Elements of a National Food- Fortification Program for Bangladesh

Section 5: Elements of a National Food-Fortification ProgramAlthough roller mills represent theonly practical means of introducing flourfortification on a sustainable basis, it mustbe recognized that this will initially limitrural access to the fortified product, sincemost rural consumers obtain their flourthrough chakki mills. In the longer run,as the economy develops further and astransportation improves, it is likely thatBangladesh will follow the same pattern thathas been observed in other countries: rollermill production will expand and account foran increasing share of the rural market. Asthat occurs, fortified flour will further extendinto rural areas.ConsumptionThe bulk of sugar consumed in Bangladeshis imported in an already refined form, thusplacing severe limitations on the amountof sugar available for fortification. Localproduction is only about 20-25 percent of totalsugar consumption, equivalent to less than2g/day/person. Moreover, per capita sugarconsumption in rural areas — where mostof the vulnerable groups can be found — ismuch lower than in urban areas. Increasedcompetition between sugar and gur (molasses)in recent years has put additional pressure onper capita sugar consumption in rural areas.A Voluntary, not Mandatory, ProgramThe number of mills, their size, and the extentto which flour milling is centralized willdetermine whether a mandatory or voluntaryprogram is the better option. The structure ofthe milling industry in Bangladesh suggeststhat a mandatory flour-fortification programwill not be realistic for two reasons. First, thesmaller mills, especially those located in ruralareas, typically will lack the capital resourcesneeded to participate in the fortificationprogram. Second, implementation of a qualitycontrolsystem will not be possible when mostparticipants consist of a large number of smallmills scattered throughout the country.CostAt about Tk630, or $10.8 per MT, the costof sugar fortification is more than twice ashigh as that for wheat flour and nearly threetimes as high as for oil. The additional costassociated with fortification would lead to anincrease of over 2 percent in the retail price ofsugar. Assuming fortification costs are passedon to consumers, this increase may placefortified sugar at a disadvantage relative tothe imported unfortified product. Only a shiftin demand for local sugar — stimulated, forinstance, by a strong promotion and healtheducationcampaign — would enable fortifiedsugarproduction to compete with unfortifiedprivate-sector imports.SugarThe case for sugar fortification in Bangladeshis based on two major arguments, the firstbeing that the country has only 15 sugarfactories, which would make programcoordination and quality-control systems easyto implement. The second argument is that theBSFIC, a state-owned company, operates allthose factories.However, strong evidence presented inthis study suggests that sugar fortificationin Bangladesh is not recommended. Thisconclusion is supported by a combinationof very low per capita consumption andrelatively high fortification costs.Fortification FormulationTable 5.1 describes the fortificationformulation and micronutrient supply foroil and wheat flour in Bangladesh. Fortifiedat a minimum vitamin A level of 20mg/kg,oil would supply about 52 percent of EAR— an amount expected to have a significantbiological impact.Based on the formulation described in table5.1, fortification of maida would supply about20 percent of EAR for vitamin A, iron, folate,B-12, B-1, B-2, B-6, niacin, and zinc.16MOST The USAID Micronutrient Program