymensingh District. The locations were chosen based on a vulnerable mapping exercise and in joint consultations with Ministry of Primary and Mass Education and development partners.

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Project BADUTA in Indonesia

The BADUTA project focuses on improving maternal, infant feeding and care practices at the community level, strengthening the delivery of nutrition services through the health system and improving access to clean drinking water.

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Bangladesh Universal Salt Iodization

Bangladesh is one of the countries where vast number of people suffers from iodine deficiency disorders (IDD). In 1989, the Government of Bangladesh (GOB) formally accepted universal salt iodization (USI) as the safe, cost-effective and sustainable strategy to ensure adequate iodine nutrition for the population.

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Improving the Nutritional Status of Vulnerable Population Groups in Yemen

GAIN signed a Cooperation Agreement with the World Food Programme (WFP)/Yemen on a collaborative effort to improve the nutritional status of vulnerable population groups. Through this partnership, GAIN and the WFP will engage private-sector partners in improving the nutritional value of their products for the general population and targeted population groups.

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Fortification of Wheat Flour in Pakistan

This GAIN-supported project aims to develop a roadmap for a national, sustainable and effective large-scale food fortification program, a functioning regulatory monitoring system, and increased consumption of fortified foods in the country. After the devolution through 18th amendment in 2011, Pakistan’s provincial governments are now responsible for developing their own province-focused nutrition policies, strategies and operational plans.

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Multi-nutrient Supplements Initiative (MSI) in Vietnam

Vietnam has a population of 86 million people spread across 63 provinces with an estimated 6.5 million children under 5 years of age. Nearly one third of the children aged 0 to 5 years (27.5%) are stunted, and the prevalence of iron deficiency anemia (29.2%) and subclinical vitamin A deficiency (14.2%) remains high nationwide. Additional formative research conducted by GAIN in 2012 revealed that, for most parts of Vietnam, the current diet of infants and young children is not sufficient in terms of calorie intake or for protein/fat requirements.

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Nutrimark in Southern Africa

The Nutrimark project aims to address malnutrition during the 1000 day window of opportunity in southern Africa. This multi-sector project is designed to set the foundation for a scale-up of IYCN promotion and access to good-quality, affordable complementary feeding products in the region, harnessing both public delivery and market-based approaches. The project supports activities to: catalyse private-sector investment in good-quality, affordable fortified complementary feeding products; demand-creation and public promotion of optimal IYCN practices targeting vulnerable households; stakeholder engagement through policy advocacy; and monitoring and evaluation.

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Innovative Finance and LNS in Haiti

GAIN and LGT Venture Philanthropy have jointly made a loan to Meds and Food for Kids (MFK), a Haitian-based producer of lipid-based nutrient supplements (LNS). This investment was made in January 2012 to finance the construction of a new production facility.

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Innovative Finance and LNS in Ecuador

Through the GAIN - International Finance Corporation Nutrition Trust Fund, GAIN has supported Reybanpac to develop, market and distribute a semi-solid dairy-based fortified complementary food product called Lenutrit that is aimed at children 6 to 24 months old in Ecuador. The goal of the project is to commercialize this high quality, affordable fortified yogurt in low-income regions in Ecuador through Reybanpac’s distribution network. The product was launched in early 2014 and is now available to customers in Ecuador.

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Fortification of Wheat Flour and Vegetable Oil in Morocco

The first three-year phase of the fortification of wheat flour and vegetable oil project in Morocco (June 2005 until August 2008) introduced the fortification of wheat flour (with iron, folic acid, riboflavin, thiamine, niacin and vitamin B12) and vegetable oil (with vitamin A and vitamin D). The Phase I project was extended to increase the local production of fortified industrial wheat flour and fortified locally produced vegetable oil in order to reach a population of more than 30 million, including 19 million vulnerable women of reproductive age and children aged 1 to 14 years.

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Nigeria Food Fortification

In 2002, Nigeria mandated the fortification of selected food staples – wheat flour, maize flour, sugar and vegetable oil. GAIN made its first grant disbursement in 2007 to the National Planning Commission to mobilize stakeholders and establish the National Fortification Alliance.

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Mozambique Fortification of Staple Foods

Since 2011, GAIN has been working with the National Committee for Food Fortification in Mozambique (CONFAM). The project has three main components—creation of legislation to make fortification of oil and wheat flour mandatory, supporting private-sector partners with access to food fortification equipment and access to premix, and behavioural change campaign materials.

