The Gujarat Food Fortification Programme

1. 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. 1

2. 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).

3. 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. 3 3

4. Under weight PopulationNational Nutrition Monitoring Bureau Gujarat Survey (2006) • > 25% people cross section is underweight • This rate will be higher among poor population Adult Men 26%, Adult Women 30%, 6-60 months children 54% 10-13 yrs children 50%, 14-17 yrs children 23%

5. 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

6. Observations from NFHS-III 6

7. 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 7

8. 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. 8

9. 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. 9

10. 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. 10

11. Phases of the program 11

12. TPDS - NORMS OF DISTRIBUTION & PRICE

13. 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. 13

14. 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. 14

15. 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: 15

16. 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: 16

17. 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 (FCS&CAD) 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 miller’s 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. 17

18. 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 . 18

19. 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. 19

20. Fortification of Wheat flour with vitamins & multi micronutrients (9) under ICDS Strategy: As per GOI’s 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. 20

21. 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. 21

22. Micronutrients (as per GOI guideline) used for fortification of Wheat Flour under ICDS & MDM 22

23. 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. 23

24. 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. 24

25. Comparison of Composition of Whole Wheat Atta and Soya Fortified Atta (per 100gms) 25

26. 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. 26

27. 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. 27

28. “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 28

29. 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. 29

30. Iodised salt under ITDP, PDS & ICDS for Nutritional Security 30

31. 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: 31

32. 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 32

33. 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. 33

34. 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.

35. 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 @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” 35

36. 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%. 36

37. 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 Deskroi’s 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.

38. 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 14-Nov-14 38

39. 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 14-Nov-14 39

40. 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

41. Conclusion It was experienced that legislative sanction was not crucial but administrative /stake holder’s 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. 41

42. Thanks 42