Business Innovation to Combat Malnutrition Case Study Series
59428
Faire Tache d'Huile:
Cooking Oil Fortification
in West Africa
This case was developed "Whose responsibility is fortification? It doesn't describes the Faire Tache d'Huile initiative with
by the World Bank Institute
have a natural home in the public sector. At the a particular focus on the coordination issues
(WBI) with the support of the
Global Alliance for Improved
public level, fortification is a multiple orphan: involved and the conditions under which such
Nutrition (GAIN), and edited though indirectly relevant to the work of multiple a public-private partnership is likely to succeed
by Michael Jarvis (WBI). agencies, it has no explicit parent. While every- (in this case addressing a pressing public health
Case development benefited
one has a role to play, it's no one's central interest. challenge).
from in depth inputs from
organizations involved in the
It's no one's day job. But given the stakes, it must
Faire Tache d'Huile initiative, be everyone's central interest. It must be every- In developing economies, rapid and thorough
particularly the staff of Helen one's day job." food fortification for public health worked
Keller International. The
--Shawn Baker, Vice President and Africa Re- best as a multi-sectoral effort that included
contribution of all parties is
most gratefully acknowledged.
gional Director, Helen Keller International governments, industries, researchers, non-
governmental organizations (NGOs), and
In May 2007, Helen Keller International other social actors. What made Faire Tache
(HKI) announced a new $2.7 million multi- d'Huile nearly unique among such initiatives
partner public-private initiative to produce was that it operated not only at the level of
vitamin A-fortified cooking oil (oil) in eight individual UEMOA member states, but at the
countries in West Africa. These eight coun- regional level as well. This made coordination
tries--Benin, Burkina Faso, C�te d'Ivoire, essential to any and all progress. HKI had
Guinea-Bissau, Mali, Niger, Senegal, and helped bring together the key private, public,
Togo--comprised the West African Monetary and not-for-profit stakeholders with the goal
Union (known as UEMOA from its French of achieving mandatory vitamin A fortifica-
initials; see Exhibit 1). The program was tion of industrially-produced cooking oil
dubbed "Faire Tache d'Huile," literally similar throughout UEMOA. Funding for the initia-
to a "snow ball effect" in French, used figura- tive was led by the United States Agency for
tively to express the scope and outcomes of this International Development (USAID), which
multi-country, multi-partnership approach to contributed $1.3 million. Other financial
vitamin A fortification of cooking oil in the partners included the Michael & Susan Dell
West Africa Region. The successful implemen- Foundation (contributing $750,000), the
tation of this cooking oil initiative catalyzed Government of Taiwan (China) ($300,000),
a similar regional initiative on micronutrient the Global Alliance for Improved Nutrition
fortification of cereal flour, with the two re- (GAIN, $200,000), and the Micronutrient Ini-
gional initiatives declared at the Clinton Global tiative (MI, $173,775). These were investments
Initiative as "Fortify West Africa." This case that augmented prior country level funding
Copyright � 2009, WBI - World Bank Institute, Washington, DC, United States, and GAIN - Global Alliance for Improved Nutrition, Geneva, Switzerland.
The views expressed in this paper are those of the authors only.
by MI and GAIN, supporting food fortification in VAD was a public health problem in more than half
C�te d'Ivoire and Mali. of all nations, hitting hardest young children and
pregnant women in low-income countries, especially
By early 2009, three countries in West Africa were in Africa and Southeast Asia (see Exhibit 2 for data
fortifying vegetable oil--Burkina Faso, C�te d'Ivoire, on the prevalence and impact of VAD in West Africa
and Mali, with Benin and Senegal expected to do so and Exhibit 3 for estimates of economic losses in
within the year. Within this initial group, common Africa from all vitamin and mineral deficiencies).
language and geographic proximity had made it Worldwide, an estimated 250 million preschool
easier than expected to spread practice from one children were vitamin A deficient, and it was likely
country to another. However, the collaboration that in VAD areas a substantial proportion of preg-
that was emerging at the regional level concealed nant women were vitamin A deficient. An estimated
many challenges that had to be overcome in each 250,000 to 500,000 vitamin A deficient children
individual country, where industry dynamics and became blind every year, half of them dying within
institutional contexts differed. Clear understanding 12 months of losing their sight. Research indicated
of the challenges in individual countries could help that even children with mild VAD and no clinical
stakeholders wishing to implement food fortifica- symptoms had 25% to 30% higher death rates than
tion in other parts of Africa and beyond. those without VAD. VAD compromised the immune
systems of approximately 40% of the developing
world's children under the age of five and led to the
Vitamin A Deficiency in West Africa1 deaths of as many as one million young children each
year. Hundreds of millions more were at increased
Vitamin A deficiency (VAD) was the leading cause risk of disease and early death.
of preventable blindness and visual impairment in
children. VAD also significantly increased the risk To successfully combat VAD, short-term interven-
of severe illness, and even death, from such com- tions and proper infant feeding had to be backed
mon childhood ailments as diarrheal disease and up by long-term sustainable solutions. For deficient
measles. VAD increased one's susceptibility diseases children, the periodic supply of high-dose vitamin
such as malaria as well. For pregnant women in A in swift, simple, low-cost, high-benefit interven-
high-risk areas, VAD occurred especially during the tions had produced remarkable results, reducing
last trimester when demand from both the unborn mortality by 23% overall in high VAD populations
child and the mother was highest, and typically first and by up to 50% for acute measles sufferers.
manifested itself during this period as night blind-
ness. The impact of VAD on mother-to-child HIV The arsenal of nutritional well-being weapons in-
transmission awaited further investigation. Ade- cluded a combination of breastfeeding and vitamin
quate vitamin A in high-risk areas could significant- A supplementation for the youngest victims, coupled
ly reduce mortality. Conversely, its absence caused a with enduring solutions such as promotion of vitamin
needlessly high risk of disease and death. A-rich diets and food fortification. Since breast milk
was a natural source of vitamin A, promoting breast-
1. For more details, please refer to our sources, www.who.int/nutrition/topics/vad/en/index.html, accessed February 7, 2009; WHO
country data: www.who.int/vmnis/vitamina/data/en/index.html, accessed March 3, 2009; and, African prevalence of VAD: www.who.
int/nutrition/publications/ micronutrents/vitamin_a_deficiency/WHO_NUT_95.3/en/index.html, accessed March 3, 2009.
2
feeding was the best way to protect babies from VAD. to improve child survival. One high-dose vitamin A
However, because breastfeeding was time-limited capsule every six months could help protect a child
and the effect of vitamin A supplementation capsules from the death and disease associated with VAD.
lasted only 4�6 months, these were but initial steps to- These capsules cost approximately two U.S. cents
ward better overall nutrition, not long-term solutions. each and could often be delivered through existing
child health programs. However, doing so in West
In 1998, the World Health Organization (WHO) Africa was challenged by the gaps in local healthcare
and its partners--the Canadian International De- delivery systems; food fortification was seen as a
velopment Agency (CIDA), MI, UNICEF, HKI and more direct way to help populations at risk.
USAID--launched the Global Alliance for Vitamin
A (GAVA). In addition, WHO, UNICEF, and oth-
ers subsequently provided support to countries in Vitamin A Fortification
delivering vitamin A supplements with the goal of
eliminating VAD by 2010. Linked to sick-child visits Fortification of oil products with vitamin A initially
and national poliomyelitis (polio) immunization occurred in Europe in the early 20th century after
days, these supplements averted an estimated 1.25 rates of VAD there rose as consumers switched from
million deaths in 40 countries since 1998. dairy-based butter to new, oil-based margarines.
