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The History of Cooking Oil Fortification in Indonesia: Government Support for the Program and Challenges

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The History of Cooking Oil Fortification in Indonesia: Government Support for the Program and Challenges by Idrus Jus’at, Senior Lecturer, Esa Unggul University, Indonesia. Presented at the ReSAKSS-Asia - MIID conference "Evolving Agrifood Systems in Asia: Achieving food and nutrition security by 2030" on Oct 30-31, 2019 in Yangon, Myanmar.

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The History of Cooking Oil Fortification in Indonesia: Government Support for the Program and Challenges

  1. 1. THE HISTORY OF COOKING OIL FORTIFICATION IN INDONESIA: GOVERNMENT SUPPORT FOR THE PROGRAM, AND CHALLENGES Idrus Jus’at1,2 Soekirman1 1. Indonesian Coalition for Fortification, (KFI), Jakarta 2. Dept. of Nutrition, Esa Unggul University, Jakarta, Indonesia
  2. 2. Nutrition Problems Prevalence (%) Source Stunting 30.81) MOH, 2018 Vitamin A Deficiency 12.22) Sanjaya et al, 2015 Nutritional Anemia 48.93) MOH, 2018 Endemic Goiter 11.14) MOH, 2004 Overweight 35.45) MOH, 2018 1) Children under 5 years of age 2) Children 6-59 m, school, children, female adolescent, women at reproductive (15-29 y) 3) Pregnant mothers 4) School entry pupils, 5) 15+ y Nutrition problems in Indonesia (latest data)
  3. 3. Vitamin A deficiency in Indonesia VAD, defined as a serum retinol < 20 μg/dL or 0.7μmol/L, persisted as a public health problem, affecting 5%-50% of different population sub-groups [Wieringa et al 2003; Herman et al 2006].
  4. 4. The main cause is insufficient dietary intake of vitamin A. The predominant diet in Indonesia is rice-and vegetable- based, and provitamin A has low bioavailability. [De Pee et al 1995; Campbell 2009].
  5. 5. Strategies to reduce Vitamin A Deficiency A semi-annual vitamin A capsule (VAC) distribution program to children 6-59 months has been implemented in Indonesia since 1978. Approximately 30% of eligible children are not reached [MOH 2008 and 2010]
  6. 6. Strategies to improve vitamin A status of infants below 6 months of age are even more challenging [Ayah et al 2007]. Other age groups at risk for VAD are not targeted by VAC: school age children and women of reproductive age.
  7. 7. Fortification of cooking oil with vitamin A is considered a cost-effective, simple-to-implement strategy to cover all segment of population [Allen et al 2006; West & Darnton Hill 2008; Martianto et al. 2005; Martianto et al. 2007]. The discussion on fortification of cooking oil with vitamin A started in late 2005.
  8. 8. Retinylpalmitate is common in vitamin A fortification, and has been used successfully in fortifying sugar, monosodium glutamate and wheat flour [Arroyave G et al 1981; Solon et al 2000]
  9. 9. Cooking oil use in Indonesia The portion for domestic consumption is marketed using two approaches: + 30% is sold in larger quantities of branded oil in supermarkets ( presently, much of which is voluntarily fortified with 45 IU/g vitamin A = 13.5 mg RE/kg). About 70% of the oil is sold as unbranded and unpackaged oil in small neighbourhood shops/stalls (warung). Consumers bring their own bottle to be filled from a bulk container or buy small plastic sachets of oil [Soekirman et al 2012].
  10. 10. Branded cooking oilUnbranded cooking oil Unbranded cooking oil
  11. 11. Fortified Cooking oil with vitamin A A small demonstration project undertaken in Makassar, South Sulawesi showed that cooking oil fortification with vitamin A improved serum retinol concentrations of school children and was acceptable to poor consumers. [Martianto et al 2009]
  12. 12. Questions asked by oil companies: • Why should I involve in the fortification program; • What are the benefits and risks for my business; • Would it detriment my product: color, taste, flavor, texture; • Who will pay the cost if it gives a negative effect to consumers; • How much should I pay for first investment and for operational cost (Martianto, 2009)
  13. 13. Discussion on developing of SNI (Indonesia National Standard) on cooking oil was on the table in 2008-2012.
  14. 14. As a prerequisite for mandatory fortification of cooking oil with vitamin A (Ministry of Industry=MOI), an effectiveness study was conducted in West Java province in 2011-12.
