Conference on Micronutrient Fortification of Foods: Science, Application

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Conference on Micronutrient Fortification of
Foods Science, Application ManagementSponsored
by International Life Sciences Institute-India
Co-Sponsored by Ministry of Food Processing
Industries, Government of India and National
Institute of Nutrition

• The Gujarat Food Fortification Programme

Presentation by The Gujarat State Civil Supplies
Corporation Ltd. Gandhinagar, Gujarat.
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Article 47 and Food Security

• Article 47 (Directive Principles) - State shall
  regard the raising of the level of nutrition and
  the standard of living of its people and the
  improvement of public health as among its primary
  duties
• FAO - Food security exists when all people, at
  all times, have access to sufficient, safe and
  nutritious food to meet their dietary needs and
  food preferences for an active and healthy life
  (Website).

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Hidden hunger-The Need for Essential
Micronutrients

• Micronutrient malnutrition or hidden hunger is
  widespread apart from the problem of generalized
  protein energy malnutrition (PEM).
• Impact most on -Women who are pregnant or
  breastfeeding, the young adolescents, infants and
  preschool children, school age children
• Lifecyclical vulnerability.
• Poor most affected by micronutrient deficiencies,
  but affluent groups not spared due to faulty food
  habits.
• General need to tackle the problems of iron-folic
  acid and protein deficiency
• Cost effective strategies to reduce these
  deficiencies are available.
• One of the key strategies for control of these
  deficiencies - food fortification.

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Under weight PopulationNational Nutrition
Monitoring Bureau Gujarat Survey (2006)

• Adult Men 26,
• Adult Women 30,
• 6-60 months children 54
• 10-13 yrs children 50,
• 14-17 yrs children 23

• gt 25 people cross section is underweight
• This rate will be higher among poor population

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Food and nutrient intakeNational Nutrition
Monitoring Bureau Gujarat survey (2006)

• Daily per consumption unit Pulses intake is 50,
  this will be even lower in poor families looking
  at the cost of pulses
• Total calorie intake is 2/3 of recommended
  allowance.
• Food energy intake at household level is now
  given prominence as food security measure
• In poor families Animal protein as a source is
  low and they depend on vegetarian protein
• To provide good quality protein to them cereal,
  pulse combination is important

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Observations from NFHS-III
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ADVANTAGES OF FOOD FORTIFICATION

• Consistent Delivery Maximizes Benefit
• Safety in Low Daily Doses
• Minimal Behavior Change
• Enhances Health Nutrition Strategies
• Transfers Costs of Protecting Health to sectors
  otherwise not involved
• Cost Effective

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Food Fortification - Gujarat Model

• Based on Public-Private Participation Model with
  involvement of society.
• Stakeholders State Government and its agencies,
  the Private Sector's oil producers, refineries
  and packers, Roller Flour Millers Association
  and its member mills
• The fortification began in open market with
  private public partnership.
• In the first phase, Govt. decided that about 2.5
  lakh tons of wheat, which is sold in open market
  shall be made into wheat flour and the same may
  be fortified with pre-mixed iron and folic acid
• Initially Micronutrient Initiative (MI) NGO of
  Canada also supported this programme technically
  and financially. World Food Programme also
  provided free premix to the small atta chakkies
  of Surendranagar and Surat districts.
• Based on the experience, fortification of items
  of daily food intake like wheat, edible oil, salt
  through basic Govt. programmes Public
  Distribution System (PDS), Integrated Child
  Development Scheme (ICDS) and Mid-day Meal (MDM)
  scheme.

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Food Fortification - Gujarat Model

• Role of the Government as catalyst to the project
  
• Based on partnership, not legislation.
• Success in markets lead to internalise this
  programme to PDS, MDM, ICDS with fortified flour
  and oil to remove deficiencies of iron/folic
  acid and Vitamin A D.
• Most of the population being vegetarian, to fight
  against protein deficiency, model was further
  adopted to include Defatted Soya Flour
  fortification Food to Food Fortification.

