Making fortified foods more accessible

Trevor Augustine Claude Mansell A TOPIC high on the agenda of Government is food fortification.This is the practice of adding essential vitamins and minerals to staple food products to improve their nutritional content. Their aim is to fill gaps in the nutrition of the population who do not have access to adequate quantities of fruits, vegetables, and meats where micronutrients are abundant. Because providing vitamin tablets poses logistical and economic constraints, food fortification is a practical and inexpensive alternative. At the core of the debate right now is not whether fortification of basic food is needed to address the malnutrition in Rwanda, but how the target groups should be reached. Studies (see Poor Economics by Abhijit V. Banerjee & Esther Duflo, 2012) show that poor people, when their income increases by say 1 per cent, will not spend per cent more on food. The relative growth of money spent on food will be less. It is also known that whatever additional money is spent on food it is spent on higher volume of food intake, not necessarily on more calories or more micronutrients. In Rwanda we clearly see this as well. The fortified maize flour offered to the market at a marginally higher price than the non-fortified product, is seldom bought by consumers. This can be caused by ignorance about the benefits, prejudices about the micronutrients added, or a belief that the benefits do not outweigh the slightly increased additional costs. Spending money on nutritious food is preventive maintenance to the body. It is an investment that only pays off later. A study undertaken in Indonesia found that iron supplements made the men work harder and the resulting increase in their income was many times the cost of a yearly supply of iron-fortified fish sauce. The iron reduced their anemia and made the men strong. Benefits of good nutrition are particularly beneficial for unborn babies and young children. Nutrient needs during the life stages of pregnancy and lactation are increased relative to women who are not pregnant or lactating. In fact, energy requirements increase by an estimated 300 kcal/day during pregnancy and 500 kcal/day during lactation. Likewise, the requirements for most micronutrients (vitamins and nutritionally essential minerals) are higher during pregnancy and lactation. A child who receives proper nutrition will earn more every year of his life compared to a child who has not been fed well. Few parents however have the insight to make that investment for the future, as current needs and desires “must” also be fulfilled. As an analogy: who takes their car to the garage for preventive maintenance? One will rather wait until it falls apart, only to realise that the breakdown could easily have been prevented at much lower costs. A family would rather spend money at the pharmacy on prescribed medication for a sick child than spend some extra money on fortified products that strengthen the immune system. What does this tell us? That a major sensitisation program needs to be undertaken to convince the population of the benefits of fortified food products. But this is by no means sufficient. Even schools are still buying non-fortified products because they are slightly less expensive, notwithstanding the fact that school-boards have been informed about the benefits of micronutrients. In surrounding countries governments have implemented either or both of the following additional measures: making fortification of common processed food mandatory and/or making these products exempt of VAT. In other words, if consumers only find fortified products on the shelves they will have no other choice than to buy them. That is, if they can afford it. Yet as long as these ‘mandatory’ products are carrying VAT, the poor will still revert to buying unprocessed food, which in Rwanda would largely be the potato which, of course, is VAT free…. Other ways of making sure that the poor have access to food containing micronutrients is heavy subsidisation by the Government. This already happens in Rwanda, with the help of the Ministry of Health and certain international institutions. The question that may be asked is whether feeding the population should ideally be the responsibility of each household, of the private sector or of the Government. Asked in a different way: If the Government has $1m available, should it invest in making the population self-supporting (eg growing its own healthy diet on its own land), or should it instead facilitate the distribution of nutritious food by the private sector by eliminating VAT, or should it spend the money on heavily subsidising or giving away food? Which of these approaches is most effective? Which one changes behaviour of the consumers? Which one is sustainable in the long term? Which makes Rwanda independent from outside funds? Which measure builds a strong local process industry that can keep providing nutritious products to the growing population, thereby fighting stunting, anemia, and strengthening the immune system of the poor? These questions call for a serious dialogue. Trevor Augustine is the General Manager, Minimex Ltd, and Claude Mansell, the Director of Miniment Ltd.

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Making fortified foods more accessible