  15. 15. The most rewarding result of the cooking oil fortification project is the impact on the vitamin A status of children and women. The VAD prevalence (serum retinol <20 mg/dl) was reduced more than 60% for all ages, with the highest reduction seen among school children and women of reproductive age (Sandjaja et al., 2015).
  16. 16. 6 5.4 0.4 1.2 2.1 0.6 18.2 15.2 9.9 10.9 10 5.3 0 2 4 6 8 10 12 14 16 18 20 Infant 6-11 m Children 12-23 m Children 24-59 m Children 5-9 y Lactating mothers Non Lactating women 15-29 y Prevalence of Vitamin A deficiency (serum retinol <20μg/dL) at baseline and endline Base-line End-line Source: Sanjaya et al, 2015
  17. 17. Figure 1. Vitamin A content of cooking oil at different distribution levels Source: Sanjaya et al, 2015
  18. 18. National Figure, 2018 Cooking oil consumption + 9.6 kg/p/y ~ 26 g/p/d 2.4 13.5 22.3 24.8 31.5 29.1 0 5 10 15 20 25 30 35 Infant 6-11 m Children 12-23 m Children 24-59 m Children 5-9 y Lactating mothers Non Lactating women 15-29 y Cooking Oil Consumption g/p/d Sanjaya et al, 2015
  19. 19. In 2012 it was agreed that all cooking oil should contain 45 IU vitamin A/g. SNI 7709:2012
  20. 20. August 13, 2012 A letter from MOH to MOI Full support for mandatory fortification of cooking oil with vitamin A to be implemented in April, 2015
  21. 21. Actually, the SNI should be imposed by the GOI in April 1, 2015, Political situation changed, a new government policies also changed, new government officers came in. Postponed to 2016, and again postponed to 2018
  22. 22. The cooking oil industries lobbied to postpone the implementation with the following reasons: • Vitamin A should be imported, technology is not available; • No guarantee vitamin A content still 45 IU at consumers’ kitchen since the turn over of cooking oil was relatively slow; • If the police or Indonesian FDA found the level of vitamin A in cooking oil at consumers below 45 IU, the CEO will go to jail; • Should conduct a study to put back β carotene to cooking oil; • At the other side, this group exported fortified oil to other countries, financial profit. Actually those reasons were unclear and not acceptable
  23. 23. THE HOT DEBATE CONTINUED SCIENTISTS Some OIL COMPANIES + VS + Most OIL COMPANIES SCIENTISTS CONSPIRACY WITH GOVERNMENT OFFICERS
  24. 24. End of 2017 Meeting at MOI (new Minister) The implementation of SNI 2012 postponed again
  25. 25. FEBRUARY 24, 2018 A MEETING AMONG IDI, KFI, IAKMI, PERSAGI, PDGMI  A PRESS RELEASE OF INDONESIAN MEDICAL ASSOCIATION AUGUST 8, 2018 A LETTER FROM MOH TO MOI ‘FORTIFICATION OF COOKING OIL WITH VITAMIN A IS A COST EFFECTIVE PROGRAM’
  26. 26. AUGUST 2018 – APRIL 2019 PRESIDENTIAL CAMPAIGNED INCLUDED ‘STUNTING’ ISSUES GOVERNMENT DEVELOPMENT POLICY ON SUSTAINABLE DEVELOPMENT GOALS (SDG’S) WHICH EXPLICITLY INCLUDES ‘FOOD FORTIFICATION’ GIVE A PRESSURE TO THE COOKING OIL COMPANIES TO COMPLY
  27. 27. AUGUST 23, 2019 A MEETING AT THE OFFICE OF VICE PRESIDENT, ALL PARTIES AGREED UPON IN JANUARY 2020: * ALL COOKING OIL SHOULD BE SOLD IN A PACKAGE * BE FORTIFIED WITH VITAMIN A or β-CAROTENE
  28. 28. SEPTEMBER 18, A MEETING AT MINISTRY OF TRADE • All oil distributed to consumer must be in various size of packages (250 gr, 500 gr, 1L and 2L) (non-branded cooking oil will not be available at the market anymore) • Oil fortification with vitamin A or β Carotene will be mandated in January 1, 2020. • Level of vitamin A 45 IU/g only at the factory not at consumers
  29. 29. SOFT LAUNCHING ‘PACKAGE – FORTIFIED COOKING OIL WITH VITAMIN A’ WAS EXECUTED ON OCTOBER 6, 2019 IN CAR FREE DAY AREAS, JAKARTA (MOT-MOI-MOH)
  30. 30. BUT WITH A NEW CABINET WE JUST CROSS OUR FINGER
  31. 31. 2007-2012 *Feasibility *Effectiveness * SNI 2012-2018 * IMPLEMENTATION POSTPONED * HOT DEBATE * INDUSTRY OPPOSED * STUNTING - FORTIFICATION IN SDG’S PROGRAMS 2019 * AUG 23. MEETING AT VP’S OFFICE – - SEPT 18, MEETING AT MOT JAN 1, 2020 *BE IN A PACKAGE *BE FORTIFIED 2020 HOPING THIS OPTIMISTIC WILL BE MATERIALIZED THE ROAD TO A SUCCESFUL OF FORTICATION OF VITAMIN A IN COOKING OIL, INDONESIA
  32. 32. Source: Lawrence, 2014
  33. 33. Priorities among nutritional deficiency conditions (present) Condition Extent Social Significance Feasibility of Control Energy Protein Malnutrition Vitamin A Deficiency Nutritional Anemias Endemic Goiter Obesity

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