Food Fortification in Ethiopia Adding value to ancient grain Wheat flour and pasta International Conference

Addis Ababa, Ethiopia

Hilton Hotel

[December 6 – 7 , 2014]

Alem Hadera Abay

Country Manager, GAIN

Public Nutritionist, BA, MPH

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Why do we need to fortify?

- We don’t get adequate micronutrients from our staple

foods!

- Food (gain staples) loss its micronutrient content during

process- milling as high as 80% for wheat

- As food prices increase now, more than ever, we need to

add micronutrients to staple foods as our people move to

increasing reliance on those staples & most staples

such as do not meet our RDA for vitamins & minerals

• Folate – 28 slices of Bread (800g)

• Zinc – 4 to 5 cups Maize meal (450 to 600g)

• Iron – 800g to 1.2Kg red beef meat

• Vitamin A – 27 to 34 cans of sardines (2.5 to 3Kg)

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21st BOARD MEETING 3

Why fortify? Cereal-based Agricultural

Production & Consumption

2%

QTs(M)

0

Meher Season

2010/2011

69%

8%

300

7%

200

100

2%

5% 5%

3%

Sugar cane

Fruit crops

Oil crop

Vegetables

Root crop Cereals

Pulses

Others

16%

28%

22%

20%

14%

Total

cereals

Sorghum

Maize

Wheat

Teff

Other

Chickpeas: 17%

Soybeans: 1%

3

% of average daily calory intake

100

80

60

40

20

0

Rural

6 2

2 5

2 1 7

73

Urban

7 3

3 4

5

7

6

65

National

7 3

3 5

2 2

7

72

Animal Products

Fruits/Veg

Root Crops

Oils/Fats

Pulses

Cereals

Source: FEWS 2011; Food Grain Consumption and Calorie Intake Patterns in Ethiopia, Working Paper 23, IFPRI 2011 based on CSA

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Indicators 2005 2011

Anaemia in Children 54% 44%

Anaemia in women 15-49 years 27% 17%

Anaemia in men 15-49 years --- 11%

Households consuming iodized salt 4% 15%

6-23 months children consuming Vit. A rich &

iron rich food

13%

Why fortify? Micronutrient Deficiencies,

EDHS

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Why fortify? Prevalence of anemia

among children in rural & urban areas

-26%

-17%

-39%

-36%

%

0 5

Rural Urban Rural

40

60

13 18

28

11

18

45

54

35

47

Rural Urban

20

Urban

2005

2011

Children Women Men

WHO Cut offs:

Severe

Moderate

Mild

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Why Fortify? Projections on Impacts of

Several Deficiencies in Ethiopia

• Mortality: ~ 17% of Deaths in Children

• Vitamin A Deficiency

• > 38 thousand deaths/yr in children 6-

59 months

• Iron Deficiency Anemia

• > 8 thousand maternal and perinatal

deaths/yr

• Folic Acid Deficiency

• > 2 thousand deaths/yr

• Economic Impact: ~ USD ½ Billion/yr

• Depressed productivity in Adults

• Retarded cognitive development & lost

workforce Source: WB

Standard Inception Workshop, FMHACA

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Effects of folate deficiency: Spinal Bifida

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a. Health benefits

b. Improve Productivity

c. Economic benefit

Reduce global & national burden of disease, and deaths

Increased cognitive capacity, physical activity and work performance

GDP Growth

USI- 1 : 26 (1.15 $/ton) Iron (wheat): 1:8

(costs 3 $ per ton)

Vit.A (oil) 1:50

(costs 2$ per ton)

Benefits of Food Fortification:

Individuals

Society

National Development

Impact

of

VMD

Standard Inception Workshop, FMHACA

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Opportunities for fortifying wheat:

Markets and Profitability • Committed government to address malnutrition: NNP, FF

Steering committee & organized millers in association

• There is huge demand for wheat flour in-country,

regional and global levels.

• Ethiopia urbanization is growing at higher rate total

population that lives in urban area is estimated at 20%

• It is the only country in the region suitable for wheat

farming.

• Ethiopia has easy access to markets in the Middle east,

North Africa, and Europe. Ethiopian Airlines plays an

important role

• Many wheat millers fortify their products and they are all

still in business. The ever increasing demand for staple

food and strategic location of Ethiopia will make such

business ever profitable.

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Ethiopia’s Food Fortification plan

• FMoH led team participated in ECSA-HC 2009 & 2010

• 4th Regional FF & wheat & maize fortification workshops

• FMOH Commissioned Assessment in Oct, 2010

• Techno-feasibility & market landscape.

• The food consumption survey carried out by EHNRI in 2011

• Preliminary results shared today

• National Legislation for USI signed by late PM Meles , Feb 2011

• Legislation mandating all salt for edible consumption be iodized

• Multi-stakeholders initial planning of national FFP,Feb 7-8, 2012

• agreed on launching of national FF Program

• Fortification of wheat flour (9 micronutrients) & edible oil (vit A & D)

• Mandatory regulation

• FMoH Assess & provided 5 days training to public sectors at AAU, Feb,

2013.

• FMHACA prepared 1st draft and open for consultations and feedback with

partners, 29th -30th May, 2013.

• Draft NFCS shared by EPHI indicating high iron intake, September 2013

• Consensus reached in moving forward FFP & at the same time look for more

evidences of bioavialability of iron, July 2014

• Ethiopian standards national Technical Working Group on wheat flour

and edible oil convened in Adma from August 29th to September 1st, 2014 to

develop the standards

What Does it Require to Fortify?

What What it takes to fortify ?does it take to fortify? Who Does

What?

Government Enables the Market

Place

Industry

Fortifies

Consumer Pays

Regulation Education

Monitoring Enforcement

Business Expertise Capital Costs

Recurring Costs

Donors Assist Start-Up

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Cost & coverage for three potential

fortification Vehicles

Vehicle Nutrition

Protection

Feasibility industrial

coverage

Estimated cost Cost/

person

% WHO Standard % Share 000,000

Consumers

USD Million/Yr $/yr

Flour 26% EAR Iron; 64%

EAR Folic Acid

28% 22 $2.28 $0.10

Oil ~ 37% RNI Vitamin A 48% 38 $0.95 $0.02

Sugar ~ 36% RNI Vitamin A 20% 16 $5.98 $ 0.38

Standard Inception Workshop, FMHACA

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Standard Inception workshop , FMHACA

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What Can Flour Fortification with 8

Essential Vitamins & Minerals Achieve?

Nutrition Protection from Fortification Profile

at Mean Consumption 128 g/day (NFCS 2011)

Fortification

Level [mg/kg]

Source of

Recommendation

Added

WHO RNI [%]

Thiamin 9.8 ECSA 80%

Riboflavin 6.6 ECSA 54%

Niacin 50 ECSA 44%

Folic Acid 2.6 WHO 67%

Vitamin B6 6.5 ECSA 45%

Vitamin B12 0.02 WHO 80%

Iron (NaFeEDTA) 30 WHO 34%

Zinc 55 WHO 142%

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Conclusion and Way forward

• Fortification is the most cos-effective and safe way of

replacing and adding micronutrients to staples

• Build the capacity of the MoI, FMHACA and Industry.

• Strengthen the national steering committee on food

fortification spearheaded by MoI

• Finalize the mandatory standard development process

by FMHACA

• Active engagement of the milling industry

• Resource mobilization and fund raising for the national

FFP

• Establish robust cost recovery and procurement system

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ይቻላል!

እንዴታ!!!