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Kenya Food Fortification

GAIN is currently supporting the Ministry of Health in implementing Kenya’s national food fortification program. The aim is to reach 95 percent of the population with fortified vegetable oil and 74 percent of the population with fortified wheat flour. The program ran from February 2011 to September 2015.

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Ethiopia Universal Salt Iodization

The GAIN-UNICEF Universal Salt Iodization Partnership, GAIN’s longest-running project in Ethiopia, supports the government’s efforts, with the goal of reaching 90 percent coverage by March 2015.

Only a small percentage of households had access to adequately iodized salt in Ethiopia, but progress has been made over the last couple of years, with the program reaching some 84 million of the 96 million estimated population. The Ethiopian Public Health Institute (EPHI) reports that over 88% of salt in the country contains iodine in its recent survey report ; however, coverage of adequately iodized salt remains very low estimated at 23.2%(EPHI, June 2014)

While focus of the national USI program remains on improving quality of iodization, efforts are still needed to improve coverage of iodized salt in the remote areas of the country, where coverage is very low.

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Fortification of Edible Oils in Bangladesh

This project aims to reduce malnutrition through the fortification of oil with Vitamin-A and other strategies aimed at improving the health and nutrition of populations at risk, such as raising awareness amongst the general Bangladeshi population of the health benefits of fortified oil.

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Afghanistan Fortification of Vegetable Oil/Ghee and Wheat Flour

The quality of the Afghan diet is generally poor. Food fortification is one way to improve nutrient intake. More than 95 percent of Afghans consume wheat flour and vegetable oil and ghee, the latter being imported mainly from Malaysia, UAE and Pakistan.

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In Afghanistan there is limited access to healthcare particularly for women. Healthcare services are dependent on the affordability, physical accessibility and acceptability of services. High maternal and child morality is a major health problem as are challenges in health equality especially so for gender sensitive issues such as physical and sexual violence, mental health and child neglect.

Malnutrition is also a real issue

  • Prevalence of chronic malnutrition among children under age 5 (stunting) is 60 percent
  • Forty eight percent of non-pregnant women are iron deficient and 25 percent are anaemic
  • 72 percent of children aged 6 to 59 months are anaemic and nearly 34 percent are iron deficient
  • Seventy five percent of women of reproductive age and 72 percent of children are iodine deficient
  • 10 percent of pregnant women suffer from night blindness.
  • Up to 10 percent of the population in areas severely affected by drought (2002 and 2003) were found to have scurvy (vitamin C deficiency)

Malnutrition impairs children’s mental and physical development, which affects their ability to learn in school and their work capacity as adults. It also increases household healthcare costs. The economic costs of malnutrition to households and to the country undermine development efforts and can reduce GDP by 2 to 3 percent.

The underlying factors of malnutrition in Afghanistan are complex. The immediate causes are inadequate intake of food that has nutritious value and well as a high disease burden which perpetuates the problem. Other factors include poverty, food and nutrition insecurity, and poor access to social services, such as public health, water, sanitation and education. These factors are compounded by traditional and cultural beliefs, harsh climatic conditions, poor infrastructure, women’s low social status, and three decades of war. Afghanistan has an annual population growth of 2.6 percent, with urban and rural variation. There is a constant migration from rural to urban areas. Such population dynamics have potential health consequences and need to be continually addressed.


Malnutrition in Bangladesh is alarmingly high. 41 percent of children under 5 years of age are stunted; 16 percent are wasted; 36 percent are underweight. Malnutrition and poverty hinder access to education and the ability to learn. Only 51 percent of those in school will complete primary education. Children of uneducated mothers are significantly affected. This has a bearing of significant impact on the nutritional status of future generations.

Widespread vitamin and mineral deficiencies also exist: one in five preschool/school-aged children suffers from a vitamin A deficiency; 33 percent of preschool children are anaemic, a percentage that is declining; folate and vitamin B12 deficiency affect 9 percent and 22 percent of women respectively; and iodine deficiency is on the rise. The national prevalence of zinc deficiency is 44.6 percent amongst preschool age children and 57.3 percent amongst non-pregnant non-lactating women, according to the National Micronutrients Survey 2011-2012.

