The document discusses a proposal to address micronutrient malnutrition in Peru through a rice fortification program implemented in partnership with the Foundation for Social Innovation (F4SI) and the Peruvian government. The plan involves six initiatives over 18 months to conduct clinical trials of fortified rice, engage the public and private sectors, manage the supply chain and quality, conduct monitoring and evaluation, and implement social marketing. The goal is to expand access to fortified rice, particularly through school lunch programs, to significantly reduce undernourishment among children. Political support and institutionalizing the program are seen as key to the long-term success and sustainability of impacts.

1. Rice Fortification: Building an innovative model to address
micronutrient malnutrition
Sergio Segall, Ph.D
Foundation for Social Innovation
sergiosegall@f4si.org
@f4si_lataml

2. Page 2
• Partners: F4SI and your Government
• Problem: Micronutrient Malnutrition
• Solution: Food Fortification
• Plan: Implementation Program in Peru

3.  Who is F4SI
 Real impact for a better future
 How we can help grow your
business in Latin America
 What you get

4. - Vision and objectives alignment at executive
level
- Unify above statement with of all areas
- A Holistic view of Health and
- An impartial view of business processes with
improvement areas
- Share regional and world wide best
practices
- Results will be measured by citizens’
feedback (and votes)

5. Improve health and outcomes, today's challenges and how they can adapt to future needs,
the pressure of fulfilling the objectives and demands with fewer resources are critical issues.
Working together with leaders in health, FSI have the opportunity to help Healthcare
organizations and the communities around Latin America to have an impact for better
health.
FSI will focus on young people assisting them to cross the gap of opportunity helping them
to envision and achieve their full potential through a variety of innovative educational
programs. We partner with Governments, non-governmental organizations and educational
communities to offer models and scalable technologies, services and programs to allow a
quality education and opportunity for all young people.

7. It is the latest and most widely used today
It has received the approval of 183 countries and many UM/international
Organizations including: United Nations, FAO, WHO, WFP, WB and IFAD
“Global food security exists when all people, at all times,
have physical and economic access to sufficient, safe
and nutritious food to meet their dietary needs and food
preferences for healthy and active life”

8. • Source: Worldmapper, 2009

10. 1Mason JB, Lotfi M, Dalmiya N, et al. The Micronutrient Report: Current Progress in the Control of Vitamin A, Iodine, and Iron Deficiencies. Micronutrient Initiative/International Development Research
Center, Ottawa, Canada, 2001.
2Black et all. The Lancet Maternal and Child Undernutrition Series, 2008
3UNICEF Child Survival fact sheet, 2005.
Malnutrition
2,000,000,000
Billion people
Global prevalence and health consequences:
Contribute
1/3
of death and disability
Iron deficiency
Every 2nd
pregnant woman
40% of preschool kid
Vitamin A and Zinc
1,000,000
deaths
Lack of Folic acid
causes
200,000
severe births defects
Deficit of Thiamin,
Iron and other
nutrients
HIGH
Rates neonata
mortality
Economic Consequences:
The consequences of
malnutrition
reduce the GDP
of developing
countries by 2%

12. *Caulfield et al. Undernutrition as an underlying cause of child deaths associated with diarrhea, pneumonia, malaria, and measles. AJCN. 2004;80:193-8
* *Black et all. The Lancet Maternal and Child Undernutrition Series, 2008
Malnutrition
underlies
35% of all
under-5
deaths**

13. PATH’s Ultra Rice® Technology
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©PATH/ Satvir Malhotra

14. Intervention:
Nutritional awareness &
diet diversification Supplementation Food Fortification
Description:
Improve awareness of, access to
and consumption of foods with
vitamins & minerals in target
population.
Supply target population with
capsules, drops or syrups, which
provide vitamins and minerals
needed.
Add vitamins and minerals to
staple foods and spices already
well-established in the eating
habits of target population.
Cost Medium High Low
Begin to see results Long-term Short-term Short-term
Compliance issues Medium High Low
Behavior change High High Low
Possible Solutions
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15. Copenhagen Consensus 2012
• World’s top economists (4 Nobel Laureates) convened to prioritize how
development dollars should be spent.
• Interventions to Reduce Chronic Under nutrition in Pre-Schoolers
(including micronutrient provision) ranked among the top international
development priorities
• Food fortification is viewed as highly cost-effective, with high return on
investment; benefit to cost ratio (BCR) at 9.5:1*
• Vernon Smith (Nobel Laureate) said: “One of the most compelling
investments is to get nutrients to the world’s undernourished. The benefits
from doing so – in terms of increased health, schooling, and productivity –
are tremendous.”
* Horton et al: Copenhagen consensus 2008, Malnutrition & Hunger- Executive Summary.