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Food Fortification Overview of Schemes

• Areas
• To fight against malnutrition through medium of
  Food Fortification, Government of Gujarat with
  GSCSC as an implementing agency has started
  following programmes
• Fortification of Edible Oil in Open Market and
  Welfare Schemes
• Fortification of Wheat Flour with Iron Folic
  Acid (IFA) in Open Market and TPDS
• Fortification of Wheat Flour with vitamins
  multi micronutrients under ICDS MDM
• Fortification of Wheat Flour with IFA Toasted
  Defatted Soya Flour (TDSF) under PDS
• Fortification of Wheat Flour with Vitamins, multi
  micronutrients Toasted Defatted Soya Flour
  (TDSF) under ICDS MDM
• Fortification of Salt under ICDS PDS
• Distribution of Nutri Candy under ICDS MDM
• Steps forward for programme improvements
• Studies, Seminars, Quality Specifications,
  Quality assurance methods, Monitoring and
  Evaluation.

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Phases of the program
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TPDS - NORMS OF DISTRIBUTION PRICE
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Fortification (Edible Oil)

• Strategy
• Public Private Partnership (P-P-P) Model.
• Discussions were held with the Oil Oil Seed
  Producing Millers' Associations and members of
  the Saurashtra Oil Mills Association (SOMA) for
  edible oil fortification during October, 2005.
• Producers were educated about the procedure of
  mixing Vitamin A D in edible oils, cost and
  testing.
• Method
• 20 gram of Vitamin Premix is added into 1 MT of
  edible oil. The cost of fortification of 1 MT of
  edible oil is currently Rs.100.
• Ring Test is conducted with Antimoni Tricloride
  to check the presence of vitamins into the
  fortified edible oil.

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Fortification (Edible Oil)

• Implementation
• At first, edible oil with Vitamin A D was
  produced in two oil mills of Rajkot. After
  analyzing the success of this venture, it was
  decided by the millers, producers and refineries
  to sell only fortified edible oil from
  01-02-2006.
• This does not only tackles the micronutrients
  deficiency but also ensures sale of edible oil
  through packages and implementation of packing
  order.
• Ban on sale of loose edible oil.
• The edible oil consumed under all Govt. schemes
  like PDS, MDM and ICDS is fortified with Vitamin
  A and D.

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Fortified Edible Oil under TPDS

• State Govt. creates buffer stock of edible oil
  almost every year for the distribution of the
  same mainly during festival seasons.
• Since last three years, Govt. of India is
  providing RBD Palmolien oil for PDS under the
  subsidised scheme and allocating the same to the
  States for distribution under TPDS.
• The quantity of RBD Palmolien Oil enriched with
  Vitamin A and D which is distributed to AAY and
  BPL cardholders since 2006 is as follows

Year Distribution(MT)
2006-07 1500
2007-08 12000
2008-09 19942
2009-10 6000
2010-11 11950
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Fortified Edible Oil under MDM ICDS

• GSCSC procures fortified edible oil (Refined
  Cotton seed oil) for MDM ICDS through
  e-tendering system for their requirement.
• Refined Cottonseed Oil enriched with Vitamin A
  and D distributed under MDM and ICDS since 2006
  is as follows

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Fortification of Wheat flour with IFA in Open
Market

• Strategy
• The project was initiated under the
  public-private partnership and it was decided to
  implement food fortification in the open market
  before it was introduced in the welfare schemes
  run by the Government.
• Food, Civil Supplies Consumer Affairs
  Department, Govt. of Gujarat (FCSCAD) conducted
  several rounds of meeting with the concerned
  industries and convinced the respective millers
  for doing the needful and implementing the
  fortification process at their manufacturing
  facilities.
• The millers were also very willing to proceed
  with the project as their corporate
  responsibility towards the society.
• Method
• The 1.5 gram premix of Iron (30 ppm) and Folic
  Acid (1.5 ppm) is used for the fortification of
  10 kg. wheat flour.
• The approximate cost of the iron folic acid
  fortification is Rs.10 / MT.
• Presence of premix is tested with the spot test.