GAIN’s Role: The Fortification of Edible Oil with Vitamin A: supporting the Government, in partnership the Bangladeshi Oil industry, in the fortification of edible oil with vitamin A. In December 2013, the Government of Bangladesh formally requested that GAIN and the World Food Programme (WFP) draft the National School Feeding and Nutrition Policy. GAIN and WFP will provide support to the Ministry of Primary and Mass Education and the Directorate of Primary Education in facilitating the formulation of the policy during the first quarter of 2014. In a third formal engagement, GAIN has also been requested to participate as a co-lead in the National Micronutrient Deficiency Control Strategy. The development of the strategy is a high priority for the Bangladeshi government, and involves many stakeholders, including program managers, researchers, academics, rights groups, and social and health activists. GAIN led the development of the Zinc, Vitamin B12, and Calcium and Vitamin D Strategy under the National Micronutrient Deficiency and Control Strategy.

Featured Projects: 

Community-Led Integrated School Nutrition Program

Fortification of Edible Oils



Brazil is the world’s seventh largest and potentially most emerging economies in the world today. The large South American country has also recently come into the spotlight in the health arena in its fight against hunger. In 2010, GAIN joined this push for a healthier future for Brazil by partnering with PATH to create a large-scale commercial model to generate demand for fortified rice. Ultra Rice technology fortifies rice with a number of micronutrients to provide a nutritious option for one of Brazil’s staple foods.


After years of social and political turmoil, Cambodia has become one of south east Asia’s most emerging economies. Reaching not only economic success, Cambodia has demonstrated a range of improvements in national health. The prevalence of malnutrition in Cambodia, however, is still an extreme social challenge, affecting over 40 percent of children. In an effort to combat iron deficiency, the greatest cause of child malnutrition in Cambodia, GAIN supplies financial and technical support to the Reproductive and Children’s Health Alliance (RACHA) through projects which fortify fish and soy sauce with iron.



Over 20 percent of children in China live with the permanent effects of malnutrition, which stunts developmental growth physically and mentally. Poor nutrition is a particular problem for children in rural areas, where the majority of the country lives. GAIN has supported the Chinese government in a two-phase program to tackle the prevalence of malnutrition. Through providing funding for premix and for equipment, developing a public health monitoring system, and creating a wide-reaching consumer education campaign, GAIN has expanded the project of soy sauce fortification to those on the lowest incomes in China.

Source: UNICEF

Côte d’Ivoire

The UNDP Human Development Index ranks this West African nation 168th out of 186 countries. Primary school enrolment is below 50 percent and employment is just barely above this, with over 23 percent of the population living below the poverty line. Social displacement and political crises create extreme obstacles to addressing these problems, particularly those involving health. Côte D’Ivoire has the highest rate of HIV prevalence in West Africa at 3.7 percent of the population currently living with the virus. Nutrient deficiencies add to the vulnerability of the population to diseases.


Featured Projects: 

Complementary foods in Côte d’Ivoire

Dominican Republic

Although there has been a steady improvement in the nutrition of the Dominican Republic population, they still face great amounts of malnutrition especially among children with 19% of children suffer from stunting. The Dominican Republic’s main problem is micronutrient deficiency, with the significant economic gap between the rich and the poor; many Dominicans cannot afford the nutritious foods that are necessary.



As the fourth smallest country in Latin America, Ecuador lacks the resources for its people to maintain a healthy lifestyle. Over 25% of Ecuadorian children under five currently suffer from malnutrition. These children risk a life of preventable physical and mental stunting effects as well as a range of diseases. In order to tackle malnutrition and its effects, most significantly anemia, GAIN supports Ecuador food company REYBANPAC to produce a nutrient-fortified food aimed at improving the health of children in Ecuador aged 6 to 24 months.



Ranked 112 out of 187 countries in the 2012 UNDP Human Development Index, Egypt has experienced numerous hardships following the political transitions after the 2011 revolution. Egypt may be classified as a middle-income country, but it still faces development issues due to its considerably large regional inequalities, with the rural areas ranked at the bottom of the socioeconomic scale. Egypt struggles with the challenge of feeding the rapidly increasing population, of which a quarter is under 30. Not only is food insecurity increasing and poor dietary diversity enduring, malnutrition, specifically among children, is also on the rise, with 31 percent of children below 59 months stunted.



GAIN, in partnership with UNICEF, has been working in Ethiopia since 2008 through the Universal Salt Iodization Partnership Project. The project also supports government and industry in nutrition interventions, such as food-fortification-standard initiation and foods for mothers and young children.

