Monitoring of Flour Fortification Programs: Case Studies in Three Countries

Abstract

Objectives: Although monitoring should be an integral part of any fortification program, little is publicly known about the design, implementation, and results of flour fortification monitoring systems. The objectives are to assess the monitoring systems in three countries including the strengths and weaknesses of each system, how weaknesses are addressed, and lessons learned. Methods: South Africa, Indonesia, and Chile were selected using predetermined criteria (e.g., mandatory fortification legislation, represent different world regions, importation of flour, and existence of a functioning flour fortification monitoring system). Eight categories of regulatory and household/individual monitoring were assessed. Results: The monitoring systems for each country had different strengths and weaknesses. Overall, strengths included having a structured plan for at least some aspects of monitoring, an adequate number of trained inspectors, and the ability to modify regulations and protocols. Monitoring weaknesses included an insufficient multiple agency approach with poor communications within and between organizations, absent commercial monitoring, and lack of laboratory resources and funds.  None of the countries had a cohesive monitoring program with regular collection of regulatory and household/individual monitoring information.  Conclusions: A functioning flour fortification program depends on having an effective monitoring system in place. Critical to a successful monitoring system was the planning, budget, human resources, and political will necessary to implement monitoring and review monitoring data on a regular basis.