This document discusses wheat flour fortification in Pakistan. It begins by defining food security and malnutrition, noting high rates of both in Pakistan. Micronutrient deficiencies like iron, folic acid, and vitamin A negatively impact health. Food fortification is presented as a cost-effective strategy to address hidden hunger. Wheat flour fortification was implemented nationally in 2007 but later suspended; efforts are underway to restart the program in Punjab province with support from GAIN, the flour mill industry association PFMA, and the government. Key factors for success include political will, industry cooperation, legislation, and public acceptance. The goal is to improve nutrition and reduce malnutrition's huge health and economic costs in Pakistan.

1. 1
Wheat Flour Fortification
Malik Tariq Sarwar Awan, Food Technologist,
Chairman Research Wing to Pakistan Flour
Mills Association,
Editor, Wheat Milling News, PFMA .
Member Pakistan Society of Food Scientists
and Technologists
&
Munawar Hussain
Program Manager Food Fortification
Global Alliance for Improved Nutrition (GAIN)

2. 2
What is Food Security?
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 an active and healthy life.
Source: according to World Food Summit
FOOD SECURITY
Availabilityof
nutritiousfood
FoodAccess
Stability
FoodUtilization

3. 3
Food Security in Pakistan
28.4 26.5 29.2
19.8
17.7
20.7
9.8
8.2
10.5
0
10
20
30
40
50
60
70
Pakistan Urban Rural
Food Insecure with
hunger (Sever)
Food Insecure with
hunger (moderate)
Food Insecure without
hunger

4. 4
Food Insecurity
• Food Insecurity principally connected to
o Low production
o Low socio-economic status
o Increasing prices of food
o Geographic hurdles and distribution
• The main determinant of food insecurity is
malnutrition

5. 5
Malnutrition and Food Insecurity
25
32
42
0
5
10
15
20
25
30
35
40
45
food secure food insecure without
hunger
food insecure with
moderate to severe
hunger
%ofyoungchildrenstunted
The worse the food insecurity, the higher the
child malnutrition

6. 6
Pakistan’s Progress on Malnutrition
Indicator
NNS
2001-02
NNS
2011
1. Wasting % (Low Weight for Height) 12% 15%
2. Stunting% (Low Height for Age) 31% 44%
3. Under Weight% (Low Weight for Age) 42% 32%
4. Anemia (Children) 51% 62%
5. Anemia (Pregnant women) 29% 51%
6. Iodine Deficiency (Children) 63% 36%
7. Iodine Deficiency (Women) 76% 36%
8. Vitamin A Def (Children) 13% 54%
9. Vitamin A Def (Non-pregnant women) 6% 42%

7. 7
Why Malnutrition Matters?
Pneumonia
15%
Injuries, 3%
Other, 19%
Neonatal 42%
HIV/AIDS 1%
Diarrhoea
19%
Measles 1%
Malaria
1%
45%
attributable to
Under
nutrition
Globally 45% of under-five deaths are attributable to
under nutrition

8. 8
Why Malnutrition Matters?
Costly inefficiencies (e.g.
illness, deaths)
Direct links: Decreased
physical productivity
Indirect links: impaired
cognitive development,
schooling and
productivity
Overall loss to
the economy
of 3% of GDP
annually
Bigger than energy crises (2% of GDP)

9. 9
Micronutrient Deficiencies
Affect mainly women and children
due to poor quality of diet or
depletion due to losses (e.g.
infections)
Main deficiencies:
Iodine
Vitamin A
Iron
Folic acid
Zinc
Also called HIDDEN HUNGER – often invisible

10. 10
Consequences of Iron
and Folic Acid Deficiency
 Iron deficiency anemia
 Poor cognitive development
 Reduced body immunity and resistance
against diseases
 Neural tube defects
 Increased child and mother mortality

11. 11
“Hidden Hunger”
Iron Deficiency Folic Acid Deficiency

12. 12
Maternal Anemia
Source: NNS 2011
0
10
20
30
40
50
60
70
No Pregnant
Women
Pregnant
Women

13. 13
Anemia - Children Under
Five Years of Age
Source: NNS 2011
61.9 62.9 61.4 60.3
72.5
47.3
56.8
46
41
0
10
20
30
40
50
60
70
80

14. 14
Addressing
Micronutrient Malnutrition

15. 15
Addressing Micronutrient
Malnutrition
Food Fortification
Dietary Diversification
Supplementation
Food fortification is safe and cost-effective
intervention for the prevention of micronutrient
deficiencies and has been widely practiced in
developed countries for well over a century

16. 16
Why Fortification?
Could target population at large
Technology - simple and well established
Global success history of addressing
deficiencies of micronutrients
Economical - very cost-effective
No need to change dietary habits of targeted
population
Fortification vehicles are easily accessible

17. 17
Top 10 Investments for
advancing global welfare
1 Micronutrient supplements - Malnutrition
2 The Doha development agenda - Trade
3 Micronutrient fortification - Malnutrition
4 Expanded immunization coverage for children - Diseases
5 Agricultural R&D on micronutrients - Malnutrition
6 Deworming and nutrition programs at school - Malnutrition
7 Lowering the price of schooling - Education
8 Increase and improve girls’ schooling - Women
9 Community-based nutrition promotion - Malnutrition
10 Provide support for women’s reproductive role - Women
Copenhagen Consensus

18. 18
Fortification - Key
Success Factors
Political commitment and support
Industry support
Adequate legislation
Consumer acceptance
No cultural or other objection
Availability of micronutrients and
fortification equipment/ dossifiers
Economically sustainable interventions

19. 19
Wheat Flour
Fortification
 National Wheat Flour Fortification
Program started in 2007 with the
support of GAIN
 Over 200 flour mills started
producing fortified wheat flour
 More than 12.7 M people got
access to fortified wheat flour
 Program suspended in 2011 after
18th constitutional amendment.
 GAIN agreed to support Punjab
Government toward end of 2013 to
restart the program.

20. 20
GAIN’s Support to
Project
 Training and capacity building of industry and regulatory
bodies
 Laboratory strengthening and provision of spot testing kits
 Set up supply chain mechanism for market based
availability of micronutrients in Pakistan
 BCC to increase the demand of fortified wheat flour
 Support government and industry for legislative and legal
framework
 Support in setting up monitoring and evaluation
mechanism
 Assist government and industry for mechanism to pass
through the fortification cost to consumer

21. 21
PFMA’s Support to
Project
 Secure commitment from industry
 Production and distribution of fortified wheat flour
 Set up fortification equipment at mills
 Demand generation of fortified wheat flour
 Design and use the bags for fortified flour in line with
BCC campaign

22. 22
Government Support to
Project
 Political commitment and patronage of the
program
 Legislation for mandatory fortification and legal
framework
 Allow industry to pass through the minor cost of
fortification to consumer
 Coordination and collaboration among
stakeholders
 Awareness raising through public services
messages
 Regulatory monitoring and enforcement of

23. 23
Thank you