Several years of fortification virtually eliminated
An important part of an integrated package of essen- VAD from Europe. Further, in 1944, for example,
tial services that promoted child health and stopped margarine fortification with vitamin A reduced
preventable deaths, high-dose vitamin A supple- VAD in Newfoundland, Canada, from 48% to 2% of
ments were also among the most cost-effective ways the population in four years.2
Table A. Selected vitamin A fortification standards for margarines and oils
Country Parts per million (mg per kg)
Belgium 6.75�8.1
Brazil 4.5�15.0
Canada 9.9
Chile 9.0
Denmark 7.56
Indonesia 7.5�9.0
Malaysia 7.5�9.0
Peru 9.0
Sweden 9.0
United States 9.9
United Kingdom 7.2�9.9
Food aid standards 10.0�15.0
Source: Commonwealth Regional Health Community for East, Central, and Southern Africa, reprinted in The
Micronutrient Initiative, "Sugar and Oil Fortification with Vitamin A," brochure, n.d.
2. Commonwealth Regional Health Community for East, Central, and Southern Africa, reprinted in The Micronutrient Initiative, "Sugar
and Oil Fortification with Vitamin A," brochure, n.d.
3
While vitamin A supplements could immediately tion in preventing blindness was a natural con-
protect children from VAD for six months, the nection to HKI's mission of eye health, since VAD
experience of Europe and Canada suggested that was the leading cause of preventable blindness in
programs of vitamin A fortification could eliminate children. To accomplish its cooking oil fortification
the problem entirely. Table A shows some of the vi- goals, HKI partnered with industry, government,
tamin A fortification standards in place in countries and donors, fostering communication between
around the world. Because the production process stakeholders, brokering relationships, and creating
and losses from heat and light could reduce the information flow. "HKI's value added is in know-
initial amount of vitamin A in fortified foods by up ing the actors," explained Shawn Baker, HKI Vice
to 20%, producers typically added somewhat more President and Regional Director for Africa. "We
fortificant to compensate. The three primary manu- play the roles of both broker and catalyst. We are
facturers of vitamin A fortificant included German not a watchdog."
chemical giant BASF, Swiss-based DSM Nutritional
Products, and New York's Fortitech. This was hard to do, Baker added: "People talk about
partnership but don't realize what it actually takes
In addition to the cost of fortificant, MI research to make it happen. It takes commitment, time, and
summarized the cost of oil fortification as follows. relationships. Donors don't understand why we
Tanks and dosing pumps to combine the vitamin need our number of staff, why we need meetings,
A premix with refined oil cost between $20,000 to and why we need time. Look at our cost structure:
over $200,000 to procure and install. Chemicals we are more expensive than an NGO that is hiring
and equipment for quality control and quantitative frontline health workers, but we need the time to
testing could require initial investment between develop relationships and we need the people to put
$30,000 to over $80,000 depending on the testing in the time. We are also dealing with a higher level
protocols to be used.3 However, every $1 invested of relationship than frontline health and service
in vitamin A fortification returned $7 in wages and delivery groups do."
decreased disability, according to HKI estimates.
The Micronutrient Initiative
Players
Since 1998, MI had supported semiannual preventa-
Helen Keller International tive vitamin A supplementation along with CIDA,
HKI, UNICEF, USAID, WHO, and many other
HKI was an international NGO, headquartered in organizations in close collaboration with national
New York, that fought blindness and malnutrition governments. By 2004, almost 60% global cover-
in over 21 countries, primarily by providing exper- age had been achieved. MI and partners in GAVA
tise, training, and technical assistance to establish continued working for higher coverage with the
nutrition and eye health programs in partnership aim that every child under 5 at risk of VAD could
with host countries.4 The role of vitamin A fortifica- receive a high-dose vitamin A supplement every 6
3. Micronutrient Initiative, "Fortifying Africa's Future," (Johannesburg, South Africa: Micronutrient Initiative, 2006), table 4, page 11.
4. See www.hki.org, accessed May 4, 2009.
4
months. In 2006 alone, MI programs arranged the are a small section. Nutrition and malnutrition are
supply of sufficient vitamin A to meet the needs of a social issue for the UEMOA Commission. There is
347 million children in over 70 countries. a quality program in place to set regional standards,
but the objective is to develop a common industrial
In addition to supplementation, MI explored pos- policy for the region. In all areas, however, UEMOA
sibilities to reduce VAD through foods that were is responsible for harmonizing national regula-
naturally rich in nutrients, such as red palm oil tions. One objective of regional harmonization is
and orange-fleshed sweet potatoes. MI also sup- to break technical and nontariff barriers to trade.
ported the fortification of food staples, such as flour, With harmonization, we create the political willing-
oil, and sugar, with vitamin A and other essential ness among member states to get involved. With-
vitamins and minerals. To this end, MI developed out harmonization of standards, there will be no
and maintained the FortAf (Fortify Africa) website result. There is an additional principle: the UEMOA
and email newsletter as an information resource Commission should not duplicate what individual
and portal focused on African fortification and food member countries can do themselves, but instead
processing industries. MI was also a key partner in look for where it can add value."
Faire Tache d'Huile.
Mawuli Sablah, HKI Regional Coordinator for Faire
Tache d'Huile, worked closely with the UC. He
UEMOA elaborated, "The UEMOA Commission provides
legal backing, legislation, logos, tax exemptions
UEMOA was an economic and monetary union of on intraregional trade, direct investment on public
West Africa formally created in January 1994, based health grounds, and standards, particularly sur-
on the pre-existing West Africa Monetary Union rounding customs and trade. HKI and UEMOA
Bank of the CFA franc zone,1 with eight members have an MOU [memorandum of understanding]
in 2008, a currency guaranteed at fixed parity to on mandatory fortification of specific multiple food
the Euro (CFA 656 = 1), and zone-wide fiscal and products, currently focused on cooking oil and
monetary rules, including a common external tariff wheat flour. The issue is how to accelerate results.
and free trade among its members. Patterned after Challenges in meeting responsibilities remain."
the European Union, the UEMOA Commission
(UC) was located in Ouagadougou, Burkina Faso, To set regional standards, the UEMOA secretariat
and financed by a share of a one percent levy on all coordinated among member states. If half of the
UEMOA imports.5 member states agreed, UEMOA then launched a
formal process for setting up a new standard. To
According to Adelaide Belemsigri, who headed this end, the UC ran 17 technical committees and
NORMCERQ, the UEMOA department in charge coordinated with member state national commit-
of all regional standards, product quality, and tees and their national standards organizations.
norms: "UEMOA's emphasis is on economic and "Countries can pass their own directives," Belemsigri
monetary issues. Social issues [such as fortification] noted. "They can go ahead and do it themselves. But
5. For more details please see http://knowledge.uneca.org/Members/Summermkhululi/observatory-on-regional-integration/regional-
economic-commissions-in-africa/uemoa-waemu-westa-african-economic-and-monetary-union/uemoa-waemu-west-african-mone-
tary-union, accessed April 20, 2009.
