Objectives
2011 National Nutritional Survey reveals that very little progress has been madein multiple micronutrient deficiencies among women and children in Pakistan, despite gains in iodized salt use and large reductions in urinary iodine deficiency rates. Pakistan has not invested in food fortification at scale to address the problem. This study investigated options for food fortification, the regulatory environment post-devolution, the role of the private sector and potential agricultural solutions.
Methods
Through literature reviews andkey informants interviews , we analyzedcurrent regulatory enforcement systems, private sector rolesaround staple food fortification in Pakistan with particular reference to wheat flour, edible oil/ghee, salt iodisation and biofortification.
Results
There is much support for large scale fortificationprogramme in Pakistan to address iron and folic acid and vitamin A deficiency. Its successrequires a regulatory environment in which government legislation is enacted, compliance is effectively monitored and enforced.Compulsory fortification of staple foods obliges private-sector producers to adapt manufacturing and quality control processes, requiring financial and technical resources. The options appraised for scale-up: wheat flour fortification with iron, edible oil/ghee fortification with vitamin A and D, biofortification to address iron and zinc content of wheat, and zinc-fortified fertilizers. Benefits included increase in child and maternal lives saved and economicbenefits from morbidity and/or mortality that were averted. Estimated benefit:cost ratios were 7.2:1 for wheat flour fortification, 9.8:1 for edible oil/ghee fortification; 0.11:1 for biofortification, and 0.06:1 for zinc-fortified fertilizer.
Conclusions
Scaling up could build on the success of the iodized salt program and improving quality of complementary foods. The outcome of this analysis was translated into a food fortification program for Pakistan
