Fortifying Pakistan’s Future

Case Study

Project Food Fortification Programme Client Department for International Development (DFID) Location Pakistan Expertise International Health – Technical Assistance, Private Sector Development and Programme Management

Fortifying Pakistan’s Future Malnutrition in Pakistan is increasing and is a major contributor to high maternal, newborn and child death rates. The Food Fortification Programme (FFP) works at government, industry and consumer levels to transform the nutritional status of people across Pakistan, particularly women of child bearing age and children. One of the greatest challenges is to unblock market barriers to enable private sector wheat flour and edible oil millers to drive this change.

Opportunity According to the last National Nutrition Survey, 44% of children under five suffer from iron deficiency and 54% from vitamin A deficiency. Amongst women of childbearing age, 27% have iron deficiency wile a staggering 67% suffer from vitamin D deficiency. As well as having serious health impacts, this chronic malnutrition causes life-long damage to brain development, perpetuating cycles of disadvantage into future generations.

Food fortification - adding essential vitamins and minerals to commonly eaten staple foods - is a cost-effective and safe way to address micronutrient deficiencies. However, lack of availability of food fortification premix and feeder equipment, lack of awareness and consumer demand and absence of regulations to create a “level playing field” are significant barriers to the 326972 | January 2014 - March 2019

production of fortified wheat flour and edible oils/ghee. Ensuring that market participants understand the benefits of fortification, are able to implement it easily, and operate in a robust and transparent regulatory environment, are crucial to ensuring the successful uptake of fortified food in Pakistan.

Solution Funded by UKaid, the five-year Food Fortification Programme was launched in 2016. Implemented in Punjab, Sindh, KP and Baluchistan, FFP is significantly enhancing the production, access and consumption of fortified wheat flour with iron, folic acid, zinc and vitamin B12 and edible oils and ghee with vitamins A&D. Our team manages the programme and provides technical assistance to millers of wheat flour, edible oil and ghee to help them prepare for future mandatory legislation (in the case of wheat) and more effective enforcement of existing legislation (in the case of oil). The project has contributed to the costs of microfeeder equipment as well as providing “smart subsidies� towards the cost of premix as an incentive to pass quality inspections. Working directly with millers as well as industry associations, we have supported establishment of laboratories and provided practical training and guidance as the industry adopts fortification processes.

We work to address market failures, for example where millers do not fortify foods because of a lack of supply chain and low perceived consumer demand.

FFP has brokered arrangements for suppliers of premix to enter the market and acts as a trouble-shooter to ease frictions. For example, when importers experienced issues clearing premix from Customs after a new requirement for registration of any nutritional product, the issue was taken up by the programme and resolved. We have also successfully advocated with government to reduce taxes, duties and tariffs on fortification equipment and premix.

To induce greater buy-in by industry, and manage the risks posed by resistant mills, we have brokered deals with a number of large retailer stores to stock fortified flour and oil/ghee products across their 5,000 plus outlets. Names of mills fortifying their products have been passed to purchasers from these stores, and this arrangement used to stimulate increased fortification by millers.

To address consumer demand, we have contracted a media agency and run television adverts so far in 12 districts of Punjab and 4 districts of Sindh, with billboards also prominently displayed in these districts.

Outcome With the programme approximately halfway through, it has already reached over 1 million people with fortified wheat flour and a huge 42 million people with fortified oil/ghee, with these numbers growing as the programme expands.

Overall, 405 flour mills are enrolled in the programme and 801 microfeeders have been installed by millers who have signed MOUs with the programme.

115 oil/ghee mills have been enrolled in FFP against an initial estimate of 102 mills existing in Pakistan. The increase is due partly to some new mills opening but also because some existing peripheral mills, previously unregistered with the food regulatory bodies, have been brought into the formal sector through the influence of FFP. This brings additional benefits of the programme on wider food safety/quality issues, particularly benefitting poorer consumers more likely to purchase from unregistered suppliers.