5
when a UEMOA directive is passed, country direc- health standards among ECOWAS countries, and
tives need to fit its terms. If not, member states must viewed vitamin fortification as a tangible means to
adapt their rules to UEMOA's directive." As of early this end. In 2005, WAHO advanced salt, flour, and
2009, UEMOA had approved nine standards for oil oil fortification, in 2006 passing a resolution for
fortification covering such variables as microbio- member MOHs to facilitate mandatory fortification.
logical content, chemical content, and the level of This resolution was re-affirmed in the 2008 General
vitamin A. The standards would not go into force, Assembly of Health Ministers meeting of the 15
however, unless approved by member state minis- ECOWAS countries.
ters. Said Belemsigri, "The ministers have to pass
the legal application of these guidelines. Technical
documents are ready for use, but we need political AIFO-UEMOA: The Cooking Oil Industry
recognition to make it official." UEMOA's Statu- Association
tory Council, a group of member state officials, met
semi-annually to review such applications. AIFO-UEMOA (AIFO) was a professional associa-
tion of cooking oil producers and refiners located in
Once approved, member states had three months in UEMOA countries, initially established in 2000 with
which to voluntarily adopt the standards. However, 14 member companies primarily in response to the
because vitamin A fortification of cooking oil was economic challenges created by UEMOA's deci-
deemed a public health issue, UC oil fortification sion to adopt WTO import duties. The opportunity
standards would be imposed on a mandatory basis, this created for cooking oil imports was dramatic:
with judicial recourse in the event of non-imple- UEMOA import duties fell from 45% on processed
mentation. According to Belemsigri, the internal oil and 20% on unrefined oil to 20% on refined oil,
legal issues delaying the imposition of mandatory 10% on semi-refined oil, and 10% on unrefined oil.
oil fortification would be resolved in 2009, and A November 1999 meeting of UEMOA oil produc-
mandatory fortification would be approved or en- ers led to AIFO's formal creation the following July.
dorsed in 2010. "We went to the UEMOA Commission to do a big
study of our problems," said AIFO founding mem-
ber, former president, and current vice president,
West African Health Organization Angora Tano. "Also, we went to all the member
states to explain the problem and solicit for help to
Functional since 2000, the West African Health Or- preserve the oil industry. We were not successful
ganization (WAHO) served the public health needs with the governments [of the member states], so
of the 15 member states of ECOWAS, the Economic we went to UEMOA because decisions adopted by
Community of West African States, which included the UEMOA Commission can require the member
UEMOA member states as well as Cape Verde, states to change their laws in conformity."
Gambia, Ghana, Guinea, Liberia, Nigeria, and
Sierra Leone. In 2002, WAHO officially became the The issue was not simply increased competition
UEMOA regional health agency as well. Through its from cheaper oil imports. There was also in some
annual assembly, WAHO worked closely with mem- instances rampant smuggling, and AIFO sought
ber Ministries of Health (MOHs), particularly those greater customs surveillance of UEMOA ports and
in UEMOA countries, to help influence national border crossings to at least ensure that import duties,
6
whatever the rate, were being collected. Moreover, the locus of the actual fortification process. National
UEMOA imposed upon consumers a value added laboratories and national standards organizations
tax on oil of 18�20% that AIFO wanted reduced. certified technical aspects of fortification, and uni-
versity laboratories hosted additional testing. MOHs
As a collectivity, AIFO had more clout with national typically sought overall responsibility for food forti-
customs authorities, for example, than did its indi- fication efforts but lacked the political influence over
vidual members. Noted Sablah, "Senegal's main oil policy formulation maintained by their Commerce
producer, Suneor, has much more trouble lobbying and Industry counterparts. Moreover, MOHs rarely
successfully in Senegal than if AIFO does so as a had staff expertise to take decisions about either oil
group. There is unity among the producers in order production or legislation and regulation.
to advocate for one's own interests in one's own
state." Yet large members often had significant influ-
ence in their home countries, and this benefited Individual Cooking Oil Producers
AIFO as well by creating focal points around which
the expectations and objectives of AIFO and other AIFO reported that its 14 members--the largest
players coalesced.6 producers in the UEMOA zone--directly employed
some 20,000 people and held CFA 500 billion in cap-
Another motivation for AIFO's creation was to ital. There were two main scenarios that governed
improve operational efficiencies and secure a stable how industry players might get involved with fortifi-
base of raw material supply. Cotton, peanuts, and cation efforts, Baker said: "The government is doing
palm were the three primary sources of oils in West its job or producers pressure government to do it.
Africa. Improving public health was not part of Companies can go forward without government, but
AIFO's agenda until several years after its founding. as long as no legal framework stating that fortifica-
tion is good, companies open themselves to risk.
Food legislation that allows fortification is not the
Government Ministries and Agencies same as legislation that makes it mandatory. Here
producers want a mandatory statement, but they are
While the MOH was the government agency whose willing to do voluntary fortification. There's a liability
mission most closely matched the objectives of food issue and there's a fear that rivals could slam fortified
fortification, in practice the participation, assent, products with accusations of poisoning."
and coordination of multiple other ministries and
agencies were required to prepare for, regulate, and
oversee the implementation of food fortification at Getting Started
the country level. Ministries of commerce or trade
oversaw import duties, customs regulation and Initial Studies
enforcement, and regulated wholesale and retail
distribution. Ministries of industry regulated the The elements that eventually comprised Faire
production and refining of cooking oil, which was Tache d'Huile emerged as early as 2000. MI in
6. On focal points as the implicit locus of decision making and negotiations, see Thomas Schelling, The Strategy of Conflict (Cam-
bridge: Harvard University Press, 1960).
7
2000 and 2001 funded population studies to help decision to adopt the lower, WTO tariff rates; (2)
identify potential food vehicles for micronutri- the belief that joint action to lobby governments
ent fortification. This involved mapping nutrient would be more effective than their individual ef-
deficiencies and food consumption patterns to forts; and (3) the desire--at least among the stronger
identify commonly consumed, inexpensive, and producers of the region--to capitalize on the pos-
centrally produced food vehicles that could be eas- sibilities of intraregional trade created by UEMOA's
ily fortified. Cooking oil proved desirable due to customs and monetary union. Recalled Tano, "Our
its low cost, daily use in West African cuisine, and productivity was already low because factor costs--
low cooking temperatures (relative to Asia, where energy, logistics, and internal taxes--were high.
repeated stir frying at high heat could break down Some taxes in Senegal were as much as 60%. So we
the fortificant). MI in partnership with HKI also opposed the idea of reducing import duties."
commissioned consultants to undertake industry
assessments to determine which food industries To make its case, AIFO proposed that UC staff
were capable of doing the fortification work. Pre- attend workshops and seminars on tax policy and
paratory work was intense, and was not funded economics. Tano recalled that AIFO's advocacy
by GAIN grants but was required from GAIN ap- was rewarded: "UEMOA took our advice and got
plicants. Questions that needed to be answered in involved, and we developed a good relationship
the preparation phase included: Was food fortifica- with UEMOA. In the process, our organization
tion justifiable? Were local industries sophisticated became well known and involved in policy formula-
enough to incorporate fortification technology tion. No UEMOA decision could be taken without
into their production processes? our knowledge. Getting involved also increased
UEMOA's visibility vis-�-vis member states." AIFO
Government policy dictated whether and how food did not dictate policy, however. Tano fretted that
could be fortified and certified, so any fortification AIFO long wanted to reduce UEMOA's value added
initiative required thorough knowledge of the legal tax on oil products, but had no success until 2008,
framework for fortification policy. In some coun- when rising food costs became a cost of living issue.
