Five lessons for advancing large-scale food fortification in the Global South

An exchange of ideas and best practices within the Global South is critical for advancing sustainable development goals (SDGs), particularly SDG 2, which aims to improve nutrition and food security, and SDG 3, which promotes health and well-being. In January, PATH and the Deutsche Gesellschaft für Internationale Zusammenarbeit GmbH (GIZ) organized a two-week Global South learning exchange visit on advancing large-scale food fortification (LSFF) efforts in order to tackle key micronutrient deficiencies that differ from country to country.

India is a pioneer in implementing large-scale fortification of staple foods and mandating them through social safety net programs (SSNPs). Strong political support, robust regulatory frameworks, and active support for local capacity have enabled India to scale food fortification initiatives, an approach that can be replicated in countries with shared challenges.

As part of the immersion visit, 16 delegates from seven countries, including Burkina Faso, Côte d’Ivoire, Ghana, Madagascar, Nigeria, Senegal, and Sri Lanka, visited India to gain firsthand experience from the country’s flagship rice fortification program. The delegates, primarily technical experts, represented the West African Health Organization (WAHO) and their respective National Fortification Alliances (NFAs). Participants shared their diverse experiences and explored opportunities to strengthen end-to-end fortification efforts through public-private partnerships, policy enhancements, and and digital innovations. They also discussed key challenges including supply chain gaps, cost considerations, and regulatory enforcement.

The delegates interacted with policymakers, researchers, technical experts, academics, fortified rice kernel (FRK) manufacturers, and other key stakeholders such as the Food Safety and Standards Authority of India, Department of Food and Public Distribution, Indian Institute of Technology-Delhi, National Institute of Food Technology Entrepreneurship and Management (NIFTEM), and Sir Vithaldas Thackersey College of Home Science, among others.

From touring an FRK and vitamin and mineral premix production facility to visiting a public school to understand how fortified rice is cooked and distributed through the school’s mid-day meal program, the exchange offered delegates an opportunity to fully experience the fortification value chain.

The visit culminated in a learning exchange meeting that convened stakeholders and partners working across the food fortification value chain to discuss shared challenges and the way forward.

Here are five key takeaways from the Global South learning exchange:

1. Invest in locally sustainable manufacturing

Strengthening local manufacturing capacity emerged as one of the top priorities of Economic Community of West African States (ECOWAS) countries. Building capacity at the local level is crucial to ensure the sustainability of food fortification initiatives and self-sufficiency in the region.

For example, Côte d’Ivoire has explored multiple rice fortification models—ranging from importing FRK to domestic production. Sri Lanka transitioned from importing FRK to establishing a local production plant with private-sector support

Delegates emphasized the importance of technology and knowledge transfer to establish local premix and FRK production units and blending facilities, including facilities for producing fortified snacks and cereals. Training and capacity-building of manufacturers and experts is an important area where Global South collaboration and exchange can make a real difference.

2. Strengthen policy and regulatory support

A strong regulatory and policy framework emerged as a key driver of success, with several countries benefiting from multisectoral coordination, clear government mandates, and financing models supported by development partners. The revival of NFAs in multiple West African countries was emphasized as a critical step in ensuring sustainable implementation. Additionally, participants acknowledged the role of regional bodies like ECOWAS and WAHO in harmonizing fortification policies and facilitating South-to-South learning. For instance, WAHO has established a Nutrition Forum to convene a range of actors and stakeholders to discuss and ensure that programs developed at the national level are mutually reinforcing and consistent with international standards.

Quality control, lack of compliance, and adherence to standards are common challenges that stall fortification efforts. Support for developing national fortification standards, standard operating procedures, and testing mechanisms can fast-track food fortification initiatives. Strong monitoring and regulatory frameworks are essential to ensure quality and compliance, and delegates noted the need for enforcement mechanisms and penalties for non-compliance.