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Fortification of Wheat flour with IFA in Open
Market

• Implementation in Open Market
• Phase I 34 Flour Miller members of GRFMA
  initiated the sale of iron and folic acid
  enriched flour in the market since 16th of
  January 2006.
• Phase II 50 odd Organized Atta Chakki Plants
  across the state were clubbed in the project
  since March, 2006 Thus increasing the reach of
  the fortified wheat flour.
• Phase III 1.5grms. of the iron and folic acid
  premix pouches were introduced in the market in
  order to encourage fortification at the Nookad
  Chakki level as well as the house holds which
  practiced grinding of wheat at their own places.
• Benefits
• Fortified flour can curb the possibility of
  adulterated flour or wheat.
• Availability of flour in proper packages with
  correct measurements.
• Accessibility of iron and folic acid to
  beneficiaries with effect on mental and physical
  development .

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Fortification of Wheat flour with Iron Folic
Acid (IFA) under Antyodaya Anna Yojna (AAY)

• Strategy
• Pilot project with the help of Gujarat Roller
  Flour Millers Association (GRFMA) in Ahmedabad
  City.
• Barter System in the initial phase.
• Phasewise implementation.
• Method
• Fortified Atta specifications as per PFA
• The 1.5 gram premix of Iron (30 ppm) and Folic
  Acid (1.5 ppm) is used for the fortification of
  10 kg. wheat flour.
• Presence of premix is tested with the spot test.
• Implementation
• The Govt. of Gujarat started distribution of
  fortified wheat flour in place of wheat in
  Antyodaya Anna Yojana (AAY) from April, 2006 on
  experimental basis.
• Initially the programme was stated only in
  Ahmedabad City, thereafter expanded to the major
  cities of Gujarat and subsequently to the State.
  Till March-2010 all cardholders of AAY scheme
  were getting 16.7 kg. fortified wheat flour in
  HDPE bag in place of 19 kg. wheat.

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Fortification of Wheat flour with vitamins
multi micronutrients (9) under ICDS

• Strategy
• As per GOIs letter dated 31st March, 2006, nine
  micronutrients were to be added to the food
  provided by ICDS to accomplish the supply of 50
  RDA to the beneficiaries. It was decided to
  provide whole wheat flour fortified with 9
  micronutrients in place of wheat.
• Pilot project and then Phasewise implementation.
• Method
• Fortified Atta specifications as per PFA
• 9 micronutrients used for the fortification of
  wheat flour.
• Presence of premix is tested with the spot test.
• Implementation
• A pilot project started on 21st June, 2006 in
  Daskroi Taluka of Ahmedabad District.
• The dosage of this particular premix is 14kg per
  metric ton of wheat flour.
• The programme was expanded to tribal districts
  and then all over the State.
• As on date Fortified Wheat Flour is being
  distributed in all the districts of the State and
  approx. 40000 Anganwadis are benefited.

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Fortification of Wheat flour vitamins multi
micronutrients (9) under MDM

• Strategy
• Looking to the success in ICDS, it was decided to
  provide whole wheat flour fortified with 9
  micronutrients (like ICDS) in place of wheat.
• Pilot project and then Phase wise implementation.
• Method
• Fortified Atta specifications as per PFA
• 9 micronutrients used for the fortification of
  wheat flour.
• Presence of premix is tested with the spot test.
• Implementation
• A pilot project started during 2008 in Chanasma
  taluka of Patan District.
• The programme was expanded all over the state on
  25th September, 2009.
• As on date Fortified Wheat Flour is being
  distributed in all the districts of the State and
  approx. 36000 MDM Centres are benefited.