GAIN is mainly involved in supporting the national universal salt iodization program by: providing over 27 tons of potassium iodate to date; building the capacity of the regulatory body to strengthen its quality management system through supplying state-of-the-art technologies; and including salt producers when establishing internal quality control systems. GAIN has also supported the government in the fortification of wheat flour and oil through developing national food standards, and recently started formative research to explore the appropriateness of home fortification in rural Ethiopia.

The cost of hunger study estimated a loss of US$ 4.5 billion in 2009 due to malnutrition, the equivalent of 16.7 percent of Ethiopia’s GDP in 2009. These losses limit Ethiopia’s capacity to meet growth and development targets and from fully utilizing its human potential.

Forty-four percent of Ethiopian children are stunted and, 21 percent are severely stunted. Anemia affects 44 percent of children under age 5 and 17 percent of women.

The Ethiopian government launched the National Guidelines for Control and Prevention of Micronutrient Deficiencies in 2004. This was followed by a comprehensive National Nutrition Strategy in 2008, revised in 2013 to clearly indicate the multi-sectoral approaches and the role of the private sector in addressing malnutrition and improving nutrition using a life-cycle approach.

GAIN’s Role:
Only 15 percent of households have access to adequately iodized salt. However, in 2012 and 2013, good progress was made in improving access to adequately iodized salt, which is estimated to be 88% in recent study conducted by EPHI(Ethiopian Public Health Institution) More concerted effort is still required to reach the remote woredas in the country,  and more so,  address the quality of iodization. The Universal Salt Iodization Partnership Project with UNICEF is GAIN’s longest-running project in Ethiopia. It aims to improve the quality of salt iodization and consumption of iodized salt.


Nutrition situation in Ghana

Ghana has made great progress in terms of health and economic development over the least decades. Available data, however, show that critical food security and nutrition challenges persist in the country. About 1.2 million Ghanaians are considered food insecure and while chronic undernutrition has decreased in the past five years, it still affects one quarter of Ghanaian children under five. Micronutrient deficiencies including vitamin A, iodine and iron are a critical public health challenge with the highest burden on young children and women.

Undernutrition affects Ghana’s economic productivity and development in several ways. Three major problems that have a profound impact on worker productivity are:

  • Stunting due to undernutrition (which refers to children that are too short for their age)
  • Iron deficiency anaemia
  • Mental impairment due to iodine deficiency

In 2011, Ghana joined the Scaling Up Nutrition (SUN) Movement – a global movement uniting national leaders, civil society, bilateral and multilateral organizations, donors, businesses, and researchers in a collective effort to improve nutrition. Ghana’s priorities under SUN include increasing government nutrition funding, prioritizing nutrition among key stakeholders and improving the measurement of nutrition indicators.

Investing in and scaling up proven, effective nutrition interventions during the next 10 years will boost economic productivity, save lives and improve the well-being of Ghanaians, particularly women and children. By decreasing stunting alone, economic gains could exceed 720 million cedis (US$ 504 million) by 2020.

GAIN’s Role

GAIN has been working in Ghana since 2006 in support of a number of projects in the areas of large-scale food fortification; multinutrient supplements; and agriculture and nutrition.

Focused Ethnographic Study and Optifood Analysis of Infant and Young Child Feeding in Ghana

GAIN was commissioned by USAID-Ghana to conduct a Focused Ethnographic Study (FES) and dietary analysis using the Optifood system to understand the eating habits of Ghanaian families and how mothers feed their children.

The FES and dietary/Optifoods analysis are two related, but separate activities. The FES is the formative/landscape analysis aimed at understanding the cultural, social and economic contexts of infant and young child feeding behaviours from the household and marketing perspectives. Optifood is a linear programming software that identifies the lowest-cost combination of local foods that meets, or comes as close as possible to meeting, nutrient needs of specific target groups.


The series of catastrophic political, social and environmental catastrophes which hit Haiti between 2010 and 2012 has led it to become one of the poorest and most vulnerable nations in the world. While progress has been made in pulling Haiti out of poverty, nearly one-third of the population is still considered ‘food insecure’, meaning it is able to ward off malnutrition only because of help from external aid programs. Despite aid assistance, one in five children suffer from malnutrition and need more than food aid to address the related health problems they are likely to develop. In January 2012, GAIN worked with LGT Venture Philanthropy to provide a loan to Meds and Food for Kids (MFK), a Haitian-based company that provides nutritional supplements to improve child nutrition.



