{"id":26206,"date":"2024-01-15T06:53:21","date_gmt":"2024-01-15T06:53:21","guid":{"rendered":"https:\/\/www.kfindonesia.org\/?p=26206"},"modified":"2024-01-22T07:28:46","modified_gmt":"2024-01-22T07:28:46","slug":"world-food-programme-a-guide-to-settingup-rice-fortification-standards-examplesfrom-the-asia-andpacific-context","status":"publish","type":"post","link":"https:\/\/www.kfindonesia.org\/en\/world-food-programme-a-guide-to-settingup-rice-fortification-standards-examplesfrom-the-asia-andpacific-context\/","title":{"rendered":"WORLD FOOD PROGRAMME – A GUIDE TO SETTINGUP RICE FORTIFICATION STANDARDS: EXAMPLES FROM THE ASIA ANDPACIFIC CONTEXT"},"content":{"rendered":"

<\/path><\/svg><\/span><\/span>Estimated reading time: <\/span>28<\/span> minutes<\/span><\/p>\n\n\n\n

1. Introduction<\/h2>\n\n\n\n

In 2021, more than half the people affected by hunger in the world (425 million) lived in Asia (1). The factors that can contribute to the micronutrient deficiency burden across various life stages include limited access to diverse and healthy diets due to non-affordability or poor dietary choices resulting from limited knowledge, socio-cultural norms, preferences, and convenience (2). In South Asia, micronutrient deficiencies are at levels that can only be addressed through policy solutions (3).

Addressing these deficiencies through targeted interventions can help improve public health outcomes and reduce the burden of disease in the region. While improving diets through dietary diversification is the ideal solution to addressing micronutrient gaps, food fortification is recognized as a low-cost, effective complementary strategy. Fortification is defined by the World Health Organization (WHO) as: \u201cThe practice of deliberately increasing the content of essential micronutrients (i.e., vitamins<\/a> and minerals) in a food, so as to improve the nutritional quality of the food supply and provide a public health benefit, with minimal risk to health”. Large-scale food fortification involves enhancing the vitamin and mineral content of widely consumed foods during post-harvest processing. Essential micronutrients (vitamins and minerals) that are often added during food fortification include iron, zinc, vitamin A, folic acid and other vitamins, either as single compounds or as a blend of several micronutrients (i.e., premix).

The main goal of a fortification programme is to correct inadequate micronutrient intakes; it can be defined as the practice of deliberately increasing the content of essential micronutrients in a food so as to improve the nutritional quality of the food supply and provide a public health benefit, with minimal risk to health.<\/p>\n\n\n\n

Figure 1: Food fortification interventions<\/strong><\/p>\n\n\n\n

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2. Food fortification regulatory framework<\/h2>\n\n\n\n

The need for fortification regulatory frameworks<\/p>\n\n\n\n

The regulatory framework for food fortification refers to the set of rules, regulations and guidelines established by government authorities to govern food fortification practices within a country or region. It provides the legal and administrative structure for implementing food fortification initiatives.

The food fortification regulatory framework is essential to ensure the safety, efficacy and consistency of fortified foods. It is important for food manufacturers, producers and regulators to follow a set of guidelines to ensure that fortified foods are beneficial and not harmful to health.
In the case of large-scale food fortification programmes, fortification of any staple food must be implemented in coordination and harmonization with other staples that are being fortified, and it must be in line with international practices and guidelines.<\/p>\n\n\n\n

Food fortification standards<\/p>\n\n\n\n

Standards are an essential component of the regulatory framework for food fortification. They provide the technical specifications and criteria that must be followed by food manufacturers and producers when adding essential nutrients. They need to be country- and context-specific and align with national laws and regional regulations. Standards can encompass various aspects, including:
Nutrient levels (quantities):<\/strong> Specify the permissible levels of fortification for each essential nutrient in different food categories. These levels are determined based on scientific evidence and the specific nutritional needs of the target population.
Nutrient forms:<\/strong> Define the acceptable forms of nutrients that can be used for fortification, such as specific vitamins or minerals.
Food categories: <\/strong>Identify the food categories that are eligible for fortification. This ensures that the selected foods are appropriate for delivering the fortified nutrients to the target population.
Labelling requirements: <\/strong>Dictate the information that must be included on the product labels of fortified foods, such as the nutrient content, serving size and health claims.
Monitoring and compliance:<\/strong> Establish protocols for monitoring the nutrient levels in fortified foods to ensure that they meet the prescribed requirements. Compliance mechanisms are also put in place to address any deviations from the standards.
Food fortification is implemented through two
main approaches: mandatory fortification, where the government or regulatory authorities require specific food products to be fortified with certain nutrients, or; voluntary fortification, which allows food manufacturers to choose whether to add specific nutrients to their products.
Fortification standards play a crucial role in supporting both mandatory and voluntary fortification of food products and facilitating regional and global trade.
In the case of mandatory fortification, standards set
the minimum and maximum requirements for the fortification of specific foods to ensure that they meet the targeted nutrient levels needed to improve the health of the population. They also provide guidance on the forms of nutrients that should be added, the concentration of these nutrients, and the methods used for fortification.
In the case of voluntary fortification, standards are essential to ensure that the fortified products meet the quality and safety requirements necessary for consumer protection. These standards provide a reference for manufacturers to produce high quality fortified products that meet specific nutrient levels without compromising the safety and quality of the food.<\/p>\n\n\n\n