tries legal permission was required to add fortifi- "Now we are in the process of reducing VAT to 5%,"
cants to food products, for example. With this in he said.
mind, planners needed to consider whether an ap-
propriate legal framework was in place for fortifica- A continent away, GAIN was launched in 2002 at a
tion to proceed, and if not whether the appropriate United Nations Special Session on Children, with
infrastructure could be developed easily. the goal of fighting malnutrition through public-
private partnerships in affected countries. In Oc-
tober 2002, HKI, MI, UNICEF, and WAHO--four
Producers Coalesce NGOs that had already collaborated at country level
for several years in preparation for regional food
Separately, cooking oil manufacturers and refiners fortification--organized the first public-private sec-
in 2000 founded AIFO, an industrial association tor dialogue on food fortification in West Africa in
whose members shared (1) an anxiety over their Accra, Ghana to increase awareness of the advantag-
individual exposure to cheap cooking oil imports es of food fortification in combating micronutrient
from Brazil and Southeast Asia created by UEMOA's deficiencies. A follow up dialogue for countries not
8
attending the Accra meeting was held in conjunc- November 2007 as well as a regional logo for brand-
tion with the ECOWAS Nutrition Forum in 2003. ing fortified foods.
Separately, HKI's Baker helped catalyze industry
interest in oil fortification by asking to present Meshing the Parts
to AIFO on the subject once he learned of the
group's existence in the course of his work on oil Interests
fortification in Mali. At AIFO's general assembly
of 2004, Baker gave a presentation on oil fortifica- The main challenge was designing a partnership
tion to a receptive audience. The oil industry saw that satisfied the interests of all the various parties.
not only the public health benefits of fortification, "These alliances are fraught with tension," noted one
but also thought that fortification could success- observer. Sablah explained: "There are public in-
fully differentiate their products from the cheap terests in strengthening public health and industry,
(and unfortified) oil imports. AIFO moved at the creating jobs. Private interests are corporate social
meeting to adopt a resolution supporting the for- responsibility and adding value to their product
tification of all oil produced in UEMOA countries. in distinction to foreign imports of unfortified oil.
According to the minutes, AIFO "recommended Fortification strengthens the producer alliance, it
that the [AFIO] executive office undertake the strengthens UEMOA. The oil industry has a strong
necessary steps with policy makers, being the regional association. You have to fortify." This fol-
UEMOA Commission and the Governments of lowed the model used for flour fortification being
our countries to have vitamin A fortification of oil expanded to ECOWAS. To effect change, a stake-
adopted as standard practice within UEMOA and holder explained, "we need strong advocates at the
to undertake communication campaigns targeted regional level. We link the cost of VAD and malnu-
at the population to promote consumption of vita- trition to investment needs. We are also trying to
min A-fortified oils exclusively." Individual AIFO remove import taxes on pharmaceuticals. Vitamin
members supported regional norms as a means of deficiencies are no longer just a public health but
promoting their products and expand intraregional now an economic issue as well. The Copenhagen
trade. As Tano recalled, "I was the managing direc- Consensus made it one of the top issues." However,
tor at Cosmivoire, and at the time we saw fortifica- advocacy was more complex in a context of high
tion purely as a marketing opportunity, as a way to governmental turnover--when officials changed,
promote the brand." the process repeated.
In 2007, the second public-private dialogue in Ba- It was important to consider that all players could
mako, Mali, saw the creation of a regional alliance also be highly complementary. WAHO's Ismael
for food fortification that for the first time included Thiam explained: "The partnership is based on
financial partners, a welcome development, noted comparative advantages. HKI have experts on the
Baker: "Donors tended to be strongly risk averse ground, they also have expertise in VAD. WAHO
and want clear validation of a program's potential tries to catalyze subregional activities. Ministers
direct impact before they commit funds." The UC are informed. Our political mandate gives us an
expert technical committee on standards approved opportunity to ask for information from Ministries
and adopted standards for fortifying cooking oil in of Health. We have to show the private sector what
9
role they can play and that fortification is an oppor- National Fortification Alliances: ANF
tunity to add value to their products and expand
markets." National fortification alliances (ANFs, from the
French acronym) brought together representatives
Particular challenges emerged when all partners from public and private parties needed to par-
agreed on the benefits of fortification, but were ticipate in fortification to supervise and promote
competitors, as was the case for Unilever and Cos- ongoing cross-sectoral dialog on fortification. Only
mivoire (more below). Originally Cosmivoire had actors participating in an ANF received support for
wanted to fortify sugar, not palm oil, because it was fortification from GAIN. Each country set up its
part of a group with a monopoly on sugar produc- ANF differently, often by presidential or ministerial
tion in C�te d'Ivoire. Unilever was not involved in decree, or as an NGO. As such, the ANF was usually
sugar production there. a multi-stakeholder private-public sector legal entity.
However, one observer asserted that "The ANF is
At the public sector level, HKI need to get authori- the result of good intentions that pave the way to
ties involved and think about tradeoffs. For example, hell. While an ANF gives the private sector an op-
the public sector lost money on making fortificant portunity to pressure the government for legislation,
tax exempt. HKI and its experts worked to convince for standards, the forums tend to discuss issues
government to get involved and accept that losing ad nauseum without taking decisions." Although
some tax revenue is worth the gains made by fortifi- cross sectoral discussion could be done without
cation. Many issues such as legislation, competition, the ANF as an intermediary, the ANF facilitated
taxes, and tariffs were addressed by different depart- introductions and relationship building before
ments whose staff and leaders needed to be enrolled actors interacted directly. Conflicts were never far
and subsequently informed. "We need a common away. Oil producers could see the budget figures for
view," a stakeholder explained, "which will lead to a fortification projects and therefore knew what to bid
common understanding of the problem if we are to to win deals.
make progress."
Another potential lever was consumer associations. Launching Fortification:
"We used to bring consumers associations to come in The Experience of Selected Countries
order to have them sensitize consumers about the ex-
istence and value of food fortification," Thiam noted, With an estimated average of 31% of its 235 million
"so that they will look for and register the meaning of people living in towns of over 10,000 inhabitants,
the logo. Consumers associations met in the Bamako West Africa was more urbanized that eastern and
meeting of 2007. But consumer associations didn't do southern Africa.7 In 2005, West Africa produced 1.2
enough. At the country level, they don't know what million tons of palm oil. Average consumption was
role to play. We are even involving the press."
7. "Africapolis: Urbanization Trends in West Africa 1950-2020," Agence Fran�aise de D�veloppement, 2008, www.afd.fr/jahia/Jahia/Afri-
capolis, accessed July 2009.
