Which Choice of Delivery Model(s) Works Best to Deliver Fortified Foods?

Micronutrient deficiencies (MNDs) occur as a result of insufficient intake of minerals and vitamins that are critical for body growth, physical/mental development, and activity. These deficiencies are particularly prevalent in lower-and middle-income countries (LMICs), falling disproportionately on the poorest and most vulnerable segments of the society. Dietary diversity is considered the most effective method in reducing this deficiency but is often a major constraint as most foods rich in micronutrients are also expensive and thereby inaccessible to poorer members of society. In recent years, affordable commodities such as staple foods (e.g., cereals, roots, and tubers) and condiments (e.g., salt and oil) have been targeted as “vehicles” for fortification and biofortification. Despite efforts by many countries to support such initiatives, there have been mixed experiences with delivery and coverage. An important but little understood driver of success and failure for food fortification has been the range of business models and approaches adopted to promote uptake. This review examines the different models used in the delivery of fortified food including complementary foods and biofortified crops. Using a keyword search and pearl growing techniques, the review located 11,897 texts of which 106 were considered relevant. Evidence was found of a range of business forms and models that attempt to optimise uptake, use, and impact of food fortification which are specific to the ‘food vehicle’ and environment. We characterise the current business models and business parameters that drive successful food fortification and we propose an initial structure for understanding different fortification business cases that will offer assistance to future designers and implementors of food fortification programmes.

. High income and Upper middle income countries by regulation type, food vehicle and household coverage/proportion industrially processed.

Country
Year Coverage refers to the proportion of the fortified vehicle being consumed from the overall population i.e. percent of households found through quantitative analyses to be consuming a fortified produce. Proportion industrially processed reflects the proportion of the food vehicle in the country that is industrially processed and thus presents an opportunity for fortification. A food vehicle that has been industrially processed is defined as "processed in facilities of the following capacity: (i) Wheat and Maize Flours -20 MT/day grain processing rated capacity; (ii) Rice -5 MT hour paddy processing rated capacity; (iii) Oil -5 MT/day rated capacity. (iv) Salt -5,000 MT/year raw salt rated capacity" (See Global fortification Data Exchange). The same notes apply to Tables A2 and A3. consumed by majority of X population) and centralized production with few produce. The fortified produce must also not change i.e. sensorially so as to deter consumers. Effective monitoring and evaluation data on coverage quality, coverage needed as failure often relate to lack of industry buyin and government political will and regulatory enforcement capacity, which is reflected in inefficient or non-existent quality control.
Garrett et al., x Legal framework from Indonesia and vietnam The legal framework is a crucial factor for the success of food fortification programs, as it shapes to a large extent the implementation of food fortification. The legal framework is instrumental to ensure the quality, x x x Indonesi a and Vietnam safety, availability, costeffectiveness, and sustainability of food fortification. In the first place, the legal framework should specify the fortificants and fortification levels, as well as the food vehicles and the fortification procedures. In addition, it should ensure the commitment of policy makers and producers to fortification [25] Large scale x Strong political commitment including enforcement of regulation. Engaging of private sector but with strong public backing and partnerships i.e. donors medical organisations etc. social marketing to raise awareness among population and diagnostic work on the scientific merits of the intervention includes data on deficiency in relevant groups etc. awareness and promote demand. Market studies to ensure implementation goals are being delivered and/or the need to make adjustments where needed.

Scale Gaps/lessons/business model Maize Orange sweet potato
Wheat Beans Nonspecified Africa Asia Asia [13,49] Large scale Cumulatively, more than 150 biofortified varieties of 10 crops have been released in 30 countries to date bred through conventional plant breeding rather than transgenic (genetically modified). Scaling will building and expanding existing partnerships across the value chain. Delivery strategies have varied dependent on crop and location. Some where private seed companies have played a stronger role and public sector leading (e.g. where public sector multiplies and distributes seed). Integration of biofortification into standards e.g. Codex will also help cross border marketing distribution.
Large scale/smallscale Challenge of continued supply of biofortified crops and adequate extension services. social networks increase, for biofortified crops, including proximity to local seed multipliers which are likely to improve the opportunity of learning and information regarding planting materials.
x Rwanda Meenakhi [10,11] Cost effectiveness of biofortification very high x [12] Better diagnostic work is needed in order to identify wherefortification/biofortification is likely to have an impact (e.g. where the product has already very high coverage rather than divesting resources where impact is unlikely x