Aligning fortification standards with national and international guidelines<\/p>\n\n\n\n

Guidelines provide recommendations and best practices for the addition of nutrients to food products and are typically issued by public health authorities or international organizations. They aim to offer guidance to food manufacturers and fortification programmes.
The global source for food standards, guidelines and codes of practice is the Codex Alimentarius Commission established by the Food and Agriculture Organization (FAO) and the World Health Organization (WHO). Codex sets international food guidelines and codes of practice to protect the health of consumers and ensure fair trade practices within and outside a given country. The adoption of the recommendations is voluntary but they are often used as a basis for national food standards, including fortified foods. Codex has developed guidelines for the fortification of foods with vitamins and minerals to ensure that they are safe, effective and provide the intended nutritional benefits (5).
FAO and WHO have also published a set of guidelines for food fortification with micronutrients (6). These provide recommendations on the selection of nutrients, levels of fortification, and monitoring and evaluation of fortification programmes. WHO has also published guidelines for fortification of wheat flour with vitamins and minerals (7), which provide recommended fortification levels based on estimated average per capita wheat flour consumption. These guidelines are used as a benchmark to set standards for other foods, including rice.
In addition, many countries have their own regulations and guidelines for food fortification. For example, in the United States of America, the Food and Drug Administration (FDA) regulates the fortification of foods with nutrients, including vitamins and minerals. The FDA has established a list of nutrients that can be added to foods and sets specific levels of fortification.<\/p>\n\n\n\n

Harmonizing standards at the regional level<\/p>\n\n\n\n

The adoption of consistent fortification practices helps prevent trade barriers and disparities in food quality and promotes the free flow of fortified food products across borders, benefiting both producers and consumers. Harmonization of standards with neighbouring countries or surrounding regional trading blocs needs to be considered as countries adopt or update national fortification standards, in particular
in countries where import levels of fortified\/fortifiable foods are high to allow for an efficient allocation of resources and expertise, to reduce duplication of efforts and costs through leveraging economies of scale. It encourages countries to collaborate and share best practices in fortification, helps strengthen institutional frameworks and ultimately leads to more effective and cost-efficient programs.<\/p>\n\n\n\n\n\n\n\n

3. Developing standards for fortified rice: country examples<\/h2>\n\n\n\n

In comparison with staple foods such as wheat\/maize flour, salt and edible oil, which have been fortified for decades, rice is a more recent addition to the portfolio of staple foods that can be fortified to address nutritional deficiencies. In most settings, fortifying rice should benefit from the regulatory framework already in place for large-scale food fortification and the experience gained in developing current or past standards.

In Asia and the Pacific, three countries mandate the fortification of rice with micronutrients: Papua New Guinea, the Philippines and Solomon Islands. Fortified rice is provided in social safety net programmes in Bangladesh, Bhutan, India, Malaysia and Nepal. It is also available in retail markets through a voluntary, market-based approach in Bangladesh, India and Myanmar, and in Bangladesh workplace benefit programmes offer fortified rice.

In recent years, several countries in Asia have been through the process of developing new standards for fortified rice. These include Bangladesh, India and Timor-Leste, which now offer a good benchmark for other countries embarking on rice fortification. While India and Bangladesh already had standards in place for other foods (including wheat flour, salt and edible oil), Timor-Leste developed a multiple-staple fortification standard process for four foods at the same time: rice, wheat flour, oil and salt.

These experiences are relevant to all countries in the region regardless of their expertise and experience in setting food fortification standards. They are described in the following section and have subsequently been used to develop a recommended standard approach to setting rice fortification standards for other countries.

Bangladesh (2014\u20132015)<\/strong> The Government of Bangladesh initiated the standards development process to support the launch of fortified rice into national food systems. Standards were developed simultaneously with acceptance trials and effectiveness studies. These three elements formed the basis of the evidence required before fortified rice could be launched into food systems.

An iterative process led by BSTI and facilitated by WFP<\/strong> The Bangladesh Standards and Testing Institution (BSTI) led the process. WFP was asked to facilitate and coordinate the initiative based on its experience in leading the standard development process for wheat flour fortification and its credibility as a major distributor of rice through emergencies in the country.

