Large Scale Food Fortification (LSFF) in East, Central, and Southern Africa: Gaps, opportunities and the way forward

Micronutrient deficiencies affect 2 billion people globally, especially in sub-Saharan Africa, where iron, vitamin A, iodine, zinc, calcium, selenium, folate, and vitamin B12 deficiencies are common. Large Scale Food Fortification (LSFF) - addition of micronutrients to commonly consumed, industrially processed foods and condiments - can improve micronutrient intake at population level. Progress across East Central Africa Health Community (ECSA-HC) and the Southern Africa Development Community (SADC) regarding fortification of wheat and maize flour, edible oils, and sugar has been uneven. This paper discusses the current status of LSFF, challenges and opportunities to inform future LSFF programming.

Qualitative situation analysis comprised of 19 key informant interviews (KIIs) with global, regional, and country stakeholders. KIIs were analyzed by themes and subthemes using Dedoose software.

Findings reveal wide variation in LSFF progress across ECSA-HC and SADC countries, with better institutionalized legislation, coordination, and monitoring in ECSA-HC countries than SADC countries. Key challenges are: weak enforcement of mandatory food fortification standards, little data on market reach and coverage of fortified foods and limited country capacity for monitoring LSFF programs. Opportunities to strengthen LSFF program implementation, measured by compliance and coverage of fortified foods, center on raising awareness of public health benefits of LSFF via targeting governments and consumers, engaging private sector to improve compliance with fortification standards, and incorporating small-scale producers into LSFF.

Moving forward, investment on LSFF programming by country governments, and private sector should prioritize integrating reach and coverage indicators into existing national health surveys. Supporting public education campaigns to raise awareness of fortified foods' health benefits, improving collaboration between government regulators and industry quality assurance personnel (i.e., small millers) through targeted fiscal policies and/or incentives as well capacity strengthening for compliance to fortification standards to attain intended nutrition outcomes for LSFF programming is sorely needed.