In India and Sri Lanka, PATH is supporting government efforts to strengthen laboratory testing capacities to ensure the quality of the fortified rice at every point in the supply chain. The digital QA/QC and traceability system developed with PATH’s support enables real-time tracking of fortified rice production and supply across the ecosystem, enhancing transparency and accountability in fortification programs.

The importance of standardized testing protocols, accredited laboratories, and digital compliance systems such as Fortified Rice Quality Management System (FRQMS in Sri Lanka) and Fortified Rice Traceability (FoRTrace in India) have been instrumental in ensuring quality control and traceability of fortified rice, offering an example to other countries.

3. Promote resilient supply chains

Without an efficient and resilient supply chain, large-scale food fortification is impossible. The cornerstone of India’s rice fortification program is a robust supply chain and logistics system that enables nationwide fortified rice distribution through social safety net programs such as the Public Distribution System, Integrated Child Development Services, and mid-day meal scheme, now known as PM—POSHAN.

Strengthening the local availability of affordable and quality premix through regional procurement and subsidies was flagged as necessary to scale fortification initiatives. Establishing local production facilities for FRK and blending and training millers and manufacturers, developing capacity for maintenance and support, policy-level support for machinery imports, and building the ecosystem for local fabrication were some of the key lessons noted to improve and sustain a robust supply chain.

Across the discussions, the role of the private sector and public-private partnerships was emphasized as crucial in strengthening the food fortification value chain and scaling fortification programs across the ECOWAS countries.

4. Establish South-South Centers of Excellence

Establishing regional centers of excellence is vital for facilitating an exchange of research, knowledge, and ideas to scale fortification and other nutrition programs. The centers of excellence can also house Innovation Hubs, a model that has found success in India.

“It will be good as a critical next step to see how we can establish centers of excellence, similar to some of the Innovation Hubs that we have here in India,” said Mawuli Sablah, Program Manager–LSFF at the Catholic Relief Services.

One such initiative from PATH, in partnership with Institute for Competitiveness, is the Global South Research Collaborative (GSRC), which is aiming to catalyze research and nurture cross-learning and collaboration through simplified sharing of knowledge, expertise and best practices in and with Global South countries.

These centers can create knowledge-sharing platforms and facilitate learning exchange programs for health professionals, policymakers, and researchers providing a pathway to sustainability. This will enable countries in the Global South to learn from each other and adapt strategies to local contexts.

5. Implement community awareness and communication strategies

Evidence shows that the success and adoption of fortified foods hinges on strategic advocacy and awareness campaigns. Combating myths or changing community perceptions of fortified foods were flagged as challenges that emerged from pilot programs.

To address this, local or national campaigns and focused awareness activities must be conducted to educate consumers and stakeholders, especially target populations. Countries in the Global South can learn from each others’ experiences in conducting such awareness and behavior change campaigns, generate evidence, and adapt successful strategies to local contexts.

For example, PATH conducts information, education, and communication and awareness-generation activities around fortified rice in India. These campaigns 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.

As countries refine their strategies, fostering regional coordination, securing sustainable funding, and leveraging technological innovations will be key to scaling up effective food fortification initiatives.

Collaborative alliances to implement nutrition strategies effectively while ensuring alignment with global and regional priorities are crucial to meeting SDGs 2 and 3 and shaping the outcomes of others. So is a multi-sectoral approach involving governments, industry, academia, and think tanks. Standardizing data collection and monitoring frameworks will help improve decision-making and program effectiveness.

Ultimately, self-reliance, investment in culturally relevant solutions, and private-sector engagement will be critical for enhancing health and nutrition outcomes across the Global South, and such practical learning exchanges between the Global South Countries need to take place more regularly.

Rike Riesmeier, Global Coordinator of Fortification Component, GIZ, called it “the start of something new.”

“We had one-to-one discussions with key partners from the government, private sector, research, and development…I hope we can take this further and continue exchanges like this,” she added.

(With inputs from Sachin Gupte, Danie Shajie, Shruti Arora, Zehra Kazmi)