10
1.7 million tons, with average per capita consump- cost of fortification passed on to the consumer was
tion of 6.3 kilograms per year.8 This compared to not high, about 5 CFA cents, or 1 U.S. cent, per
collective 33 million tons produced by Indonesia, liter. Nevertheless, communications were key. The
Malaysia, and Thailand in 2006.9 "At one point in communications component ranged a gamut of
time Asia could not compete with West Africa," formats from formal advocacy, to elevator talks, to a
Tano pointed out. "Now, in one week Asia out-pro- concerted media campaign, in West Africa on radio
duces West Africa." and television in that order, as low literacy levels
precluded the effectiveness of print media in the
See Exhibit 4 for an overview of the state of imple- areas and populace most affected by VAD.
mentation in francophone West Africa and Exhibit
5 for the state of oil fortification in West Africa According to David N'Dri, HKI Adbidjan, there
outside UEMOA. Baker felt that Senegal should be were three major strategies: advocacy, social mar-
the farthest along with fortification. "The industry keting, and communication/mobilization. Social
is ready to produce," he explained, "but the bu- marketing was marketing the cause, not selling a
reaucracy is glacial." Thiam agreed: "Advocacy of product. "We are selling a cause," he explained. "We
fortification is facing a big bureaucracy in Senegal. use traditional marketing strategies such as TV,
So far, the bureaucracy is winning." On March 5, radio, and commercials, as well as mixed marketing
2009, however, Senegal's president signed a decree tools and community participation and mobiliza-
for mandatory fortification such as existed in C�te tion to raise the awareness on the benefits of forti-
d'Ivoire and Mali. According to MI's Banda Ndiaye, fied foods." Selling a case required advocacy at many
"In Senegal, we hope fortification will start within levels, N'Dri explained. "At the institutional level it
three months. We also want to evaluate imports. We takes time for ministries to come to agreement and
want to do a baseline survey too, to assess existing execute on their areas of responsibility. Typically,
vitamin A and iron coverage, and we await funding the MOH took the lead in approaching the others
for lab analysis." and urged them to get involved. Coordination also
required discussions in the UEMOA Ministerial
Examination of the fortification process in Mali and Council with heads of state as a Ministry of Health
Burkina Faso follows a deep dive into the process agenda item. It involved the development of train-
and outcome in C�te d'Ivoire, one of the most ing workshops for regional directors of health and
advanced countries in terms of oil fortification, regional district directors, and finally an effort to
beginning on page 14 below. reach social opinion leaders.
A common logo for the fortified product was
Telling the Story in the works. A West African logo would help
consumer awareness about fortified foods and
Regardless of location, consumer adoption was key their benefit to the health of children and moth-
to the effort bearing fruit. It helped that additional ers. The target group would be the population at
8. Micronutrient Initiative, "Fortifying Africa's Future," (Johannesburg, South Africa: Micronutrient Initiative, 2006), p. 26.
9. United States Department of Agriculture, Foreign Agricultural Report, "Indonesia: Palm Oil Production Prospects Continue to
Grow," Commodity Intelligence Report, December 31, 2007, www.pecad.fas.usda.gov/highlights/2007/12/Indonesia_palmoil/, ac-
cessed May 11, 2009.
11
large and specifically those in the rural areas and ergistic rather than conflicting. One advantage of
at greatest disadvantage. At the time of the case, regional effort was the ability to set out a regional
the C�te d'Ivoire logo (see Exhibit 6) was adopted standard for practice, legislation, and certification.
with some modifications for application on a Another was the ability to work directly from the
regional basis. However, a number of obstacles start with regional institutions and a region-wide
made its immediate use problematic. These ob- industry association to accelerate fortification
stacles were in the process of resolution in order within individual countries and the region. A third
to make the logo available for branding fortified was the impact of harmonized standards. The
foods by the industry. challenge was in managing a large number of ac-
tors all moving at a different pace. The advantage
National governments tended to promote logos of national level effort was its easier focus and the
their industries use, Baker explained, but it became ability to bypass the idling that regional coopera-
clear at the regional level that myriad logos might tion typically entailed when some members were
be counterproductive. Branding was important and less prepared or capable than others.
should be considered at a pan-national level, he said.
The topic was discussed at a conference in Dakar in Patrice Bosso in HKI's Abidjan office elaborated:
February 2009 that brought together the UC and "The community based process is very slow. Oil
WAHO plus technical representatives from UEMOA fortification started in 2007 and is to be completed
member countries. "The UEMOA wanted a stan- by 2010. However, it took one year to develop the
dard logo to be applied to any fortified product, re- regulatory framework. Member countries have
gardless of industry or place of manufacture," Baker the ability to go faster, but once adopted at the
explained. The conference was discussing what stan- regional level, it becomes compulsory for each
dard to agree to. In addition to adopting a regional member country to adopt. The dilemma is whether
logo to allow consumers to easily identify fortified to wait on adoption regionally or move early at the
food products, it was proposed that UEMOA create national level."
an additional mark indicating conformity with food
fortification standards. Industry players were also Broadening HKI's regional efforts to the 15
interested in the use of the broader regional logo, ECOWAS states would follow, Baker added:
Baker believed. "Working with the UEMOA Commission as a first
step in the regional effort is ideal for moving the
fortification agenda more easily to the broader
Ongoing Challenges ECOWAS level." This was because a memorandum
of understanding existing between the UEMOA
Regional versus National Fortification Efforts and ECOWAS Commissions stipulated that
ECOWAS would adopt standards established by
Among the most vexing challenges HKI faced UEMOA. However, this meant harmonizing UE-
was the complex question of whether and to what MOA standards with existing national standards
extent to forge national effort into a regional level in Anglophone countries, such as Nigeria and
initiative, and conversely how to use a regional ini- Ghana, ultimately facilitating intra-regional trade,
tiative to accelerate national efforts. Helpfully, HKI with likely adverse consequences for the smaller
viewed regional and national efforts as mostly syn- national level players.
12
Cross-Border Trade and Harmonization food producers bore in developing countries and
help provide credit lines. Development banks, for
The next big challenge for further efforts across the example, could be contacted for discussion on the
region but also the broader continent was border establishment of a fund to support lines of credit for
control. "There are 100 land border crossings in the cereal flour milling and vegetable oil industries
West Africa," Baker explained, "versus a strategic and other private sector players. Banks could enter
number of ports. This is the advantage of a regional a partnership with GAIN or HKI to establish such a
approach: you don't have to police the land bor- funding mechanism for the private sector's fortifica-
ders with anything like the same level of scrutiny tion effort. The major concern of the private sector
as otherwise." Common external tariffs could for was carrying an inventory of micronutrients that
example limit smuggling and impose more stan- tied up cash flow at a time when working capital
dards. The borders, however, remained porous and was particularly tight.
enforcing such standards tenuous. "The big issue
is import control of competing fortified products,"
Baker explained. "When I first arrived five years ago, global premix procurement facility
village markets in Senegal mostly carried Senegal-
produced oils and palm oil producers were more Micronutrient fortificant (premix) was the largest
local. Today we see products from other countries." recurrent input cost for large-scale mass food fortifi-
cation programs. Procuring this premix was not
Furthermore, for uniformity it was recommended without complications: access to suppliers; inflated
that all countries use the same units of measure- prices; access to upfront capital for large purchases;
ment in their fortification standards, preferably lack of quality assurance and monitoring of deliv-
mg/kg, since vitamin A premix was measured in ered products; and, often, the lack of funds.
those units. As part of the harmonization, it was
also important that the fortified products be labeled Some observers suggested that GAIN had a strong
with the same units--either mg, IU, or RE (retinol comparative advantage in designing, managing and
equivalents)--to indicate the levels of added nutri- operating a Global Premix Procurement Facility.
ent included. This would make comparison of nutri- The food fortification efforts that GAIN supported
ent levels in products from the different countries were already establishing large new markets for
easier. Even as a result of the harmonization, in the premix industry and would continue to do
setting standards for vitamin A, the other sources of so with the addition of a new Infant and Young
vitamin A in the diet of particular country had to be Child Nutrition Program and the GAIN�UNICEF
taken into consideration. Universal Salt Iodization Partnership Project that
supported the creation of a revolving credit facility
to local millers and vegetable oil refineries to access
Making Things Easier fortificant. The cost of micronutrients premix corre-
sponded to US$1.00 to US$5.00 per ton of fortified
a credit line food and generally represented between 0.5% and
2% of the cost of the final product. However, for
Some observers believed that proponents of food companies fortifying large amounts of food, premix
fortification should assume some of the risks that cost could hamper cash flow.