57 million – or more than a third – of the world’s 146 million undernourished children live in India. The absence of exclusive and continued breastfeeding, inadequate quantity and quality of diet, deficiency of micronutrients in diets (particularly vitamin A, iron, iodine, zinc and folic acid), lack of access to health services, and low education levels all contribute to the high malnutrition rates in India.

The consequences of this nutrition insecurity are widespread; impacting survival, physical growth, health and cognitive development throughout life. This results in economic losses at the individual and economic level, and affects current and future generations.

Facts about Malnutrition in India

  • 48% of under-5 are stunted, six out of 10 children from the poorest households are stunted, and almost as many are underweight
  • 43% of children under age 5 are moderately or severely underweight
  • 20% of children are wasted.
  • Three-quarters of Indian women and children are micronutrient-deficient
  • National expenditure on health is just 1.34% of India’s GDP
  • Compliance with recommended infant and young child feeding practices is very low
  • Gender bias means girls are at greater risk
  • 58% of Indians are forced to practice open defecation

GAIN’s Role

In India, GAIN’s interventions are built on a strong foundation of expanding food fortification initiatives to address micronutrient deficiencies across the country. GAIN in India has made strategic investments in the government of India’s Integrated Child Development Services and Mid-Day Meal programs.

Major focus of GAIN in India is increasingly on its partnerships, advocacy and capacity building work. It has engaged with nutrition coalitions, self-help groups and policy research groups like the Public Health Foundation of India. It organized Health Writers’ Workshops, engaged with Government Ministries like Ministry of Women and Child Development, Food and Civil Supplies and many other to ensure strong support for the programs. Today, GAIN’s committed investment in India is close to USD 15 million, with an expectation to positively impact the nutritional outcomes of approximately 100 million individuals; a third of them are children and women in the reproductive age group.


Indonesia has the largest economy in Southeast Asia, with a GDP of US$ 1 trillion in 2012. It is a G20 member, a stable democracy and the fourth most populated country in the world, with 251 million people, 50 percent of whom are below the age of 30. However, it faces persistent public health problems, and the large population amplifies the numbers. The infant mortality rates are 27/1,000, and the country’s maternal mortality rate stood at 228 deaths per 100,000 live births in 2007. Food insecurity and undernutrition are persistent challenges in Indonesia, particularly in the eastern provinces, where stunting is alarmingly prevalent. Hunger and malnutrition reportedly have been halved two years before the 2015 Millennium Development Goal deadline, but pockets of the country remain a serious concern. Indonesia managed to reduce the proportion of malnourished people from 20 percent in 1999 to below 9 percent in 2013. Nevertheless, the prevalence of stunting among children under 5 is 37.2 percent (2013), and stunting is measured at more than 30 percent in most districts— ranging from 23 percent to 58 percent.

GAIN’s Role
GAIN’s projects focus on reducing micronutrient deficiencies by targeting women and infants and implementing large-scale fortification of oil and salt. GAIN’s Project BADUTA focuses on reducing stunting and micronutrient deficiencies by addressing the multiple causes of malnutrition among pregnant women and children under 2 in East Java. A behavior-change communication campaign will be launched in 2014 to create awareness of the need for change. GAIN also supports the Indonesian Ministry of Health by helping a group of scientists and professionals provide the government with input on policy and legislation. GAIN provided a grant for the Indonesian Foundation of Nutrition Development (KFI) to introduce fortified vegetable oil to local markets. As of December 2013, just below 425,000 metric tons were being sold and consumed nationally. Mandatory fortification will come into effect in March 2015. The Indonesian Ministry of Health is committed to eliminating iodine deficiency disorder through the introduction of universal salt iodization. GAIN, UNICEF and partners are working together to ensure that adequately iodized salt is available across Indonesia. GAIN concentrates its efforts in South Sulawesi and eastern Java provinces, where 70 percent of table salt is produced.

Improving the Food and Nutrition Security of Tea Farmer Households in the Lestari Sustainable Tea Program in Indonesia


Health issues

Under-nutrition is an issue that affects all the countries in Central and South Asia. For example, in Afghanistan, studies have found very high rates of micronutrient deficiencies. The prevalence of anemia (an indicator of iron deficiency) among infants, young children and women has ranged from 50-75%. The prevalence of night blindness (indicator of vitamin A deficiency) has been reported to be up to 20% among women. In these contexts food fortification should be considered a key component of a scaled nutrition program where existing food supplies and limited access to nutritious foods fail to provide adequate levels of nutrients in the diet. While not the only solution, wheat flour and edible oils as a vehicle for key micronutrients such as iron and Vitamin A can help offset some of the dietary micronutrient inadequacies. In Central Asia, the primary source of food energy intake is from wheat flour and its products. In countries such as Kyrgyzstan (50%) and Tajikistan (upwards of 70%) there is a highly disproportionate intake of energy from this flour, most of which is not fortified. In Afghanistan, consumption is also high with the annual estimated consumption of wheat flour at 4.18 million MT.


