“Fortification of staple food is one of the best investments to secure a nation’s future. With the help of Food Fortification Programme, Pakistan aims that half of the population will be consuming fortified wheat flour by the year 2020. The programme will be working with over 1,000 wheat flour mills. The programme is providing training and technical support to both government and millers, and helping flour milling industry with financial costs of micro-feeder equipment and subsidies.”

Munawar HussaIn

National Manager Food Fortification Programme-Pakistan

The nutritional status of the population is one of the important factors determining the quality and productivity of the population, which in turn affects national productivity. In the long term, good nutritional status contributes to the intelligence and health of the population. However, most countries in the world are facing the menace of malnutrition which costs the global economy $3.5 trillion every year. As per Global Nutrition Report 2017 over 2 billion people lack key micronutrients like iron and vitamin A. 88% of countries face a serious burden of either two or three form of malnutrition and the world is off track to meet all global nutrition targets. Pakistan is no exception to this with 44% under 5 children stunted and more than 15% wasted is losing 2-3% GDP annually of which the major cause is the micronutrient deficiencies. The findings of National Nutrition Survey (NNS) 2011 are evidence that 51% of women in reproductive age are anemic and 37% are iron deficient. NNS also states that 66.8% women of reproductive age; 68.9% pregnant women and 40% children are vitamin D deficient. Such micronutrient malnutrition traps communities and whole societies in a vicious cycle of poverty. Children are unable to learn and reach their full potential, while adults remain less productive. While even stunting is a result of malnutrition in the first two years of a child’s life, and limits height as well as emotional, social and cognitive development.

Populations with widespread multiple micronutrient deficiencies, fortification of staple food is one of the best investments which can make for securing its future because good nutrition is essential for a child’s healthy growth and development, their capacity to learn, and capacity to earn, and be productive, and be a part of a modern economy without being left behind. As the idea behind fortification isn’t to “cure” micronutrient deficiencies, rather it’s to prevent deficiencies and move people and whole population towards consuming recommended amounts of micronutrients through fortified foods.

The Government of Pakistan considers adequate nutrition as a key to overall development and is committed to controlling of micronutrient malnutrition through food fortification. It has introduced fortification of wheat flour with iron, folic acid, Zinc and Vitamin B12 and edible oil/ghee with vitamin A & D as a public health intervention i.e. to overcome above-stated micronutrient deficiencies. Considerable efforts are being made to improve nutrition, but these efforts take time. However, for a country like Pakistan which has large segments of the population, proven fortification solutions can be delivered through existing technology and within the limitations of the current food system.

In order to improve the nutritional status of the population, the Food Fortification Programme (FFP) has been started in Pakistan with funding from UK Government’s Department For International Development (DFID). FFP is a five-year intervention which aims to support national efforts to reduce iron, folic acid, Zinc, Vitamin B12, Vitamin A and D deficiencies, particularly among children and women of child bearing age. The FFP is being implemented by Mott MacDonald and the Nutrition International (formerly the Micronutrient Initiative). There are four building blocks of FFP which are: 1) Effective Governance through building political commitment, ensuring appropriate legislation, standards and guidelines for mandatory fortification, strengthening public sector oversight of food quality, establishing and institutionalizing a cost-effective and sustainable monitoring system; 2) Capable Industry through motivating industries to engage in the vision, building industry capability for compliance, assuring sustained availability of key inputs, incentivizing industry to scale up fortification and establishing and institutionalizing quality control for production; 3) Conscious Consumer through creating awareness of benefits of fortified food helping consumers define what they should expect an increasing demand for fortified wheat flour and edible oils/ghee; and 4) Research and studies for evidence generation around food fortification.

COOPERATION WITH MORE THAN 1000 MILLS Although various wheat flour fortification projects had been launched in Pakistan, they were not sustained or produced only limited results. FFP is designed on the success story of universal salt iodization, lesson learned from previous wheat flour projects and global best practices to ensure sustainable fortification. Wheat flour fortification under FFP aims that half of the population of Pakistan shall be consuming fortified wheat flour by the year 2020. The programme will be working with over 1,000 wheat flour mills through gradual expansion. The programme is providing training and technical support to both government and millers, and helping flour milling industry with financial costs of micro-feeder equipment and subsidies towards the cost of premix as an incentive to mills. As a part of preparing the ground for fortification, Pakistan has recently revised fortification standards as per WHO guidelines. The new standards are harmonized with the central Asian region. FFP has started raising public awareness about the benefits of fortified foods so that families can increase their demand/uptake for fortified wheat with iron, folic acid, zinc and folic acid. The fortification programme will also generate evidence on policy and practice to strengthen decision making for fortification. The programme has been successfully started in Lahore, Rawalpindi, and Islamabad and is expected to expand to all districts of Pakistan gradually over next few years.

The government of Pakistan has created enabling environment by providing exemption on taxes and duties on import of micronutrient premix for fortification. The micronutrient premix is now available in Pakistan at significantly lower cost. Punjab the largest province of Pakistan contributing almost half of the country population has recently made the fortification mandatory. The sustainability of wheat flour fortification is important for the economic development of the country. FFP is taking various measures for sustainability, which includes setting up a market-based premix supply system, generating demand for fortified wheat flour, in the country support system for fortification equipment and support to the government for bringing mandatory legislation and its enforcement. The provincial food authorities should take up the cost of monitoring and laboratories for effective enforcement of mandatory legislation. It would be worth mentioning that wheat flour fortification is a low-cost intervention with high impact. Different studies show that cost of fortification for 100 Kg bag is less than 0.2 US Dollars in Pakistan. As provincial governments through food department are regulating the price of wheat flour, so for long-term sustainability this minor cost of wheat flour fortification should be transferred to consumers. Investment on fortification could be one of the best investments which Pakistan could make. Each dollar spent on fortification may return 8 dollars or more by preventing the disease burden, improving IQ of the population and increasing productivity of human resource. Fortification of wheat flour is a low hanging fruit which is cost-effective, impactful and could produce early results. Working together FFP will make a critical contribution to freeing the people of Pakistan particularly women and children - from the burden of malnutrition.