13
Developing such a facility would require identify- for their brand: "The fortification idea came from
ing milling and refinery production capacity and HKI. We at Cosmivoire saw it as a marketing op-
market size; analyzing the cost of purchasing food portunity. At first it was a question of marketing, a
fortificant relative to each producer's productive way to promote the brand. But it has been a process
capacity; assessing the capacity of GAIN suppliers of development. The common market was not yet
to meet the demand for fortificants in each targeted implemented and [producing oil fortified with]
country; and reviewing distribution channels and vitamin A cost slightly more. At the time we gave it
the capacity to receive fortificants on a regular basis two years, one year to convince, one year to imple-
to meet production levels. ment." The goal was to be able to provide 80% of the
population with access to fortified oil by 2008.
A Country Case Study: C�te d'Ivoire
Public Participation: Setting and Running the
C�te d'Ivoire, with about 19 million people sharing ANF (Association Nationale de Fortification)
322,462 km2, bordered Liberia and Guinea to the
west, Mali and Burkina Faso to the north, Ghana Patrice Bosso, HKI Abidjan, elaborated: "Cos-
to the east, and the Gulf of Guinea and the Atlantic mivoire had a marketing concept: cholesterol free
Ocean to the south. The economy relied heavily on cooking oil. No social dimension existed in their
agriculture, with smallholder cash crop produc- thinking, it was just a marketing strategy. And
tion being dominant. C�te d'Ivoire was prescient in there was no public participation." The idea of pub-
pushing for food fortification. Salt iodization had lic-private collaboration in the region was raised by
begun in 1985, for example, and a 1998 a presiden- WAHO and HKI at Accra's 2002 first public-private
tial decree mandated that oil be fortified. The Ivoir- sector regional dialogue on food fortification.
ian standard for oil fortification is 25-30 interna- There was also an opportunity: in 2003 the Ivoirian
tional units (IU) per gram, which provided 30% of MOH tendered bids to raise funds for fortification
recommended daily allowance of vitamin A. of oil and flour at the national level. HKI supported
the proposal and approached GAIN in 2005 for its
support. As a result, C�te d'Ivoire received money
The Players for the food fortification in what was called the
PIPAF project.
Unilever began voluntary fortification of oil in
2001, well before other AIFO producers. However, Public actors also converged in the creation of the
both Unilever and Cosmivoire (C�te d'Ivoire's two Ivoirian ANF in 2003 as part of GAIN's first round
leading oil producers) participated in the 2004 of fortification funding to developing countries. It
AIFO general assembly where Baker presented. The was important to note that GAIN did not suggest
meeting changed their view: fortification was no nor mandate that ANF be set up. "They gave us
longer seen as a pure business situation. Even so, conditions for GAIN funds to be released for man-
despite the enthusiasm at the AIFO level, Tano re- agement by the ANF," ANF Secretary General Pierre
membered that he and his colleagues at Cosmivoire Gagne said. "GAIN told us how the funds were to
did not see fortification as a public health benefit. be managed: for funds to be released, the country
Rather, they viewed fortification as a marketing tool needed to create a forum of government, industry,
14
civil society, and development partners (WHO, on capitalizing the achievements to date. "When
UNICEF, World Food Program). The forum should we created the fortification logo we made sure the
elect a general assembly and establish a structure to alliance would take ownership and take it to others.
conduct operations. We decided on a structure. The Alliance members presented the logo at a UEMOA
government expressed willingness to reduce tax on meeting, for example." Finally HKI helped make
fortificant. We elected the MOH to head the ANF, members responsible for action.
unanimously. All the members were busy in their
own businesses but we needed structure in charge According to ANF Secretary Pierre Gagne, C�te
of matters on a daily basis." The ANF decided that d'Ivoire's ANF general assembly met every six months
HKI should be implementing the project under the to discuss the status of fortification implementation.
supervision of GAIN. In the process, GAIN picked In some instances, extraordinary meetings might be
HKI to manage the money so that HKI wore a called as had been the case to consider, design and
double hat in C�te d'Ivoire, as implementing agency approve the "caravan," a truck that traveled through-
and manager of GAIN funds. Bosso, from HKI out C�te d'Ivoire presenting information on food
Abidjan, actually saw three roles for HKI in C�te fortification to out of the way inhabitants.
d'Ivoire: legal framework, capacity building, and
coordination of action. The general assembly usually considered two items,
namely the daily operations of the ANF and HKI's
Headed by a political appointee from the MOH, implementation status, and was the body that made
few believed the ANF had reached its full potential. major decisions. If a newcomer wanted to join
However, it was very hard for anyone to withdraw the ANF general assembly, the assembly decided
from the group, as doing so created the impres- based on the recommendation of the Scientific and
sion that the withdrawing party has no concern Technical Committee. In terms of reporting, Gagne
for public health. "We get in touch with each ANF and the Minister of Health signed general assem-
member to make sure they respect their com- bly minutes for submission to GAIN and approval
mitments. Also studies and experience is shared," of HKI reports. GAIN usually did not ask for the
HKI's David N'Dri explained, "and so are studies report but worked via HKI to make their audit or
from different countries. We've supported alliance gather information. "GAIN is supposed to report
members to attend conferences on fortification. to ANF on meeting with the implementing agency,"
The major idea was to maintain alliances. Also, it's Gagne pointed out, "but they never have. HKI will
a way to show that all players will gain something. tell us that GAIN is here in C�te d'Ivoire. We won't
To do the organizing, we started advocacy to get otherwise know."
in touch with the various organizations relevant to
the alliance. We also convinced the public authori- The ANF permanent secretariat had a structure
ties to issue a decree to establish the ANF." This with technical and scientific committees, among
required one on one meetings to convince all others, which brainstormed issues once a month.
partners to join the alliance; HKI created these HKI funded them per the agreement. "If we wait for
opportunities. "The more they meet, the more the government to fund it would never happen," Gagne
alliance is alive. HKI capitalizes." HKI also helped explained. "On paper we have 12 people but only 4
identify international events and get members actually exist. We have no fuel. Government lacks
interested in taking part and focused members the means to equip the secretariat. Government has
15
passed laws but is losing money (in taxes) because without a legal framework. It took one year." In the
of it. It was not easy." end four ministries--of Health, Industry, Com-
merce, and Economy and Finance for the prime
minister--signed an agreement into force. The next
Institutional Framework: The Ground Rules stage was to have a presidential order issued, fol-
lowed by new legal frameworks, for salt iodization,
A second element of fortification in C�te d'Ivoire for example. The Ministry of Economy and Finance
was to build the capacity of control institutions: signed the decision for tax exemption of inputs used
labs, offices of the directorate of quality promotion for fortifying. The Customs director also signed
and standardization, and the various ministries. and enforced the implementation orders barring
The Ministry of Commerce had to control illegal imports of unfortified oil and flour.