In spite of Kenya’s economic strength in the region, malnutrition is hindering its full potential. In a population of 40 million, almost a quarter of Kenyan people are considered food-insecure. According to the last available Demographic and Health Survey (KDHS, 2009), about 2 million Kenyans face a chronic lack of food. Thirty-five percent of children under 5 are stunted, 6 percent are wasted or too thin, and 16 percent are underweight. Furthermore, vitamin A deficiency stood at 84 percent and iron deficiency anemia at 69 percent in the same age group (KNMS, 1999). The Government of Kenya issued the National Food and Nutrition Security Policy and Vision 2030. Great achievements have been made in the last few years; fortification of staple foods like wheat, maize and oil is now mandatory; the popularity of exclusive breastfeeding is low, but growing at 32 percent; nutrition-sensitive programming such as WASH is increasing; and agribusiness is booming, with several initiatives ongoing.

GAIN’s Role
GAIN has been a key player in advancing successful interventions that are based on three important nutrition pillars: Large-Scale Food Fortification, which focuses on millers and traders; multinutrient supplements to advance home fortification; and linking agriculture and nutrition programming. GAIN works hand-in-hand with crucial stakeholders to improve the standards and quality of nutritious foods in Kenya. Such is the case with the Nutrition Department at Kenya’s Ministry of Health, which leads the way in setting the nutrition agenda in the country and is creating the needed networking and policy environment space for all actors. In addition, GAIN works closely with the Kenya Bureau of Standards (KeBS), which determines technical standards and regulations and sets the pace for monitoring food quality. GAIN is aiming to work closely with county governments, which will increasingly take a more active role in public delivery of nutrition services. Finally, GAIN is also working with regional bodies like the East African Community (EAC) to improve policy frameworks for easy access to nutritious foods in the region.


Mali is the sixth lowest ranked country in the world for food security, according to the UN Human Development Index. Some 1.9 million people in Mali (11% of the population) are currently food-insecure, and approximately 660,000 children in Mali are at extreme risk of malnutrition. With a heavy national reliance on farming for subsistence, many households suffer fragile food security at best due to the frequent droughts, floods and locust invasions. Furthermore, Mali is frequented with a number of crises, whether they are social, political or environmental. Despite this unsteadiness, large numbers of families who once fled their homes due to these crises are now retuning home, which strains the Malian communities even more, as they must now share already thin resources.



Of the 30 million people living in Morocco, 63 percent are vulnerable women and children. The challenging circumstances of women and children are in large part due to the effects of malnourishment. GAIN aims to provide fortified food supplements to these groups so that they are not held back from having self-sustaining, healthy lives. In 2005, GAIN began its first three-year wheat flour and vegetable oil fortification program in Morocco. After realizing the success and potential for an even wider impact, the project was extended to support local production of these fortified foods.


Approximately half of Mozambicans are malnourished, with an average stunting rate of 44 percent. Diets are dependent on cassava, maize and other grains. Meanwhile, 70 percent of the population lives in rural areas, and subsistence agriculture continues to employ the vast majority of the workforce. Mozambique is one of the few countries in sub-Saharan Africa to have adopted a collective approach to the reduction of chronic undernutrition with its Multi-Sectoral Action Plan (MSAP). At national and provincial levels, efforts are underway to reduce malnutrition. Increasing agricultural productivity is also high on the government’s agenda, and the link between agriculture and nutrition will be strengthened through the government’s commitment to the New Alliance for Food Security and Nutrition.

