Steps for the implementation of a fortification programme (adapted from MOST)

Controlling and preventing MDD (Micronutrient Deficiency Dideases)

• Characterization and diagnosis of MDD
• Extent of the problem
• Severity
• Distribution of MDD among the population, regions, urban/rural, SES, …
• Major causes of MDD (e.g. malaria, hookworm, low intake of bio-available iron, blood loss)  

• Public Health Measures (deworming, malaria control, improv. Water & sanitation)
• Dietary modification (more Vit. C, meat products, less tea with meal …)
• Supplementation (Regular supplies, information, … low compliance, highly targeted approaches)
• Food Fortification (to correct at population level a/several recognized micronutrient deficiencies, Wheat Flour Fortification,…)

Micronutrient interventions are among the most cost-effective investments in the health sector. Addressing micronutrient deficiencies globally will require an estimated $1 billion per year about $1 per affected person (all dollar amounts are U.S. dollars). That figure is equivalent to the economic costs of endemic deficiencies of vitamin A, iodine, and iron in a single country of 50 million people. Most of these costs will ultimately be borne by consumers when purchasing food with higher nutritional quality. (Enriching Lives: Overcoming Vitamin and Mineral Malnutrition in Developing Counties, World Bank, 1994) 

• Consumption patterns and sources (subsistence or purchased)
• Capacity of Food Industry to adopt the fortification process
• >50% of the population consumed the targeted product, especially those at risk of MDD
• Fortified Food would be a fair/good source of Micronutrient(s) (15-25%/>25% of RNI)
• Food is centrally processed (under control, low cost)
• Marketing and distribution channels can be tracked
• Raw Material: marketing patterns for foods made with commercially available RM (e.g. Wheat Flour used for bread, noodles, pasta …)

• Micronutrient is stable during storage and process (e.g. baking, cooking)
• Other micronutrients could be added (e.g. Folate, Vit. B12, B1, B2, Niacin, …)
• Targeted food consumption is increasing worldwide, locally …especially in developing countries.
• Fortification doesn’t change the product characteristics.
• Fortification can be a market-based strategy (e.g. IRD in Indonesia, PSI in India & Nepal).