oil, fight fraud, enforce compliance with fortifica-
tion rules, and monitor the market for food safety Other agencies were involved too: the National
issues. The Ministry of Commerce and the Min- Public Health Laboratory sampled in the field to
istry of Industry were two distinct institutions in verify compliance with parameters and the MOI
C�te d'Ivoire. The Ministry of Industry monitored Office of Promotion of Quality and Standardiza-
factories. At the time, explained HKI Abidjan's tion performed inspections. "Each one comes and
Bosso, "there was no legislation regulating factory expresses their work conditions and concerns about
quality, but under the fortification system, firms operations," Gagne noted. "All are under the ANF
had to agree to accept Ministry of Industry check- permanent secretariat and forward the results to
ers. Minimum consensus was reached on the level HKI as implementor. HKI is in charge of executing
of fortification although the industry's wish was to on those concerns. HKI gets funded for this."
do production and raw material checks only. The
Ministry of Industry wanted to check everything
in every plant, but industry refused because it was Outcome
already producing at ISO 2000 and C�te d'Ivoire
fortification standards." New entrants had to be at The project started in 2005, though with an existing
that standard too before they could start fortifica- 55% coverage rate for Ivoirians, thanks to Uni-
tion. "This is an example of consensus: loss and lever's preexisting oil fortification. At the time the
gain to both sides. Industry agreed to MOI inspec- country's civil unrest was ebbing, but the country
tions every three months but now they are every remained effectively split in two between north
two months. MoI samples the premixed fortificant and south. Despite years of upheaval, four different
and the final product. Industry conceded to MOI ministers signed the document decreeing manda-
inspections. MOI agreed to the process. We have tory oil fortification.
not seen any implementation problems."
Production data from 2007 indicated that Unilever
Finally, the Ministry of Economy and Finance had had capacity to produce 100,000 metric tons of
to be involved to manage some grant money and palm oil, and Cosmivoire could produce 80,000
the tax exemption process. Getting all these pieces tons of palm oil. United Oil Company (UOC) was
together Bosso said, was "the hardest part. GAIN's set up in 2006 and began fortification in 2007, with
position was that there would be no more funding a theoretical capacity of 40,000 tons. Trituraf, a
16
small producer of cottonseed oil, closed due to lack catalyst. With too many people involved, conflicts
of raw material in the face of prices for cottonseed of interest abounded: industry saw the budget for
that were exceeded by the cost of production inputs. the project and hence knew what to bid; or there
Trituraf was attempting to reopen in early 2009. was poor clarity around ANF's role, as oversight or
implementer.
One third of C�te d'Ivoire production was exported.
Cosmivoire exported to Benin and Togo, Unilever
exported to Mali, Burkina Faso, and Niger. Major Country Vignettes:
agribusiness player Olam was a shareholder of Cos- Mali and Burkina Faso
mivoire, and bought unrefined oil for local process-
ing. From early 2007 unrefined oil prices rose 40%, Mali
increased finished prices in 2008.
context
To educate Ivoirians about the benefits of food for-
tification, the caravan had put on shows throughout The seventh largest country in Africa and among
C�te d'Ivoire to reach audiences as diverse as army the poorest in the world, Mali was a landlocked
leaders and local chiefs, among others. Reaching the nation, bordered by Algeria on the north, Niger
most remote areas was essential according to N'Dri, on the east, Burkina Faso and the C�te d'Ivoire on
because "not easily reached people are the most the south, Guinea on the south-west, and Senegal
important to reach. Such an effort involved a team: and Mauritania on the west. Its size was just over
HKI, a communications agency, the national nutri- 1,240,000 km� with an estimated population of
tional program, and the ANF office." The outreach almost 12 million people. Mali's borders on the
also involved public puppet shows, public criers, or north reached deep into the middle of the Sahara
"griots," as well as short speeches from prefects, the Desert, while the country's southern region, where
ANF, nutrition program staff, artists, and humorists. the majority of inhabitants lived, featured the Niger
These GAIN-funded efforts were to be completed by and Senegal rivers. Agriculture and fishing were key
August 2009. economic and social pillars, although the country
also had gold, uranium, and salt resources.
In terms of process, some saw tensions. "The private
sector was unhappy with the ANF because it took
a long time to arrive at decisions," explained a re- process
searcher familiar with the situation. "There was too
much discussion. Non-primary role people inter- A key challenge in Mali was getting the consumer
vened in areas they didn't know anything about. For organizations onboard. The power of consumer or-
example the person in charge of communications ganizations varied across countries but in Mali they
prepared a promotion campaign for fortified oil, but were strong and tended to be hostile to imported
the Ministry of Health intervened about fashioning products and highly protective of the consumers.
the message. They'd get bad advice, have to report The goal here was to head off the misperception
back to the group; it took up time and accomplished that fortified products were somehow suspect and
nothing." More generally this researcher believed should be avoided. Beyond that the power of a
that ANFs might be a roadblock as much as a consumer organization could be harnessed to serve
17
as strong advocates for the cause of fortification in the region in Mali. HUICOMA was the country's
and more generally to promote a particular product biggest industry, but it is now barely functioning."
among consumers. On the positive side, the fact
that HUICOMA; the largest oil producer in the
country produced cooking oil in Mali and fortified Burkina Faso
it with the blessing of the government meant that
the issue was not entirely novel. In addition, since context
the oil was locally produced, Mali's anti-import sen-
timent could not be channeled against this cause. Like Mali, Burkina Faso was landlocked, surround-
ed by Mali to the north, Niger to the east, Benin to
the south east, Togo and Ghana to the south, and
outcome C�te d'Ivoire to the south west. Its 13 million people
lived in 274,000 km�. Burkina Faso was the leading
Overall the edible oil industry had seen major ups cotton producer in Africa. World Bank subsidies
and downs in part because of massive price fluctua- and recommendations had encouraged Burkina
tions in the movement in other commodities. For Faso's focus on the crop at the expense of peanut
example, Mali's major oil producer, a parastatal in oil production. (Palm plantations for palm oil
the process of being privatized, came under pres- were sited only along coastal Africa.) Domestically
sure when a crash in cotton prices led to a drop produced oil met only about 40% of Burkina Faso's
in production, reduced the supply of raw materi- demand, reflecting a sharp decline in cottonseed
als and raised demand for imports of palm- and availability. Access to cottonseed depended on the
peanut-based cooking oil. The demise of the state local cottonseed associations. There were 250,000
monopoly also meant that output was now divided tons of cotton seed available for the year, of which
among several producers. In early 2009 Unilever in 80,000 tons were reserved for SN-Citec (Citec), the
C�te d'Ivoire was exporting oil to Mali. There had country's major oil producer, and 85,000 tons for
also been institutional tensions. Observers reported smaller, less efficient firms. Much of the country's
that the head of the oil company was original skepti- cotton was exported for clothing.
