Malnutrition in Tanzania: will food fortification laws work?

Tanzania has one of the world’s highest rates of chronic malnutrition. Measured as stunting (when children are too short for their age), malnutrition affects 42% of children under five. This rate has fallen only two percentage points since 2005. Malnutrition takes a major toll on human health in the country, chronic malnutrition during the first two years of life leaves children permanently vulnerable to ill health throughout their lives, even if they have better access to food as adults.

Over the last four years, Tanzania has seen a growing recognition that addressing undernutrition needs to be a political priority. One significant response has been a large-scale food fortification programme, which aims to reach 10 million Tanzanians by 2015. However, the programme faces major challenges in the informal markets, as small businesses are unlikely to comply with the legislation, where the majority of poor and undernourished people buy their food.

Tanzania’s fortification programme was initiated by an alliance between government, donors and food processing companies. Legislation passed in 2012 requires all businesses to fortify wheat flour, maize flour and vegetable oil by adding trace amounts of iron, vitamin A and/or zinc. The Tanzania Food and Drug Authority oversees compliance with the law, while donor agencies and international NGOs provide training and technology for the industry and the government regulatory agencies. The outcomes of these efforts are only just beginning to be seen. Having offered companies an initial grace period, regulators began checking for compliance earlier this year. Reports on how they have got on have not yet been released.

Even under the best of circumstances, ensuring that businesses comply with such precise standards is a complex endeavour. Tanzania’s Food and Drug Authority faces additional challenges in fulfilling its monitoring and enforcement role, being short both on trained staff and equipment. It has only four offices outside Dar es Salaam, while one regional office with only two inspectors is expected to monitor as many as 1,000 or 2,000 maize flour millers.

Nigeria’s decade of experience with fortification highlights the difficulties of motivating the private sector. According to a recent study, despite support from development partners and commitments from large companies, only about 30% of products in the country’s markets contained the levels of micronutrients required by law. Some observers suspect that, facing stiff price competition, companies chose to cut back on the micronutrient premix added to products.

Meanwhile, in Tanzania, the government and development partners are finding it particularly difficult to ensure compliance among the businesses that sell to poor people at the base of the pyramid. For example, most of the tens of thousands of small maize flour millers in the country provide a livelihood for a single person and do not even appear in government records.

Recognising this problem, a donor-funded project has since 2011 aimed to work with small businesses in several regions. Yet as of early 2014, not one of the businesses had been able to undertake fortification. One reason for this was that most were unable to meet the requirements for official registration, while the government has made it illegal for unregistered businesses to fortify their products. The project, facing pressure to demonstrate impacts in a short time frame, switched strategy and placed less priority on small businesses. The small businesses are often providing livelihoods for people who themselves are quite poor. Greater regulatory pressure means they have to go to further lengths to disguise their activities or bribe inspectors in order to avoid being closed down, and this damages their livelihoods.

Yet, small businesses will be crucial to the success of fortification in reducing undernutrition among Tanzania’s poorest communities. Even large, well-equipped companies are unlikely to comply if they are competing with cheaper, unfortified products made by small businesses.

In response to this challenge, Tanzania’s food fortification programme needs to expand its efforts to provide training and support to small enterprises. For example, it can support supply chains for micronutrient mixes tailored to the needs of small businesses, which often produce irregularly and in small batches. Reducing the costs of business registration and improving interactions between small businesses and local inspectors could also bring more businesses on board.

In addition, awareness campaigns need to provide information to the public on how to ensure good nutrition for children and the advantages of fortified products. Tanzania’s government recently formalised commitment to raising public awareness through a national nutrition social and behaviour change communications strategy. At the same time, there is a gap in knowledge about where and how people source food, and whether the products targeted by the fortification programme actually reach Tanzania’s rural poor. More detailed evidence on where undernourished people live and where they get their food is crucial to building effective nutrition programmes.

In short, Tanzania’s fortification programme needs a clearer strategy for working with informal businesses that supply poor populations – even as it monitors compliance by large companies. Yet strategies to develop new products and improve their nutritional content through fortification cannot solve the undernutrition problem on their own. Social protection programmes are urgently needed to build households’ ability to buy and produce food. Building markets for nutritious foods is part of the solution, but won’t address the factors that make households vulnerable to undernutrition in the first place.

Ewan Robinson is a research officer at the Institute of Development Studies and Martha Nyagaya is food security and nutrition adviser at Irish Aid.

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Fortifying foods: four lessons for micronutrient distribution

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