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Four principles for large-scale rice fortification

August 2, 2022 by Dr. Sudhir Maknikar (Director, Family Health)

Lessons from the groundbreaking partnership between the Indian government and PATH.

Fortified rice being cooked for a school lunch program in India. PATH provides technical expertise for scale-up of fortified rice, supply chain optimization, quality assurance and control, social behavior change, evidence generation, and more. Photo:PATH.

Fortified rice being cooked for a school lunch program in India. PATH provides technical expertise for scale-up of fortified rice, supply chain optimization, quality assurance and control, social behavior change, evidence generation, and more. Photo: PATH

Micronutrient deficiency–related malnutrition is one of India’s most pressing public health problems. It has dire consequences on people’s physical and mental development and on the country’s economic progress, demanding urgent and effective solutions that can slow and even prevent these harmful effects. One complementary solution is particularly promising: large-scale rice fortification.

The proven potential of fortified rice to reduce malnutrition has led a few countries, including India, to mandate its supply in food social safety net programs (SSNPs). The government of India aims to supply fortified rice in all its SSNPs by the year 2024, with the goal of delivering essential micronutrients to over 800 million people and improving health outcomes among people and communities experiencing the most acute malnourishment.

PATH is proud to support these efforts in India, drawing on decades of extensive rice fortification experience all across the globe. In India, PATH is a technical partner in eleven states and one union territory: Andhra Pradesh, Assam, Bihar, Jharkhand, Karnataka, Maharashtra, Manipur, Nagaland, Punjab, Tamil Nadu, Uttar Pradesh and Jammu and Kashmir.

Though every geographical context has its own unique public health challenges, there are four common principles that can—and should—guide the scale-up of large-scale rice fortification, whether in the tea estates of Assam, the tribal belts of Jharkhand, the rice mills in Bihar, or in other countries around the world. PATH calls these principles the four “A’s”: affordability, accessibility, advocacy, and awareness.

1. Affordability

The mission to supply fortified rice in all SSNPs in India inevitably raises the question of cost. Ensuring that fortified rice is affordable for producers, consumers, and other stakeholders across the supply chain is a primary goal of PATH’s work.

As such, PATH assists fortified rice kernel (FRK) manufacturers in producing high-quality, cost-efficient FRK and supports them in cost-effective manufacturing, blending, and selling of fortified rice. We engage with state governments and the private sector to increase the number of FRK manufacturers and blenders, which helps reduce the price of fortified rice by increasing its supply.

Additionally, PATH collaborates with rice millers for quality FRK production. We work with manufacturers for cost-effective blending solutions like assisting in procurement and installation of efficient and affordable equipment. PATH will work with institutions like the Indian Institute of Technology Kharagpur to create indigenous machines that would increase affordable fortified rice supply in the country.

By 2019, there were only 13 FRK manufacturers; today, thanks to efforts by the government, PATH, and many partners, there are 157 FRK manufacturers—and more on the way.

2. Accessibility

Each program that PATH undertakes is driven by its mission to advance health equity through innovations and partnerships. The very essence of health equity means that the nutritional benefits of fortified rice must be accessible to the people and communities that need it most.

The Indian government, like many others, aims to ensure this through the implementation of food social protection schemes like the Public Distribution System, where food rations are sold at a subsidized rate to those who need the subsidy; Integrated Child Development Scheme, where mothers and young children receive nutrition; and PM POSHAN, which is India’s school feeding program where children receive a hot cooked meal in schools. PATH has been chosen as a technical partner in these schemes, with the goal of increasing accessibility of fortified rice in India.

Since a resilient supply chain is necessary to ensure that fortified rice remains accessible—including during emergencies—PATH is working with the state government and private-sector firms like MicroSave Consulting to map and digitize the entire fortified rice supply chain in our target Indian states.

That means that the quality, stock movement, and traceability of government-supplied fortified rice can be monitored and accessed in real time. PATH is mapping the end-to-end supply chain of fortified rice production and supply in India, starting from rice millers, FRK producers, premix manufacturers, and equipment manufacturers, to rice blenders and distributors.

Ensuring accessibility also means viewing program development and implementation through an intersectional lens that factors in access challenges faced by different groups especially women. To this end, PATH is currently pioneering much-needed monitoring and data collection on the communities where fortified rice will be needed most, to ensure its availability.

3. Advocacy

Alongside and on behalf of several government departments in India, PATH conducts advocacy outreach to relevant communities about the benefits of the rice fortification program. For the last two decades, PATH has worked to generate evidence on how consuming fortified rice reduces anemia and improves health outcomes among mothers and children.

For example, PATH has and is currently generating evidence on the effectiveness of fortified rice in reducing diseases like anemia in a few states in India. This evidence will support advocacy for rice fortification on a national scale. PATH is also establishing several Fortification Hubs, where one of the primary activities of the centers would be to lead research activities on the impact of the consumption of fortified rice.

Through the operationalizations of these national Centers of Excellence, PATH will also advocate for and implement activities toward improving rice fortification regulations, standards setting, research and development, and capacity-building in India.

PATH is supporting state governments in upholding the government’s decision to roll out fortified rice in its programs by providing timely, widely accepted global and national guidelines and evidence on fortified rice. Furthermore, our field staff’s experience and expertise helps dispel any myths about fortified rice and helps promote large-scale rice fortification programs and their potential to positively impact lives.

In efforts to support advocacy for the supply of fortified rice in India, ensuring the quality of the fortified rice—and its ability to deliver the right nutrients to target populations—is key. PATH is undertaking measures to strengthen testing capacities of laboratories and to develop rapid testing methods for food safety officers and millers to assure the quality of the fortified rice at every point in the supply chain.

4. Awareness

Even if there is an ample supply of fortified rice, it may not be consumed in an open market if people are not aware about its health benefits. Therefore, large-scale rice fortification programs foremost must center these populations—whether pregnant mothers, school children, community health workers, or others—in efforts to incorporate fortified rice into communities’ diets.

Relatedly, PATH provides awareness about fortified rice, highlighting its health benefits, busting misconceptions, and creating demand for its consumption through social behavior change campaigns.

For example, PATH conducts information, education, and communication and social behavior change activities around fortified rice in India. These campaigns aim to spread awareness about the benefits of fortified rice to government officials and community health workers of food SSNPs, teachers, cooks, fair price shop owners, pregnant and lactating mothers, and school children. PATH also works throughout the fortified rice supply chain and trains private-sector members like rice millers, fortified rice kernel manufacturers, and blending machine manufacturers on optimizing the production of fortified rice that can be supplied to communities via SSNPs.

Four principles, millions of healthier lives

PATH South Asia’s work to scale up rice fortification in eleven Indian states and one union territory across three projects is helping the government make progress on its mission: reaching 800 million Indians with fortified rice. Together, with our partners, PATH aims to increase awareness, accessibility, affordability, and advocacy around rice fortification to help improve the nutrition and health outcomes of millions of people. This work reflects PATH’s core value to treat everyone with dignity and enable people’s abilities to make healthy, informed choices on their own. Most importantly, the principles of our rice fortification work can be adapted in other countries to improve health outcomes across borders and regions.