16. WHO + FAO
“The practice of
deliberately
increasing the content
of an essential
micronutrient, for
example vitamins and
minerals in a food so
as to improve the
nutritional quality of
the food supply and
to provide a public
health benefit.”
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Fortification History
• Developed countries began routinely
fortifying salt, wheat flour, sugar, margarine,
vegetable oils and dairy products in the early
20th century.
• Diseases such as goiter, rickets, beriberi,
pellagra and neural tube birth defects, which
were once common in these countries, are
rarely seen today.
• Developed countries fortify rice, but use a
dusting technology that is ineffective if the
rice is washed and soaked rice prior to
cooking – as it is in many developing
countries.

17. Decrease in iron deficiency:
Control : 77% to 53%
Intervention: 69% to 25%
Decrease in anemia:
Control: 100% to 85.6%
Intervention: 100% to 62%
Studied proved :
• Ultra Rice is more effective than iron drops at improving the iron stores of young children
• Young children consume enough rice per day for fortified rice to make a difference
Source: Beinner M, et all. Iron-Fortified Rice Is As Efficacious As Supplemental Iron Drops in Infants and Young Children. Journal of Nutrition. 2009; 140;49–53.

18. Source: Arcanjo
P.N.F, et all. Use of
Iron-Fortified Rice
Reduces Anemia
in Infants. Journal
of Tropical
Pediatrics. 2012;
58 (2) ;01–06.

19. Source: Arcanjo P.N.F, et all. Use of Iron-Fortified Rice Reduces Anemia in Infants. Journal of Tropical
Pediatrics. 2012; 58 (2) ; 01–06.
Evaluate the impact
of iron-fortified rice
weekly on
hemoglobin and
anemia levels
Study deals with
infants (10–
23 months)
n = 216, in an 18
week intervention.
Group received
portions of fortified
rice (50 g) provided
56.4 mg
elemental/Fe.
Anemia prevalence
for intervention
center was 31.25% at
baseline, and 18.75%
at end of
study, p = 0.045
For control 43.50%
were anemic at
baseline, and 37.1%
at the end of
study, p = 0.22.

20. •Brazil’s recent experience in reducing poverty, capacity for
technical innovation
•Recent partnership: Agency for Brazilian Cooperation and
the Gates Foundation to leverage these models for Africa
•Additional models and further innovation needed to
address Brazil’s lingering poverty and malnutrition

21. Initiatives Name Scope
1 Clinical Trials
Conduct clinical trials to evaluate the nutritional profile before (base line) and
after the intervention
2
Public sector
engagement
Focus on school lunch and other public programs at the state and municipal
levels to increase access to fortified rice. Advocacy and policy efforts at all three
levels of government
3
Private sector
engagement
Support to the supply chain and distribution channels from a commercial and
business perspective, including engagement of new millers and large retailers
and distributors, and their professional associations
4
Supply and quality
management
Support to the entire supply chain from a technical perspective, including work
with fortified grain producers and millers and with UFV on standards and the
quality verification process
5 M&E
Definition of an appropriate metrics framework for the project, tracking of
indicators and reporting
6 Social marketing Demand generation and brand recognition through all media and channels

22. 6 initiatives
18 months duration
Q1 Q2 Q3 Q4 Q5 Q6
Clinical Trial
PS engagement
Social Mktg
Supply &
Quality
M&E
PS engagement
Private Sector Private Sector
M&E
480
1440
1440
380
1440
Supply &
Quality
380
Total
Supply &
Quality
Strategic Themes
1. Expand & consolidate the gains achieved during the project
2. Build sustainability into project structures to enable long-term impact
3. Disseminate key learnings to the relevant LATAM community for replication

23. The structures and capacities resulting from the evolution and
institutionalization of food security and nutrition governance, and
continuing financial and political commitment are mandatory for the
success of the project
The political support to guarantee the engagement of all stakeholders
involved with the nutritional programs is extremely important to achieve
the goals.
The school lunch program if implemented adequately can significantly
reduce the estimated prevalence of undernourishment children in the
country.

24. Why
• Rice appealing to all social.
• No rice = no meal
• Easy to prepare
• Affordable price.
Benefits
• Considered perfect and it is not rejected.
• Recognized as a food that gives “substance”
• Consumption is allied to beans, known for having iron.
Observations
• Viewed mainly as food to
help “fill the belly”.
• Natural origin must be
stretched, too, since there
is rejection to artificial
composition.
Message
• Product should be as similar as possible of common
rice
• It is important that communication transmits it
• Valuing traditional rice characteristics and extending to
issues of rice processing.

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