in Pakistan
Zameer Haider1, Bisma Imran1, Noor Khan1 , Manpreet Chadha2
1Food Fortification Programme, Islamabad, Pakistan
2 Nutrition International, Headquarters, Ottawa, Canada
BACKGROUND
• Pakistan mandated edible oil fortification in 1965 as a strategy to address malnutrition but owing to weak implementation of the legislation, the coverage and adequacy of fortification remained limited.
• Mott MacDonald with Nutrition International started supporting food fortification under DFID funded Food Fortification Programme (2016-21).
• The programme focuses on improving the capacity of millers as well as government partners to ensure adequate fortification.
OBJECTIVES
The FFP envisages to reduce the burden of vitamin A deficiency in Pakistan and achieve the following key objectives:
1. Improve capacity of private sector millers to ensure adequate fortification of edible oil.
2. Build capacity of government departments for effective enforcement of the oil fortification standards.
3. Develop market led mechanism for sustainable supply of fortification premix
4. Increase availability and consumption of edible oil fortified with vitamin A.
APPROACH & METHODOLOGY
The program worked with national and provincial food regulatory bodies to amend and harmonize edible oil fortification standards to create an enabling environment for fortification. It established market-led premix supply chain system to ensure availability of high-quality premix to the mills. The FFP trained millers/staff from 118 (out of 136 total) oil mills on fortification processes and internal quality assurance; and provided testing kits to mills to check fortification levels. The FFP also trained government regulatory staff on quality control and build their laboratories for enforcement of standards for fortification. The FFP provided incentive to mills upon adequate fortification through reimbursement of the partial cost of premix used for fortification. The FFP signed MOUs with millers, miller's association, government food regulatory bodies to implement this programme.
1. Signing of MOU between FFP and oil mill
6. Testing each batch for vit A&D fortification using RTKs
7. Testing (2 samples/month) at i-Check cluster lab
Harmonizing fortification standards across provinces
2. Assessment of mill’s current capacity and fortification needs
3. Training of mill staff on fortification process & QA
5. Identify gaps in fortification process by millers
4. Provision of Rapid Testing Kits (RTKs) and ICheck equipment for QA
8. Testing (2 samples/month) at 3rd party lab
9. Give feedback to mills to take corrective measures
RESULTS
The FFP support to build capacity of millers and government staff, establishment of premix supply systems led to improvement in the adequacy of fortification of edible oil from around 9% in 2017 to over 90% in 2019 in Pakistan.
Reduction in Vitamin A Deficiency
42.5% women and 54% children in Pakistan Vitamin A deficient (National Nutrition Survey 2011)
Vit. A deficiency reduced to 27.3% in women (↓35.7%) and 51.5% in children (↓4.6%) (NNS 2018) likely due to a variety of factors including oil fortification, Vit. A supplementation and improved diet.
Sustainable Supply of Fortification Premix
Increased adequacy of oil fortification
Limited suppliers of fortification premix
Prequalified supplier to provide high quality premix at mill level.
139% increase in import of premix for fortification.
Market-level study found only 9% of edible oil brands adequately fortified (GAIN 2017)
92% samples (out of 2,537) from enrolled mills found to be adequately fortified with Vit A at production level – (FFP Fortis Data).
Market sampling in 8 districts indicated 82% (out of 201) of oil adequately fortified – in 2019. (Rolling District Study Phase 2).
Table 1: Comparison of Results
CONCLUSION
Capacity building of millers on fortification processes and internal quality assurance; uninterrupted supply of premix; training of government food regulatory bodies and ownership of private sector are imperative for successful implementation of large-scale food fortification interventions, including that of the edible oil fortification.
Capacity building of millers on fortification and government regulatory staff on enforcement led to improved adequacy of edible oil fortificationFigure 1: Support to Edible Oil Mills Figure 2: Support to create an Enabling Environment Supporting market-led premix supply chain Capacity building of food regulatory bodies Strengthening public sector labs for enforcement Figure 3: Comparison of adequacy of fortification of oil pre and post intervention (Source: Rolling District Study - Phase 2)