Rozy Afrial Jafar, Nutrition International

1. DELIVERING FOR NUTRITION IN SOUTH ASIA
Implementation Research in the Context of COVID-19
2nd December 2021
Rozy Afrial Jafar
Nutrition International
Revision of the wheat flour fortification
standard in Indonesia and disruption in
its implementation due to COVID-19

2. • 22.7% adolescent girls, 16.6% adolescent boys and 48.9% pregnant mothers are anemic (1)
• Food fortification:
• Safe, cost-effective nutrition intervention,
• Demonstrated health, economic and social benefits (2, 3, 4),
• Vital intervention before, during, and after COVID-19 pandemic in low- and middle-income
countries (3)
• Wheat flour fortification (WFF)
• Mandatory since 2002,
• Electrolytic iron (low bio-availability) was used earlier,
• In 2016, Nutrition International (NI), GAIN, UNICEF and FFI advocated with the
Government of Indonesia (GoI) to align the Indonesian National Standard (SNI) with the
WHO guidelines,
• Revised standard (SNI 3751:2018) mandates the use of more bioavailable iron, viz.
ferrous fumarate or ferrous suphate or NaFeEDTA
Rationale
1. Prof Endang L. Achadi, Advocacy Workshop on National IFA Supplementation Program During Covid-19 Pandemic. NI Zoom Webinar, 20 Oct2020
2. Save Lives — Food Fortification Initiative (ffinetwork.org)
3. Olson, R., Gavin-Smith, B., Ferraboschi, C. and Kraemer, K., 2021. Food Fortification: The Advantages, Disadvantages and Lessons from Sight and Life Programs. Nutrients, 13(4), p.1118.

3. Objectives
 Broad objective:
Support the GoI to undertake WFF following revised SNI in alignment with WHO recommendation
 Specific objectives:
Provide technical assistance (TA) to GoI in legislation process for issuing the revised SNI
Train/ build capacity of wheat flour millers
Provide TA to develop capacity of government monitoring agencies
Ensure production of adequately fortified wheat flour

4. Methods/ Analysis
•Mandatory
fortification
started using
electrolytic iron
2002
•NI coordinates
stakeholder
meeting with
Ministry of
Health (MoH)
2016
•Expert
meetings
•Organoleptic
study conducted
2017
•Revised SNI
released
•Risk assessment
analysis conducted
2018
•Protocol to
identify the type
of iron
developed
2019
•Revised SNI
suspended from
April-December
2020
•Revised SNI
reinstated
•Effective
implementation
started w.e.f.
September
2021

5. Methods/ Analysis (Contd.)
Technical
assistance
Regulatory impact analysis
on implementation of SNI
3751:2018
NI provided support to MoI
in developing technical
guidelines
Training/ Capacity
building
Developed an audio-visual training
aid in 2020, an audio-visual training
aid
(Training Module: Testing fortified
wheat flour – YouTube)
Training conducted for government
inspection agency and lab
personnel in 2021
Virtual capacity building of
government monitoring inspectors,
laboratory personnel and millers on
quality assurance (QA) and quality
control (QC)
Monitoring
NI developed strong QA/QC
protocols. This protocol is in
use to support government
departments in setting up
monitoring protocol
External and internal
monitoring done by NI’s
extenders
Protocol for testing the type of
iron adopted and included in
the legislation by the GoI.
Iron spot test of fortified wheat
flour conducted by our
extenders together with the
millers QC personnel
Production of
adequately fortified
wheat flour
Uninterrupted supply of
premix ensured

6. • GoI/MoI issued MoI decree no 1/2021 on
mandatory regulation of WFF based on
SNI 3751: 2018 which uses more
bioavailable iron, viz. ferrous fumarate or
ferrous sulphate or NaFeEDTA , after 10
months on fortification relaxation
Results
Adequately
fortified
wheat flour
50 ppm of
iron
2 ppm of
folic acid
30 ppm of
zinc oxide
2.5 ppm of
vitamin B1
4 ppm of
vitamin B2
Government
laboratory
personnel
28 Millers QC
personnel
64 Virtual training provided during the
pandemic to ensure the process of
fortification continues

7. • Production of fortified wheat produced from January-October
2021 based on SNI 3751-2018 after legislation was reinstated.
This reached 41 M additional people consuming adequately
fortified wheat
• This is 20 % of the total wheat flour produced during this time-
period
Results (Contd.)
• Government inspection agencies and wheat flour millers capacitated to
monitor wheat flour fortification based on SNI 3751-2018
• Number of wheat mills which started fortifying wheat using
recommended type of iron as per SNI 3751-2018.
18
out of
21
1.2
million
MT

8. Present scenario in implementation of revised SNI
Availability of
premix assurance
by the supplier
25% decrease in
production due to
pandemic
Absence of
physical
monitoring visits
Marginal increase
in production cost
Present
scenario

9. • All 21 millers In Indonesia are complying with revised SNI
• Enforcement by government monitoring agencies started w.e.f. 1 September
2021
• Assurance of sufficient resources and budget allocation to monitor, enforce
and ensure sustainability of the program
• Support to industry/millers internal QA/QC
• Strengthening of integrated monitoring system required
• Address prevention of anemia among vulnerable populations
Policy implications