Monitoring flour fortification to maximize health benefits: a manual for millers, regulators, and programme managers

Overview

Flour fortification is the practice of deliberately increasing the content of one or more essential micronutrients in flour. Fortification of wheat and maize flours with vitamins and minerals is considered a cost-effective strategy to address micronutrient malnutrition and nutrition-associated health outcomes, such as anaemia or the prevention of neural tube defects.

Designing and planning a flour fortification programme requires consideration of certain key elements, including programme monitoring and evaluation procedures to check that fortified foods contain the intended amount(s) of micronutrient(s) and that they are being consumed by the target population in adequate amounts. It is important that fortification programmes are monitored to ensure that they are working effectively, thereby assuring a nutritious and safe fortified end-product for the population.

The development of fortification monitoring systems that can be properly implemented and maintained requires careful planning. This fortification monitoring manual focuses primarily on wheat and maize flours in countries where these food staples are industrially processed and is intended for stakeholders of the country’s fortification programme who have interest in and/or authority for setting up monitoring. Stakeholders may include the government agencies that oversee fortification; the government agencies that monitor fortification, such as inspectors and staff of the food control authority; industry partners that fortify or are part of the supply chain, such as millers, flour importers, and premix manufacturers; research institutions; consumer-protection groups; fortification programme managers; and international organizations that provide technical assistance to food and nutrition programmes.

This manual distinguishes two main categories of monitoring – regulatory monitoring and household or consumption monitoring. Regulatory monitoring includes four subtypes of monitoring: internal, external, import, and commercial, which collectively aim to provide consumers with fortified flour that is of high quality, safe, and adequately fortified. Consumption monitoring involves households and their members. Each chapter is organized such that the body gives a high-level overview followed by practical and technical materials in annexes.