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Micronutrients (as per GOI guideline) used for
fortification of Wheat Flour under ICDS MDM
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The need - Fortification of Wheat Flour with Soya
Flour

• As Gujarat is a predominantly vegetarian state,
  TDSF fortification is expected to provide good
  quality and easily digestible proteins in the
  basic diet and reduce protein deficiency
• Main beneficiary categories of the Soya Flour
  fortified scheme are expected to be 0-6 children,
  Children in schools under MDM, adolescent girls,
  pregnant and nursing mothers and the aged
• Fortification with TDSF is from 5 to the extent
  of 10 on weight basis in addition to iron and
  folic acid / multi micronutrients fortification
• The amended PFA Act permits fortification upto
  10.
• The expected benefit of the programme will be
  increase in body mass and ensure better growth of
  the target groups and improve general health and
  reduce morbidity
• The approximate cost of Soya Fortification
  (addition of 5 Toasted Defatted Soya Flour) is
  Rs.1500 per MT.

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Nutritional Content of Defatted Soya flour

• Soya Flour contains about 48 protein.
• Generally, Whole Wheat Flour contain 11.5
  protein. Adding 10 of Soya flour, the protein
  content of the atta increases to 17.00.
• Simple ground Soya flour is not easily digestible
  and so Soya flour which is defatted and roasted
  is used.
• The Soya contains necessary ingredients for good
  nutrition, such as total protein, carbohydrate,
  fat, vitamin and minerals.
• Soya protein prevents cancer, reduces
  cholesterol, prevents bones diseases, and in the
  case of women, the periods become regular. Thus
  Soya protein is very useful element for health.

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Comparison of Composition of Whole Wheat Atta and
Soya Fortified Atta (per 100gms)
Particulars Whole Wheat Flour (WWF ) Soya fortified WWF
Protein g 11.5 17
Fat g 1.9 1.8
Ash g 1.6 2.2
Carbohydrate g 73 69
Fiber g 12.2 12.7
Calcium mg 34 55
Iron mg 4 4.5
Phosphorus mg 346 380
Zinc mg 2.9 2.9
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Distribution of Soya Fortified Wheat Flour
(SFWF) in the AAY BPL Schemes

• Gujarat Government announced distribution of
  Soya Fortified Whole Wheat Flour under AAY,
  BPL, ICDS and MDM as a Golden Goal (Swarnim
  Siddhi) for Golden Jubilee Year of Gujarat and
  has started distribution of the same in place of
  wheat from April-2010 in AAY BPL Schemes.

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Distribution of SFWF - in ICDS MDM

• Soya Fortified Wheat Flour distribution by
  adding Toasted De-fatted Soya Flour (5 in ICDS
  10 in MDM) to the fortified wheat flour
  containing 8 micronutrients, from 2010 as part of
  Golden Goals Programme (Swarnim Siddhi).
  Expenditure approx Rs.14 Crores per annum.

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Soya Fortified Wheat Flour Programme
implementation

• Challenges
• Limited flour production capacity in the State
• 45 days shelf-life of the flour
• Maintaining the quality
• Transportation arrangement of wheat and the flour
  prepared etc.
• Shortage of required quality of Toasted Defatted
  Soya flour (TDSF)
• Reaching out to benificiaries in very short
  period
• Need for more storage capacity
• Lack of awareness
• Steps to face Challenges
• Encouraging mills to participate
• Introduction of laminated HDPE bags for packing
• Process line Quality Monitoring and third party
  testing
• National level publicity for the purchase of TDSF
• Development of Integrated Management Information
  System (as part of computerisation)
• Study base line survey on Food Fortification
  by third party expert agency
• IEC Campaign to raise awareness

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Distribution of Iodised salt for Nutritional
Security ITDP, PDS ICDS