GAIN’s Role
GAIN oversees a portfolio of projects that represent both population-based as well as targeted nutrition interventions. In partnership with CONFAM (the national food-fortification committee), the Ministry of Health, the Ministry of Industry and Commerce and other implementing partners, wheat millers and commercial producers of vegetable oil fortify these widely consumed foods. At a large scale, these foods will provide fortified food to some 12 million people—more than half of Mozambique’s population—nationwide. The Marketplace for Nutritious Foods in Mozambique supports local businesses whose innovative products and services make diverse, nutritious food more available and more affordable in the country. The Marketplace is currently supporting enterprises in Mozambique with business-planning support as well as technical assistance and capital grants that catalyze innovation and increase the scalability of the businesses. This project is supported by USAID. GAIN brings global expertise in the area of home fortification to Mozambique through participation in the in-country Technical Working Group for Micronutrient Powders (MNP-TWG). We are currently working with other stakeholders and the Ministry of Health to identify appropriate BCC (behavior change communication) messages and media. GAIN looks forward to further cooperation with the Ministry of Health and other partners and stakeholders to continue promotion of micronutrient powders (MNPs) in Mozambique. GAIN is currently supporting the Ministry of Health on the development of the new MNP strategy, soon to be incorporated into Mozambique’s existing food-fortification policies.


GAIN has supported nutrition activities, especially large-scale food fortification, since 2007. Nigeria is a priority country for GAIN, which is exploring further opportunities in micronutrient supplements, development of nutritious foods for mothers and children, and bridging the gap between agriculture and nutrition.

With 10 million children under age 5 stunted, the prevalence of malnutrition has remained the same during the last 10 years. One-third of preschool-age children have vitamin A deficiency, which has a direct impact on a child’s immune system and sight. Anemia in preschool-age children is at 76 percent. The typical foods consumed do not have the necessary nutrients needed for their critical stages of growth, and many nutrient-rich foods are unaffordable. Stunting rates have been recorded at 41 percent; wasting at 14 percent; and underweight at 23 percent. Almost half of Nigeria’s population lives in rural areas, but malnutrition is expected to worsen in urban areas. An estimated 46 million people will be living in urban slums by 2015.

GAIN’s Role
GAIN emphasizes building an enabling environment for nutrition and nutrition interventions in Nigeria, such as: providing technical support to local manufacturers to ensure production of high-quality fortified foods that meet nutritional needs; behavior change communication (BCC) in states where the government has shown financial commitment toward addressing malnutrition; and supporting the government to put in place policy documents that embrace a wider variety of on-the-ground nutrition interventions.

GAIN’s Large-Scale Food Fortification program aims to reach 110 million Nigerians and increase the national consumption of essential vitamins and minerals through the fortification of staple foods. GAIN works with the local private sector to produce fortified wheat and maize flour, vegetable oil and sugar. In order to improve consumer awareness of the benefits of food fortification, Maverick Equinox is being supported by GAIN in implementing a social marketing campaign in the states of Lagos and Kano.

GAIN supports local production of multinutrient supplements and is involved in the launch of a home-fortification program as an intervention strategy to reduce iron-deficiency anemia. An initial batch was distributed in early December 2013 in Benue State; and another is scheduled to be released in May 2014, reaching a total of 101,000 children aged between 6 months and just under 5 years old.


Pakistan has one of the highest malnutrition burdens in the world. The National Nutrition Survey in 2011 revealed that 44% of children under the age of five were chronically malnourished while 15% were acutely malnourished. Maternal malnutrition is also a significant problem, with 15% of non-pregnant mothers having chronic energy deficiency (low BMI) and a third of mothers either overweight (21%) or obese (9.5%). This indicates a complex double burden of both under and over-nutrition.

How GAIN is helping

GAIN has been active in Pakistan since 2006. We support the National Fortification Alliance and work closely with the government at both federal and provincial levels, the private sector and various nutrition development partners. Working with the Punjab Food Authority we’ve recently helped to secure new regulation making the fortification of Atta flour with iron and folic acid mandatory, as well as develop fortification standards for Atta. We’re also working with UNICEF and the federal government on a universal salt iodization program, and are working to roll out the World Food Program’s Scaling UP Nutrition through Business Network (SUN BN).


Senegal is one of the world’s most underdeveloped countries, with nearly half the population living in poverty. The cycle of poverty is catalyzed by the persistent problems brought on by the country’s high rate of malnutrition. Malnutrition, which causes mental and physical stunting, greatly hinders people’s ability to work their way out of the hold of poverty. In 2010, GAIN initiated a grant with Cellule de Lutte contre la Malnutrition (CLM) to fortify wheat flour and oil in Senegal. GAIN supports CLM to provide nutrients to the population at the correct levels.