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BSTI started by forming a technical committee that was composed of regular members plus guest members such as international non-governmental organizations specialized in the field of fortification. The standards were developed during four different meetings held over some 12 months between the end of 2014 and 2015.

As the technical lead driving the process, it was important for WFP to have the necessary internal technical expertise to ensure credibility with partners and provide appropriate guidance. Technical staff were recruited to build expertise and capacity and to develop the initial standards based on standard operating procedures provided by BSTI.

Updating the standard<\/strong>
Over the years, practical experience revealed a number of weaknesses in the standard that was initially developed; this led to upgrading the standard in 2022, following the same process already described.
The update focused on two main points: 1) the addition of test methods to the standard, and 2) the addition of 30 percent overage for three of the micronutrients in the standard. The decision to add 30 percent to strengthen the existing standard arose after a retrospective study of traditional rice cooking methods in Bangladesh showed that rice is cooked in excess water which is discarded once cooking is complete, risking significant degradation\/loss for three of the micronutrients.

Political game changer<\/strong>
One of the effects of the introduction of the fortified rice standard was that it replaced the compulsory wheat flour fortification programme. The development of the new fortification standard revealed that rice was better adapted to local consumption habits and was therefore more likely to deliver convincing results in the fight against micronutrient deficiencies.<\/p>\n\n\n\n

Figure 2: Bangladesh journey<\/strong><\/p>\n\n\n\n

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India (2016\u20132018)<\/strong>
Creating a rigorous overarching process
The Government of India wanted to reduce levels of anaemia in the country, hence its rice fortification initiative. It was led by the Food Safety Standard Authority (FSSAI) \u2013 hosted under the auspices of the Ministry of Health \u2013 and its scientific panel, which works on setting and updating food fortification standards. The scientific panel was tasked with developing the draft standards using recommended dietary allowances and available micronutrient deficiency data. The aim was to collect as much input as possible from external subject experts to ensure that standards were technically sound and in line with international guidelines. Comments were taken to the scientific panel and incorporated following technical discussions within the panel. The process lasted two years from development of draft standards and their operationalization in 2016 to their publication (gazetting) in 2018.

Experience has shown that it is important to ensure that members of such technical committees are
not only subject experts but that they are also motivated and informed of the benefits of developing such standards. This enables them to become strong advocates of the law once it is gazetted and implemented. A detailed description of the India rice fortification scale-up journey can be found in two documents (a) Journey of scaling up rice fortification Asia: Connecting food systems with social protection to enhance diets of those who need it most (8). (b) The proof is in the pilot: 9 Insights from India\u2019s rice fortification pilot to scale approach (9).<\/p>\n\n\n\n

Figure 3: India 2-year journey to rice fortification standard gazetting<\/strong><\/p>\n\n\n\n

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Offering flexibility for expanded standards
<\/strong>One of the original features of the Indian standard is that it proposed two lists of micronutrients: a blend that met minimum micronutrient criteria and another that included additional micronutrients, which would be voluntary. This flexibility was introduced so as not to overwhelm rice millers with a potentially expensive blend of micronutrients while ensuring that a minimum set of micronutrients were present in the rice (especially those targeted at addressing anaemia). When distributing fortified rice, the state and the private sector decide whether to use a formulation adding three mandatory micronutrients (iron, folic acid and vitamin B12) or a more comprehensive formula containing one or a combination of the following micronutrients: zinc, vitamin A, vitamin B1, vitamin B3 and\/or vitamin B6.<\/p>\n\n\n\n

Figure 4: Mandatory & voluntary micronutrients for rice in India<\/strong><\/p>\n\n\n\n

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Timor-Leste (2021\u2013present)<\/strong>
In Timor-Leste, where 70 percent of the food is imported, there was no regulatory framework until the country embarked on its journey to develop multiple standards simultaneously. Because their process started in 2021, Timor-Leste was able to leverage WFP\u2019s expertise and experience gained in accompanying other countries in the region, resulting in the fast-tracking of the fortification standards adoption process. The process was extremely inclusive with external partners playing an important technical role, in particular the private sector which provided expertise and insights into the discussions and guaranteed the operational viability of the standards.<\/p>\n\n\n\n

Developing a regulatory framework from scratch<\/strong> Unlike Bangladesh and India which had long-standing experiences of setting fortification standards, Timor-Leste was unique in that none of the country\u2019s staple foods were fortified and they had never been through the fortification process. This created additional complexities, not least the need to justify such an intervention. WFP, with other partners, conducted a Fill the Nutrient Gap (FNG) analysis which recommended, among other things, the introduction of fortified
rice as an essential intervention for the country. In parallel, a rice landscape analysis and an acceptability trial were conducted. They provided evidence for the technical and logistical feasibility of fortifying rice.