cal about the effort, and the fact that the effort was
driven by the Ministry of Health, a relatively low Established in 1941, Citec in 1995 had invested
priority ministry, did not help drive policy. CFA 12 billion in new U.S. production technology
to increase capacity and modernize. The process
According to AIFO president Bintou Diallo, Mali was unusually efficient, permitting Citec to generate
had been a major cottonseed producer, with capac- 95% of the power that it consumed for production
ity three times that of neighboring Burkina Faso. from otherwise unused cottonseed husks, and to
However, due to cheap Asian palm oil imports and produce protein-rich pelletized animal feed with
the unavailability of domestic cottonseed, Mali in husks and cake created as a byproduct of the oil
2008 did not produce even 10,000 tons. "They are production process. Citec was the first plant in
flooded with Asian oil. They moved to sunflower oil, West Africa to install the process. At the time of the
brought in peanut oil, but it was hard to produce case Citec processed about 120,000 tons of cotton
up to capacity for several years in a row. We didn't seed per year, yielding 20,000 tons of oil. While this
expect this situation. Fortified oil was first launched made Citec Burkina Faso's leading oil producer, it
18
was still small by regional standards, where plants consumer was CFA 5 cents, or one US cent per liter
yielded 40,000-45,000 tons of oil per year. Burkina's of oil, an amount that observers and participants in
production of all fats (butter and oil) was 70,000- the process expected consumers could easily bear.
75,000 tons per year, of which vegetable oil com- About 70%-80% of the market would have access to
prised 40,000-45,000 tons. Number two company fortified oil by 2010. While Citec president Bintou
Josira produced some 7,000 tons of oil annually. Diallo noted that social marketing by the MOH in
Small scale artisanal producers contributed limited the media had been effective in boosting consumer
quantities as well. The remaining oil on the market awareness, "since fortification has became manda-
in Burkina Faso was palm oil imported from C�te tory, it is irrelevant in the end anyway."
d'Ivoire and Malaysia.
Unfortunately, in February 2009, Diallo had the sad
task of announcing layoffs and planned to shut-
process ter Citec for four months of 2009, far longer than
the typical annual one-week shutdown for clean-
Baker and other observers believed that having the ing and maintenance. Citec expected only 100,000
MOI leading fortification in Burkina Faso instead of tons of raw material in 2009. Citec hoped to secure
the MOH was more effective because food fortifica- another 20,000 tons through a different association
tion was primarily an industrial issue at the imple- of Burkina cotton producers. Failing to produce to
mentation level. The results improved public health, capacity could cost Citec as much as CFA 300 mil-
but the measures needed to get the program going lion (150,000) in lost discounts on raw materials.
were closer to industry's needs and related to their Citec's operations manager explained, "Cottonseed
challenges in the market and in regulatory issues. In needs to have a 21% oil content. If suppliers offer
Burkina Faso the MOH had been a somewhat more us cottonseed with 20% less than that, we pay them
difficult bureaucracy, Baker explained, very inter- less for it. There are moisture parameters too, and
ested in getting funding for projects but unwilling additional discounts for substandard cottonseed.
to commit the necessary resources to put them into Fiber content must be 11% and there are acidity
action. In addition, Burkina's ANF was considered requirements as well. All of these factors affect
less effective than others in the region. what we will pay for cottonseed. However, now that
the quantity of cottonseed in the market is limited,
Citec can no longer force discounts on suppliers for
outcome lower quality cotton because we are lucky just to
buy what we can. Regardless of cottonseed quality,
Citec began selling fortified oil in May 2008. In early however, our refined oil must meet fixed standards."
2009, 100% of Citec's oil was fortified with vita- Insufficient cottonseed supply meant that Citec
min A. The cost of fortification at Citec was as yet would face substantial oil imports in the Burkina
unclear, because HKI had been financing Citec's for- marketplace. Though Diallo was quick to protest
tificant purchases indirectly, and Citec would only the share of the West African market captured by
begin taking full responsibility for its fortificant imports from Brazil and Southeast Asia, Citec's in-
purchases in November 2009. The company added ability to meet demand offered no other choice.
60 IU of vitamin A per gram of cooking oil, and la-
beled its oil as such. Total cost of fortification to the
19
Exhibit 1. UEMOA--West African Economic and Monetary Union
20
Exhibit 2. Estimated VAD incidence and child deaths, Sub-Saharan Africa, 2004
Sub-clinical VAD in children Annual number of child
Country under 6 years of age (in %) deaths from VAD
Angola 55 34,000
Benin 70 9,000
Botswana 30 500
Burkina Faso 46 20,000
Burundi 44 8,500
Cameroon 36 10,500
Central African Republic 68 5,000
Chad 45 12,500
Congo 32 1,500
Congo Democratic Republic 58 96,000
Eritrea 30 1,750
Ethiopia 30 51,000
Gabon 41 450
Gambia 64 1,000
Ghana 60 12,000
Guinea 40 8,000
Guinea-Bissau 31 1,750
Kenya 70 23,500
Lesotho 54 1,100
Liberia 38 5,000
Madagascar 42 13,000
Malawi 59 17,500
Mali 47 24,000
Mauritania 17 1,500
Mozambique 26 14,000
Namibia 59 500
Niger 41 26,000
Nigeria 25 82,000
Rwanda 39 9,500
Senegal 61 9,500
Sierra Leone 47 13,250
South Africa 33 6,000
Swaziland 38 600
Tanzania 37 --
Togo 35 3,250
Uganda 66 29,000
Zambia 66 19,000
Zimbabwe 28 4,900
Total
Source: The Micronutrient Initiative, "Vitamin and Mineral Deficiency: National Damage Assessment and Protec-
tion Audits, 2004," (LOCATION: Micronutrient Initiative and UNICEF, 2004), p, 2,
21
Exhibit 3. Estimated annual economic losses due to VAD and other vitamin and
mineral deficiencies (percent of GDP)
Country Percent of GDP loss US$ estimate in $000s (2004)
South Africa 0.4 851.1
Nigeria 0.7 504.7
Kenya 0.8 124.8
Botswana 0.6 51.9
Mozambique 1.2 66.5
Zambia 1.3 70.1
Malawi 1.4 25.3
Guinea-Bissau 1.5 4.2
Source: Micronutrient Initiative, "Fortifying Africa's Future," (Johannesburg, South Africa: Miconutrient Initiative,
2006), p. 3.
Exhibit 4. State of implementation in francophone West Africa
Burkina C�te Guinea-
Action Benin Faso d'Ivoire Bissau Mali Niger Senegal Togo
Nutrition policy on food
fortification
Nutrition status assessment
Food vehicle identified
National alliance
established
Identification of site within
industries
Identification of equipment
needs
Establish standards
Launch fortified foods
Logo for branding fortified
foods
Social marketing/logo for
branding
Monitoring and evaluation
Impact evaluation
22
Exhibit 5. State of oil fortification in West Africa non-UEMOA
Sierra Cape
Action Ghana Guinea Nigeria Gambia Liberia Leone Verde
Nutrition policy on food
fortification
Nutrition status assessment
Food vehicle identified
National alliance
established
Identification of site within
industries
Identification of equipment
needs
Establish standards
Launch fortified foods
Logo for branding fortified
foods
Social marketing/logo for
branding
Note: No large-scale cooking oil manufacturing existed in Guinea. Normally, refined cooking oil was imported
and repackaged for domestic sale there.
Exhibit 6. C�te d'Ivoire's oil fortification social marketing and logo
23
Exhibit 6, continued.
24