South Africa

Each year, malnutrition-related diseases account for over 64 percent of deaths in children under 5 in South Africa. This high prevalence of child malnutrition is a result of extreme deficiencies of vitamins and minerals essential for basic standards of health and development. GAIN provides technical assistance and funding to UNICEF to support its partnership with the South African Ministry of Health. This partnership has led to nearly half the population consuming fortified wheat flour and over 66 percent consuming fortified maize meal.


Featured Projects: 

Nutrimark in Southern Africa


The period from birth to two years is especially important for a child’s optimal growth, health and development. Women with poor nutritional status (indicated by being underweight, of short stature, with anemia or microelement deficiency) are at higher risk of complications during childbirth. They are also more likely to give birth to an underweight infant or experience fatal postnatal complications, such as hemorrhaging. Meanwhile, breastfeeding and diet are determined by many economic and socio-cultural factors. In Tajikistan, the government has made solving the problem of children’s nutrition a priority. In order to lower morbidity and mortality rates related to poor nutrition, the government passed federal laws “on iodized salt” in 2002 (DG RT, 2002) and “on the protection of natural breastfeeding” in 2006 (DG RT, 2006). Despite these efforts, every year Tajikistan spends US$41 million on medical conditions caused by poor or insufficient diets, 43% of which goes to deal with iodine deficiency and 29% goes to preventing stunting (UNICEF and the World Bank, 2012)

The Demographic and Health Survey (DHS) conducted in Tajikistan in 2012 showed that more than one fourth of children under age five (26%) are stunted, that is, they are short for their age. This is a sign of chronic poor nutrition. Stunting in Tajikistan is lower than the rate in some neighboring countries, like Pakistan where it is 45%, but higher than in former Soviet republics of Armenia (19%) and Kyrgyzstan (18%) (NIPS and ICF International, 2013, NSC et al, 203; NSS [Armenia] et al., 2012) Among children under age 5, 12% are underweight. Children born less than 24 months after a previous birth are more likely to be underweight (14%) than children born 48 or more months after a previous birth (10%). Compared to the 2005 Multiple Indicator Cluster Survey (MICS) the percent of children who are stunted has fallen from 27% to 21% in 2012 DHS, but the share of children who suffer from wasting and underweight did not change.


In the 2012 UNDP Human Development Index, Tanzania was the 152nd poorest country out of the 186 surveyed. Additionally, it ranks among the highest of all African countries for the number of malnourished children. GAIN hopes to connect the strong subsistence-farming sector with opportunities to create a healthier nation through the fortification of wheat flour and vegetable oil. This project, which partners with Helen Keller International, has involved multiple stakeholders to create and implement mandatory food fortification legislation.



In the past decade, Uganda has seen a nearly 15 percent drop in the proportion of the population living in poverty. The country still, however, suffers greatly from many disadvantages and most significantly from those caused by poor nutrition. Over 33 percent of children in Uganda under the age of 5 are stunted. According to the WFP, it is not food availability that is the major problem but rather access to nutritious options. In 2007, GAIN began supporting the Ugandan Ministry of Health in its program to fortify wheat flour, maize meal and vegetable oil. By the end of GAIN’s financial support for the Ministry in August 2012, 95 percent of vegetable oil was fortified with vitamin A, and 40 percent of wheat flour was being fortified with iron.



Vietnam has one of the highest rates of child malnutrition in Southeast Asia. Nearly half of the population under 5 is underweight, and 40 percent of these children are or will soon suffer from physical or mental stunting. GAIN supports the Nation Institute of Nutrition in Vietnam (NIN) in its efforts to introduce locally produced micronutrient powder into people’s diets.



Over 43 percent of Yemen citizens end each day unsure of what and when their next meal will be. Of those who are food insecure, 43 percent are classified as ‘severely food insecure’, meaning they have very little hope for a next meal, particularly one that would provide even the minimum nutritional requirements for a healthy diet. A collaboration between GAIN and the World Food Programme (WFP) promotes and engages the private sector to improve the nutritional value and affordability of food sold in Yemen.



Zambia maintains one of Africa’s highest levels of malnutrition, food insecurity, malnutrition, malaria, poverty, and HIV and AIDS. Although the national levels of poverty have reduced by roughly 10 percent over the last decade, food security remains a constant challenge due to the extreme dependency on rain-fed agriculture. As a result, poor food security and nutritional availability is a daily reality for about 209,000 Zambians. Zambia also hosts nearly 34,000 refugees, thus putting further strain on its resources. With high food prices and high unemployment rates, the percentage of chronic malnutrition is high, at 45.4 percent.