Fortified food - persuading the private sector to do good

With a certain amount of fanfare, Nigeria has just officially become a middle income country. It is not the sort of country associated with widespread hunger, or a country where people normally get, or expect to get, food aid. And yet around a quarter of small children in Nigeria are underweight, and around 40 percent are stunted; they do not get enough nutritious food to reach their full physical and mental potential.

In a nation of 170 million people that is a huge number of children, far too many to be reached by any feeding scheme. You do not have to be an ideological cheerleader for the power of free markets to believe the best way to reach these children - in Nigeria and elsewhere - would be by getting more nutritious food into the normal, private sector distribution chain and into the small shops and local markets which serve the poor.

“Even people living in rural areas and working on farms rely on markets to purchase food for some or all of the year,” says John Humphrey at the UK Institute of Development Studies (IDS), “and when we talk about market provision we are in effect talking about the private sector. We are not just talking about Nestlé and Unilever and the big multinationals; we are talking about a broad range of private sector operators.”

Humphrey and his Overseas Development Colleagues colleagues are among a growing number of nutritionists and academics who have been worrying away at the problem of how best to harness the power of the private sector to deliver not just enough calories, but the vitamins, minerals and micronutrients that children need.

Working with the market

There are precedents for successfully delivering micronutrients through commercially available foodstuffs. The widespread addition of iodine to salt has almost eliminated goitre and other iodine deficiency symptoms in many countries. But the difficulties faced by Ethiopia in trying to enforce the iodization of salt show some of the problems of this approach.

Case studies
 The Role of Businesses in Providing Nutrient-Rich Foods for the Poor: Two Case Studies in Nigeria
 The Role of Business in Providing Nutrient-Rich Foods for the Poor: A Case Study in Tanzania
 Mapping value chains for nutrient dense foods in Ghana

Poor people buy their salt in small quantities from the market, and most of it comes from artisanal producers. Adding iodine at small scale is more difficult and more expensive, yet the resulting salt looks the same and tastes the same as untreated salt which can be sold at a lower price.

In Ethiopia's arid Afar region rock salt producers lobbied hard against compulsory legislation. But the government persisted. The UN Children’s Fund (UNICEF) and other organizations helped introduce easier methods for small producers to treat their salt, and the country's network of village health workers now has the job of testing the salt on sale in their areas. Even so, universal coverage has still not been reached.

The problem, says Humphrey, is that the value of fortified foodstuffs is what is known as a “credence” good. “If you say to somebody, 'this product is rich in vitamins,' you can eat as much as you like but you are still not going to know if it really is rich in vitamins; you are simply going to have to believe it. So this is a massive problem, especially for the case of nutrient-rich food.”

The classic ways of establishing belief, through brand promotion, packaging and advertising, raise the price. In fact a higher price can in itself help persuade customers that it must be good. It is - in the words of a well-known beer advertisement - “reassuringly expensive”. A study of weaning foods in Mali found that the imported baby food Cerelac outsold similar local products, even though it was three times more expensive, and many mothers could not afford to buy enough of it to derive much benefit.

Challenge of regulation

IDS has studied attempts to use local manufacturers and commercial distribution systems to reach undernourished children in Nigeria, Ghana and Tanzania. All three countries have mandatory fortification of wheat flour with iron and zinc. This kind of scheme works best when there is centralized production; in Nigeria, for instance just five big companies supply most of the wheat flour in the country. And because fortification is mandatory, there should be no issues of consumer choice, or competition from cheaper, unfortified flour.

But IDS's Ewan Robinson, who worked on the case studies, says: “In Nigeria, even though fortification has been mandatory for 10 years now, and there has been huge investment poured in by donors... a recent survey that looked at products in the marketplace rather than at factories, when they took samples and tested them, they found that only 25-30 percent met the required standard, so even in this context of very high support and investment, they still have not managed to motivate manufacturers to fully comply. It requires very strong monitoring.”

So-called “complementary” foods - baby cereals and other weaning foods - are particularly important since newly weaned infants are at risk of undernutrition. They just cannot physically eat enough ordinary, unfortified porridge to get all the nutrients they need. Many mothers do buy weaning foods, big international brands like Cerelac, locally respected brands like Gold's Custard in Nigeria, or unbranded cereal mixes, often produced on a small scale by women in their own homes.

These mixes are sold in local markets, in small packages, and do reach the rural poor. “These small enterprises are extremely vibrant,” says Robinson, “But the quality varies hugely. There's been a study done in Ghana which sampled some of these products and found that while some were mixes of different flours, like soya and other beans, and were actually equivalent to international products in nutrition, others were completely inadequate. And there was no way to tell the difference.”

So the challenge is to find a way of introducing some kind of quality control. The good news which came out of the work in Mali was that mothers, even poor and less educated mothers, were prepared to pay a premium for foods which they knew were better for their babies, and that that premium would be large enough to pay for some kind of certification scheme signalling which mixes really were nutritious. Or perhaps there could be a franchising system which would guarantee standards.

But the problem remains enforcement. Ghana is a generally law-abiding and well organized country, but Humphrey told IRIN: “In Ghana the capacity of the state to regulate any part of the food industry - even to inspect factories - is very limited. They have very limited ability to analyse products for content. We don't say that states can't do anything, but we have come across so many cases of state failure to regulate, that we are a little bit sceptical about their ability to do it.”