Introduction
As part of DC’s broader health initiatives, Wheat Flour Fortification to Combat Anemia focuses on addressing one of India’s most urgent public health challenges -iron deficiency anemia. Implemented under the Fortify Health program, this initiative partners directly with wheat flour mills to fortify chakki atta with iron, folic acid, and vitamin B12 -micronutrients essential for preventing and reducing anemia, particularly among women and children.
By working within existing market systems, the program ensures that fortified flour reaches consumers through everyday channels, making improved nutrition both accessible and sustainable.
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The core strength of the Wheat Flour Fortification program lies in its low-disruption, high-impact design. Consumers continue buying the same brands of flour through familiar commercial channels-only now, that flour is nutritionally enhanced. This model eliminates the need for behavior change or added expenditure while making healthier food accessible at scale. Most beneficiaries are everyday families-both urban and rural-who consume the fortified flour regularly.
Background
This program was initiated in 2017, sparked by the urgent question: How can one fill a gap to improve public health at scale cost-effectively? This inquiry led to the recognition of the rampant and severe impact of anaemia across India, prompting the need for decisive action.
With over 52.2% of pregnant women and 67.1% of young children suffering from anaemia, the project identified a critical avenue for intervention. In 2018, thanks to a grant from GiveWell, Fortify Health embarked on its mission to enhance the nutritional content of wheat flour at scale, making a significant step towards public health improvement.
Goals and Objectives
The project’s vision is to build a healthier world where everyone has the micronutrients they need to survive and thrive. In India, more than 52.2% of pregnant women suffer from Anaemia (NFHS-5), and 67.1% of young children in India suffer from Anemia (NFHS-5).
The project understands that anaemia has a range of negative health effects as it causes tiredness, fatigue, impairment of physical growth and cognitive development, and leads to adverse reproductive outcomes (WHO, 2023). In an attempt to combat anemia, the project looks at nutrition as a key facet in strength and hence, the project focuses on the solution of fortification.
The objectives of Fortify Health are centred around four main pillars:
Health Improvement: To decrease the prevalence of iron deficiency anemia and reduce the incidence of neural tube defects.
Nutritional Enhancement: To ensure that essential micronutrients are readily available in the daily diet of the population through fortified wheat flour.
Community Awareness: To educate the community and relevant stakeholders about the health benefits of micronutrient fortification.
Sustainable Health Practices: To facilitate the adoption of fortification practices among atta millers and integrate these fortified products into government nutritional programs.
Implementation Strategy
This program adopts a multi-faceted approach to fortification. The project partners with local atta millers to encourage the addition of essential vitamins and minerals into wheat flour. This collaboration is facilitated through the provision of equipment, high-quality premixes for fortification, and comprehensive training to ensure adherence to the standards set by the Food Safety and Standards Authority of India (FSSAI).
Moreover, Fortify Health actively engages with government authorities to ensure that fortified atta is incorporated into various government-sponsored programs, including school meals and the public distribution system (PDS).
Impact and Future Direction
Since its establishment, Fortify Health has successfully fortified 19,889 metric tonnes of atta monthly. Through partnerships with 74 mill operators across India, the project has reached an estimated 3.2 million beneficiaries each month. The ongoing expansion efforts include extending operations to two additional mills in Maharashtra and negotiating with eight more mills in both Maharashtra and West Bengal.
Additionally, Fortify Health is actively engaging with state governments to include fortified wheat flour in school meal programs and to conduct diagnostic studies on fortification in the PDS system in West Bengal.
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With its sustained impact and expansion plans, our food fortification initiative is poised to continue making a significant difference in the nutritional health landscape of India, thereby supporting DC's overarching goal of improving public health through strategic partnerships and innovative health solutions.