Food fortification in five Southeast Asian countries: the SMILING project · Food fortification in...
Transcript of Food fortification in five Southeast Asian countries: the SMILING project · Food fortification in...
Food fortification in five Southeast Asian
countries: SMILING project
Pattanee Winichagoon, Ph.D
On behalf of the SMILING team
Presented at the SMILING Symposium
20th International Congress of Nutrition, Granada, Spain
September 16, 2013
Food fortification in SMILING countries
• A 3d-workshop on Food fortification -- compiled
information on food-based strategies, including
food fortification:
– target groups, food vehicles, fortificants
– existence of specific policy and
implementation
– strengths & weaknesses of policy and
programs
• A 2d advocacy meeting – consensus and
recommendations on further actions to improve
effectiveness of food fortification programs.
Current food fortification
• All countries: Mandatory iodization of salt; Vietnam
temporarily stopped, soon to be resumed
• Mandatory fortification exists in Indonesia and Thailand
– Indonesia: iron & zinc fortification of wheat flour, multiple
fortified complementary foods, and vitamin A fortification of
cooking oil.
– Thailand: iodization of fish/soy sauce and vitamin A
fortification of sweetened condensed milk
• Voluntary fortification in 4 countries: condiments, staples
and complementary foods as a public health strategy
• All countries: Food-based strategies (malnutrition of all
forms)
– food-based dietary guidelines
– food security for nutrition
– nutrition education communication
Lessons learned from
country’s experiences
Cambodia
– National Sub-Committee for Food
Fortification (NSCFF) – oversee all food
fortification projects/programs
– NSCFF in cooperation with RACHA
(national NGO) -- implementing a five-year
program on Fe-fortified fish/soy sauce
– To be expanded: piloting Vegetable oil
fortified with Vitamin A
5
Mandatory salt Iodization:
– Potassium Iodate
– Minimum acceptable level: 40-60 mg/kg at
factory level; >20 mg/kg at household level
– Regulating body: FDD of MOH
– Legislation since 1995: Prime Minister’s
Decree on Universal Salt Iodization
– Coverage: 79.5%
Food Fortification: Laos
Planned FF with WFP In LAO PDR 2011-2015
1. Potential food vehicles:
- Soybean and peanut oil
- Fortified noodle production
- Nutri-rice, a grain-like capsule of
micronutrients mixed in with normal rice
- Lipid based, low-cost ready-to-use food
2. WFP to support the fortification of the products
& marketing
3. Social marketing and sensitization on
appropriate storage and handling are needed
FF experiences in Indonesia
1. Salt – Iodine: Mandated 1994
2. MSG - Vitamin A – Voluntary 1980-1990, then
discontinued)
3. Wheat Flour -- Fe, Zn, FA, B1, B2: Mandated
2002
4. Vegetable (palm) Oil – Vitamin A: in process for
mandatory (2013/2014)
5. Rice for the Poor (being planned)
6. Sugar – not yet feasible
Scaling up towards mandatory palm oil fortificatin
Mandatory
1
2
3
• Baseline data: prevalence, effectiveness study
0
2012/13
2010-11
2009 2008
• Strengthening research and communication
Among parties & advocacy to establish “ppp”
• Pilot project
- Develop standard QA/QC & Capacity
building for Provincial level
- Advocacy and social marketing - Voluntary fortification by industry
- Develop mandatory FF Endline data analysis
on impact
Thailand FF experiences
1. Mandatory fortification of vitamins A & D in
sweetened condensed milk
2. Mandatory salt iodization (1994)
3. Mandatory iodization of fish/soy sauce (2010)
4. Voluntary multi-micronutrient fortification:
1. Seasoning powder of instant noodle
2. Quick cooking rice for complementary food
Voluntary food fortification in Thailand
• Private-public-academic collaborative initiative
• Product development with instant noodle industry to include vitamin A, iron and iodine in the seasoning mix
• Reduced tariff for the premix (30% to 2-3%)
• Product distribution by private companies
• Nutrition education through government on importance of micronutrients
• Long latent period for industry to agree to commercialize
– Market viability i.e., business risk
• Similar experience with multi-fortified quick cooking rice for complementary food
Lessons learned
1. Public Private Partnerships (PPP)
– crucial for success and sustainability of FF
– common social goal
– continued partnership and building trust
2. Recognizing the differences in shared
responsibility and benefits
– Public sector – government provision of
fund/investment for public responsibility
– Private sector– business investment and
profit returns + social responsibility
3. Technical vs commercial feasibility & market
viability:
– cost, production feasibility
– consumer acceptability –fit in habitual diets
4. Research support
– Bioavailability – selecting fortificant
– Consumer acceptance and actual uses of FF
– Product development
– Shown impacts on nutrition, health and
functions
Food Fortification in Vietnam
Management and implementation
Steering committee
(MOH, MOIT, MOARD)
Production and distribution
Technical regulations and quality control
Social marketing Monitoring and
evaluation
Management board
(National Institute of Nutrition)
Voluntary Food fortification in Vietnam
No Food
Vehicles Micronutrient
Cost for
premix Dose
1 Edible oil Vitamin A 1.365.000
VND/kg 75 IU/g
2 Fish sauce Iron 150.000
VND/kg
2.5 mg/
10 ml
3 Soya sauce Iron 150.000
VND/kg
2.5 mg/
10 ml
4 Granules
(MNP) Zinc
150.000
VND/kg
75 mg
Gluconate/
kg
Government supports to food producers on FF
• Contact point for purchasing micronutrients
• Support 50% total amount of micronutrient in the
first year of participation
• Training, technical support for food fortification
• Develop logo and application for patents on
micronutrient fortified foods
• Communication, marketing for micronutrient
fortified foods for consumers
• Supports for product registration and monitor
micronutrient fortified foods
Summary & Recommendations
• Food fortification (FF) -- based on Optifood results, FF likely
be a choice for all countries: universal or targeted
• National FF guidelines – mandatory vs voluntary
• National body on FF is crucial for success
– SC of the National nutrition committee
– Independent FF committee for all commodities vs individual
– A functional and active secretariat is essential
• coordinate the multi-sectoral efforts
• partnering with academic, non-government & international
organizations
• Food fortification be advocated to the existing ASEAN
committee on food security
– Sharing knowledge & resources e.g., laboratory for quality
assurance
– Capacity building on FF for the ASEAN
Key challenges
• Scaling up as a national program
– A functional national food fortification
committee to formulate and oversee the
program
– Laboratory capacity & Monitoring system for
quality assurance and capacity building in FF
– Impact/effectiveness evaluation
• Harmonizing efforts in FF among ASEAN
countries beyond SEA/SMILING countries
Thank you