India

Background: India faces the double burden of undernutrition and obesity. Cases of overweight and underweight adults are now almost equal, and the number of micronutrient deficiencies is rising fast. Studies report that more than 35% of Indian children under five are stunted, and at least 50% of women of reproductive age and 40% of children aged 6 to 59 months old are anemic. Major drivers behind these figures include inadequate quality food and a growing consumption of highly processed packaged foods.

Interventions in India, such as mandatory fortification of salt with iodine to combat iodine deficiency disorders, date back decades. However, 40-60% of fortified food production is not reaching, nor being consumed by the most vulnerable groups.[i] Factors such as supply chain bottlenecks, poor distribution channels, and the COVID-19 pandemic, and a lack of regulations and monitoring around food fortification are all issues.

Staple food value chains:

To select an eligible value chain for developing an accountability tool, a set of criteria were determined when investigating the five staple commodities:

1. The coverage criteria: ATNI targets food products with high coverage of priority populations in order to have a public health impact
2. Main distribution channels and product properties: a) ATNI to focus on widely accessible products available in the commercial market. b)ATNI intends to focus on fortified products that are well-established and food vehicles that have no product quality or acceptability concerns.
3. Industry structure and maturity of the market: a)ATNI to focus on mature and structured markets with high penetration in low-income and vulnerable population groups. b)Informal markets (small businesses) are hard to penetrate and address with an accountability tool and will thus not be in focus

Findings: The wheat flour industry is highly fragmented, with only a small percentage of products fortified and distributed through the social safety net program (SSNP). For rice, PATH International India is exploring with some companies in selected states the options of bringing fortified rice products to market. Milk is currently largely produced by the informal sector and around 30% is produced privately, the government is considering mandatory fortification. Double Fortified Salt (DFS) is produced and distributed to SSNP beneficiaries and at present has a limited number of producers. These findings suggest that a tailored accountability tool may not be effective to monitor wheat, rice, milk or DFS at present.

Selected value chain of focus: Companies operating in edible oil are determined to be the most favorable value chain for ATNI to apply a tailored accountability tool. Almost half of all edible oil packaged and two-thirds fortified (the rest is sold loose and not easily traced), reaching 630 million consumers. The industry is structured with 300 large- and medium-sized fortifying companies, whose brands constitute 11% of the edible oil market share.

The main bottlenecks found in the edible oil value chain were:

1. Companies do not fortify due to a lack of internal capacity and technical knowledge, high costs of product testing, a lack of awareness about the benefits of fortification, and the belief that consumers won’t pay more for fortified edible oil​ products.
2. Fortification practices are inadequate or not up to standard, often as a result of poor-quality raw materials, high costs, and a lack of capacity, technical knowledge and equipment.
3. Sustaining adequate fortification levels seems to be challenging, because of an absence of mandatory laws and regulations, inadequate enforcement, variable consumer demand, and fluctuating costs of raw materials.

Nigeria

Background: Nigeria’s population has the greatest number of stunted children in Africa (32%), and vitamin A, iron, iodine, and zinc deficiencies remain the biggest contributors to undernutrition. Women and girls of child-bearing age are among the most vulnerable, with 58% of women suffering from anemia.[i] The greatest risk factors for undernutrition in Nigeria stem from:

• High levels of poverty
• Limited access to healthcare
• Poor water and sanitation
• Inadequate infant and child feeding practices. [ii]

Staple food value chains: Mandatory fortification of staple foods in Nigeria began in 1993, with the combining of salt with iodine. Currently, almost 95% of salt is iodized and imported from Brazil or Namibia. The fortification of sugar and edible oil with vitamin A has also since been mandated. So, too, has the fortification of wheat, semolina, and maize flour with multiple micronutrients, such as iron and vitamins – A and B12. More than 95% of flour is industrially produced and mostly consumed in the form of bread and cakes made by local bakers.[iii] There is currently no fortified rice product available on the market.

A 2017 GAIN survey demonstrated high household coverage and consumption of all mandated fortified staples. However, compliance with national food fortification standards for fortification of staple foods was inadequate, meaning the dietary contribution of micronutrients from some fortified staples was low.

Existing programs: An accountability tool from TechnoServe – the Micronutrient Fortification Index – is an established mechanism for assessing and improving the fortification practices of companies operating in the studied value chains.

Fortified packaged food: Some packaged processed food (such as bouillon cubes and seasonings, noodles, tomato paste, and bread) are currently fortified voluntarily by the food industry in Nigeria, particularly among large F&B companies. Although there are national and international guidelines and standards for companies to follow at present, there is a lack of harmonization, and adherence is not adequately monitored. As such, discussions and research are being conducted by the government to potentially mandate fortification for additional foods.

The main bottleneck identified include:

1. The lack of quality fortification inputs/premixes was cited as a barrier to sustained quality fortification. Issues such as long handling times at import level and the degradation of vitamins due to heat/light, were raised multiple times during ATNI’s visit to Lagos and Abuja. Stakeholders also mentioned the importance of strengthening collaborations with local premix providers.
2. Lack of awareness was referred to as a bottleneck, with non-fortifying companies unaware of the added value and long-term benefits of fortification.
3. Consumer awareness with regard to the benefits of fortification. The cost factor plays an important role. Low-income consumers will tend to select an unfortified product rather than a fortified one a higher cost.
4. Consumption data is challenging to obtain. This can constitute an important bottleneck for understanding consumption patterns and assessing the true impact of fortification programs.