• This programme is expected to address the problem
  of iodine deficiency, which would lead to
• reduction in still births and abortions,
• low birth weight babies and
• most importantly, prevention of irreversible
  damage to nervous tissues which leads to deaf and
  dumb children at birth and mental retardation in
  pregnant women and in children
• Improves work and scholastic performance
• Under the Tribal Sub-Plan' of the State Govt.,
  GSCSC purchases Iodised Salt and distributes
  through FPS (and Hospital/ Student Hostels) at
  subsidised rate to ration card holders in 12
  tribal districts namely Banaskantha, Sabarkantha,
  Dangs, Vadodara, Panchmahals, Dahod, Bharuch,
  Narmada, Surat, Tapi, Valsad and Navsari
• The supply (for ITDP PDS) is at subsidized rate
  of Rs 1.00 per kg, involving a subsidy of Rs 1.46
  per kg which is borne entirely by the State Govt.
  The supply under PDS has been started from Oct-09.

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Iodised salt under ITDP, PDS ICDS for
Nutritional Security
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Distribution of Nutri Candy under ICDS MDM

• GSCSC is also providing Balbhog Nutri-Candy to
  ICDS and MDM. The micronutrients used are as
  follows

Distribution figures are as follows
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State Budget for Fortified Items in TPDS Year
2010-11 (in Rs crores)

• AAY/BPL - Iron, Folic Acid Soya Fortification
  - Rs. 257.00
• Edible Oil Fortification
  - Rs. 33.00
• Salt - Fortification
  - Rs. 6.16
• Total - Rs 296.16

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Steps to improve programme implementation

• After roll out and implementation of food
  fortification programme in welfare schemes, GSCSC
  took following steps to improve the programme
  implementation
• National Seminar on Nutrition and Food
  Fortification in March, 2007
• Assignment to CFTRI, Mysore to suggest steps to
  maintain quality and enhance shelf life of
  fortified atta
• Max. Moisture level is now only 10
• Atta is distributed in Laminated HDPE bags
• E-Tendering to award work of grinding and
  fortification to millers (to have competition, to
  reduce cost and to imphasis on responsibility and
  accountability through penalty clauses)
• Posting of responsible officer from GSCSC at
  participating mills to monitor the whole
  fortification assignment and record keeping.
• Mills are not allowed to carry out private work
  while work of welfare schemes is going on.
• Appointment of qualified third party agency for
  sampling and testing
• Appointment of qualified third party agency for
  base line survey and evaluation of the programme.

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Monitoring of Nutritional Security Initiatives

• The Department has taken two pronged approach to
  monitor and evaluate the impact of the various
  nutritional security initiatives
• Firstly, the GSCSC carries out inhouse sampling
  and primary testing of the fortified flour, i.e
  Moisture Sieve and spot test indicative presence
  of Iron (Fe).
• Secondly, independent third party quality testing
  agencies are also appointed to test the quality
  of the fortified products.
• Overall schematic evaluation/ impact assessment
  has also started through third party agencies on
  both concurrent basis and also periodical basis
• IT Solution is under development for overall
  monitoring of various schemes.

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Hon. Js. Wadhwa Committee Report

• Introduction of Fortified Atta (Wheat Flour) In
  The Public Distribution System
• The Committee is of the considered view that
  fortified atta along with wheat should be made
  available through PDS outlets which would
  immensely benefit the vulnerable sections of
  society and increase off take by consumers of PDS
  food grains. Even today, persons without BPL
  ration cards, despite being eligible for the same
  and other persons with BPL ration cards are
  purchasing wheat flour from the open market as a
  matter of convenience and to save on the time and
  cost involved in grinding of wheat into flour.
  The system of distribution of wheat flout is in
  vogue in the district of Darjeeling where
  enriched wheat flour is given _at_Rs. 6.80 per kg.
  costs anything up to Rs. 150 and therefore, it
  should be possible to price a packet of fortified
  5kg. or 10kg wheat flour at a much lower price
  which may be any price between Rs.7 and Rs.8 per
  kg. This will definitely be much less than what
  may be available through the open market. The
  advantage would far outweigh a somewhat increased
  price that may have to be paid. At least,
  providing this option to the vulnerable section
  of the society though the PDS network will be a
  step in the right direction.
• The committee has also suggested modalities for
  operationalising this innovative step in the main
  chapter dealing with this subject.
• Fortified atta would also improve the general
  health of the vulnerable sections and reduce
  instances of Vitamin A deficiency and iron
  deficiency anemia. It has also been suggested
  that general instructions may be given to sell
  only fortified atta both under the PDS as well as
  the open market as this will make implementation
  easier and prevent diversion