The accumulation of this evidence led the Ministry of Tourism, Commerce, and Industry of the Government of Timor-Leste to ask WFP to support a food fortification programme in the country and to institute a legal and regulatory framework around the fortification of three staple foods: wheat flour, rice and edible oil.

A multisectoral approach
<\/strong>Developing food fortification standards is often led by Ministry of Health who reviews and revises the levels of fortification as per the micronutrient needs of the population and endorses the national food fortification law technically. While this approach has obvious advantages and rationale, a more holistic approach has been considered in Timor Leste with active leadership of additional stakeholders, in particular Ministries of Industry, Tourism and Commerce.

Specific roles were assigned to different ministries which contributed to building accountability across the board. The specific roles and responsibilities of key ministries are detailed in Figure 5.<\/p>\n\n\n\n

Figure 5: Roles of relevant stakeholders<\/strong><\/p>\n\n\n\n

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This holistic approach ensured that fortification standards were not only health-focused but also considered the broader food value chain and economic implications, resulting in a more comprehensive and effective fortification strategy. Involving multiple ministries fostered cross-sectoral coordination and alignment of objectives. Ministries often have their unique priorities and goals. By engaging several ministries in the development of the standards, it became easier to align these priorities.

Relying on international methodologies<\/strong>
As Timor-Leste was new to the fortification of staple foods, the role of WFP and all the main technical stakeholders was important. WFP helped to put in place a consultative framework that enabled a technical consensus on the standards developed. Given the lack of experience nationally, the country used available evidence, data and internationally recognized methods, such as WHO\/FAO guidelines on fortifying food with micronutrients. The estimated average requirement (EAR), recommended nutrient intake (RNI) and upper limit (UL) values from the guidelines were used to set levels for each of the selected micronutrients. Harmonization with regional and global standards and specifications was pursued through technical consultations with internal and external subject experts.

Defining a road map to implement the law<\/strong> Timor-Leste is in the process of finalizing and issuing the law and operationalization is yet to be realized. At the request of the government, WFP developed a road map to operationalize the law. It envisions a gradual adoption of the new standard to increase the percentage of rice to be fortified progressively over three years: from 25 percent in year one to a targeted 90 percent in year three for local rice, and from 50 percent in year one to 100 percent in year three for imported rice. This strategy enables industry to plan and adapt manufacturing processes and defray investment costs over a longer period.<\/p>\n\n\n\n

Figure 6: Timor-Leste standard development methodology<\/strong><\/p>\n\n\n\n

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4. Guide to standard development: four-step framework<\/h2>\n\n\n\n

The lessons learned from Bangladesh, India and Timor-Leste can be summarized as the four-step framework described in Figure 7. The process should be iterative, starting with a data collection phase that aims to define the nutritional goals of the fortification programme and identify the key micronutrients to be used and at what levels. It should be led by a national technical committee with a view to develop the draft standards through continuous consultation with relevant ministries and subject experts. The endorsement and subsequent gazetting of the standard should be accompanied by an operationalization plan to ensure that relevant stakeholders have the capacity to enforce and monitor that fortified foods meet the standard at all times.<\/p>\n\n\n\n

Figure 7: Four-step framework for the fortification standard development process<\/strong><\/p>\n\n\n\n

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Before a rice standard is developed, the staple needs to be identified as a vehicle to support and complement ongoing strategies to address micronutrient deficiencies in the population. A rice fortification standard is developed in one of two scenarios: either because one doesn\u2019t already exist, or because an existing standard needs to be updated to meet national, regional and international guidelines and recommendations. Updating an existing fortified rice standard should consider the need for updating the set of micronutrients and\/or their levels , the relevance of the standard in terms of fortification of other staple foods, and the potential need to expand the scope of the standard (e.g., to include labelling, testing requirement, etc.).

As illustrated in Figure 8, regardless of whether the standard is being developed anew or being updated, it should be driven by available national data or use supporting evidence from available national, regional and international data, resources and guidelines.<\/p>\n\n\n\n

Figure 8: Drafting decision tree<\/strong><\/p>\n\n\n\n

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Collecting data to define nutritional gaps and goals<\/p>\n\n\n\n

The decision to implement a rice fortification programme requires documented evidence that the micronutrient content of the diet is insufficient, that micronutrient deficiencies are widespread and\/or that fortification will result in a health benefit. This will confirm the need and provide the rationale for a fortification programme.

The first step in the process consists of collecting food intake data, supported by ancillary information such as biochemical data on nutritional status of the population. This information is necessary to justify the programme, to make an informed judgement about the types and amounts of specific nutrients to include, and to understand which foods would make suitable vehicles for fortification. Given the long-term effort and investment required to implement and sustain appropriate fortification programmes, this initial investment in the collection of adequate food intake data should include:<\/p>\n\n\n\n