The State of the World's Children 1998: Focus on Nutrition

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Panel 17

Making food enrichment programmes sustainable

Photo: In Ghana, workers gather salt to be taken to a processing plant for iodization.

Fortification of food staples with iron, vitamin A, iodine and other micronutrients is the most cost-effective, sustainable option for eliminating micronutrient deficiencies. Salt iodization, reaching an additional 1.5 billion consumers worldwide since 1990 and sparing millions of babies from mental retardation each year, is testimony to how successful fortification programmes can be.

But as positive as the end results are, fortification is a complex undertaking that requires government and industry to commit to working to gether as partners. Recent experience shows that fortification succeeds when producers are involved from the start in formulating regulations and in resolving the marketing and technical issues that can make or break a programme.

It's the law: Effective legislation is a basic requirement, helping to set goals and define roles of food producers, the health and nutrition authorities and scientific institutions. Without such a framework, a programme is more vulnerable to weak implementation, uneven results and possible failure. That was the experience of South Africa, where a maize-enrichment programme launched in 1983 without compulsory legislation was pronounced a failure after 10 years. Efforts are now being made to review the programme, with a focus on legislation and the role of the food industry.

Even then, legislation must be enforced and supported by policies. Guatemala passed a law in 1975 mandating that sugar be fortified with vitamin A. Not only was the law unenforced but the programme also quickly fell apart for lack of the foreign exchange needed to purchase the vitamin and because producers were not convinced of the programme's effectiveness. A decade passed before fortification was resumed, after the Institute of Nutrition of Central America and Panama (INCAP) and UNICEF worked with producers to explain the importance of fortification, provided technical assistance and helped them obtain vitamin A at below-market prices or through donation. Guate mala's Min istry of Health now enforces the law: Producers whose sugar shows low levels of vitamin A in random tests are first warned and then are either fined or shut down.

Pricing and marketing: Start-up costs of equipment and training can be high, but these are primarily one-off. Costs of the fortificant, labour and equipment maintenance are recurrent. Fortifiers' competitive position in the market place can be further eroded by price controls or taxation, and governments can play a helpful role in these areas. When Brazil's Government removed price controls and reduced a value-added tax on milk, for example, dairy production received a boost and fortification of milk became more attrac- tive to producers.

Laws can eliminate the price advantage enjoyed by non-fortified products. In 1997, Oman banned local production and importation of white wheat flour not fortified with iron and folate, and Bolivia mandated that all wheat - local, imported or donated - be fortified with iron, folic acid and vitamin B complex.

Yet government intervention does not always succeed in lowering costs to workable levels. In Indonesia, efforts to fortify monosodium glutamate (MSG) with vitamin A were unsuccessful because technical problems of maintaining vitamin stability and colour consistency were too costly to solve. In the Philippines, it was so expensive to develop fortified margarine that only one multinational corporation carried through with it.

Questions of quality: Fortification can have commercial consequences, since any change in the way a product tastes, looks or smells can hurt sales and market share. For example, when Venezuela in the late 1980s decided to fortify maize flour with ferrous fumarate (iron), in product tests the flour turned from its familiar white to grey. Sensing that consumers would not buy the product, producers baulked. The situation was resolved in 1992, when the National Institute of Nutrition allowed producers to fortify with a blend of iron components that did not change the colour of the flour.

Follow-up: It is vital to keep tabs on the process to ensure that fortified products maintain potency standards and reach consumers. Chile began fortifying wheat flour with iron in the early 1950s, but it was not until 1967 that a system for monitoring and quality control was established, and only in 1975, when a national survey revealed the iron status of the population, that the programme's efficacy from that point on could begin to be evaluated.

Commitment and coordination: "Authorities must be convinced of the need to make fortification compulsory. And to eliminate any possible resistance, producers must be convinced of fortification's benefits," says Jorge David, head of the Latin American Millers Asso ci ation (ALIM).

In 1996, Bolivia became the first country certified to have virtually eliminated iodine deficiency as a public health problem. The phenomenal success stems from legislation that expressed a public policy decision to iodize and 13 years of coordinated work by salt producers, the Govern-ment and international cooperation agencies.

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