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IMPACT ASSESSMENT STUDIES

• Impact assessment studies on food fortification
  initiative in Gujarat were conducted by third
  party independent agency.
• Study-I
• GRFMA initiated a study program to evaluate the
  effects of consuming wheat flour fortified with
  30ppm iron and 1.5ppm folic acid on a regular
  bases for a period of 1 year.
• 20 sports people from different sports as well as
  different financial background were chosen from
  Sports Authority of Gujarat.
• The results of the same were very encouraging for
  all the parties involved in the project of
  fighting malnutrition.
• It was found that the average Hemoglobin of the
  sample unit was 10.4gm which rose to 12.19gm
  after the consumption of FWF for a period of
  three months.
• At the conclusion of the third test the average
  Hb level was 12.6gm.

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IMPACT ASSESSMENT STUDIES

• Study-II
• The second study was conducted by Block Head
  Officer, Government of Gujarat on behalf of
  Dept. of Women and Child Welfare.
• Block Deskrois 16 Anganwadis were supplied with
  Fortified Atta with 9 micronutrients.
• An Hb test was conducted on 602 beneficiaries
  consisting of children, adolescent girls,
  lactating and pregnant women coming to the
  Anganwadis.
• The second test showed 505(84) people benefiting
  from the consumption of FWWF. 51(8) people
  showed a constant Hb level and 46(8) showed a
  fall in their Hb levels.

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Study-III Baseline SurveyUse of PDS Service

• For Wheat Atta, BPL and AAY population depend on
  PDS to the extent of 72 and 79 respectively
• For Wheat and rice the dependency is upto 63 and
  73 respectively
• Iodine is one of the major micronutrient highly
  deficient in hilly tribal zone , seriously
  affecting nutrition status of mother and children
• It is also important to mention that Iodised salt
  is sold at highly subsidized rate at Rs.1/kg in
  PDS and needs boost at shop and consumer level

9-Oct-13
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Stydy-III Baseline Survey- Summary

• The baseline study reveals that the prevalence of
  undernutrition and malnutrition in the indicator
  population group is high
• Utilization of ICDS supplement is high
• Utilization of FPS for Atta is high (72-79)
• SFWA through FPS is a potential intervention that
  can improve the nutritional status of the
  vulnerable population. However there is lack of
  knowledge and awareness about benefits of SFWA
• A focus on logistics plan and sale of subsidized
  Iodized salt will reinforce the overall
  malnutrition prevention initiative
• Needs Intensive and Extensive IEC support to
  improve community awareness about benefits of
  SFWA for increased acceptability and use
• IEC / BCC support to improve hygiene and
  sanitation practices and increased utilisation of
  government health promotion

9-Oct-13
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Factors for Success

• Dedicated and clear leadership of the programme
• Part of the Golden Goals (Swarnim Siddhi) of the
  State
• Public Private Partnership (PPP) which is now
  being extended to Public Private Community
  Partnership (PPCP) mode
• Regular interaction consultations with stake
  holders at all levels
• Integriting programme delivery to all other
  delivery systems
• Striving for constant improvement with planned
  stage wise progression

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Conclusion

• It was experienced that legislative sanction was
  not crucial but administrative /stake holders
  involvement and commitments made the project
  successful.
• Peoples participation, motivation and awareness
  are continuously needed.
• Costs are marginal and incidental
• Integration of logistics, training of people,
  motivation, monitoring etc. are equally
  important.

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Thanks
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