We provide support to national governments that come to us seeking assistance in building a fortification program. Once invited by a government, we use four broad elements as the framework for guiding country-specific programs:
- Situation Assessment. First, we begin with an assessment to determine if fortification is an effective intervention for the particular setting. We then hire a Country Coordinator, who is placed within the Ministry of Health, to guide government staff through the program design and implementation process. This individual consults with senior officials, food producers, and partnering organizations to ensure government ownership and long-term sustainability after PHC leaves.
- Enabling Nutrition Policy and Legislation. We assist in the drafting of national fortification policies and / or action plans to ensure the fortification program is harmonized with already-existing micronutrient and nutrition interventions. We then support the drafting of legislative decrees, where applicable, to ensure a mandatory program, which provides a level playing field for industry and consistent nutritional coverage for the target population.
- Food Fortification Standards. If food fortification standards do not already exist, we work with partners to create standards based on national consumption patterns of key staple products and micronutrient deficiency rates. We ensure the standards are harmonized with the region to preclude barrier to trade. On occasion this has required the completion of a FRAT (Fortification Rapid Assessment Tool) survey or inferring implied consumption from HIES (Household Income and Expenditure Surveys). The standards drafting process also includes ensuring WHO-recommended, bioavailable fortificants are used. If fortification standards already exist, they are reviewed in the context of up-to-date consumption, deficiency, and bioavailable fortificant data and then guided through the review and adoption process.
- Industry Implementation and Social Marketing. We guide staple food producers on what is needed to produce adequately fortified foods, where to obtain equipment and vitamin and mineral premix, and the implementation of internal quality assurance and quality control measures. We collaborate with national consumers counsels and ensure consumer advocacy messages are included in regular Ministry of Health messaging.
- Government Regulation and Monitoring. We assist in the establishment of regulatory monitoring systems including the training of inspectors and laboratory personnel, creation of sampling plans, clarification of roles and responsibilities, and compilation of results data to ensure quick action can be taken. PHC has designed a Fortification Management Information System (Fort-MIS) that is used to streamline the regulatory monitoring process. We use this system, when applicable, in each of our country programs.
PHC currently uses a Country Coordinator model of support. This model places one individual in each country of operation to guide programming, support government staff, and act as a catalyst to ensure continued and consistent focus on key program elements and to ensure fortification is included in national strategic planning. PHC provides a rigorous and standardized internal training program for each hired Coordinator on nutrition and fortification program planning.
Despite the increasing adoption of large-scale fortification programs as a means of addressing micronutrient malnutrition throughout the developing world, the majority of individuals living in rural and remote areas do not have access to centrally processed foods, and thus are denied the benefits of these efforts. Addressing this gap becomes critical when considering the fact that these populations are the most vulnerable and in the greatest need of strategies to combat micronutrient malnutrition.
With this in mind, Sanku has designed an effective model that will enable small and medium scale, village-level mills to cost-effectively and sustainably fortify their grain.
Understanding the Situation
Previous programs attempting the direct “hand-scoop” method of fortification at small-scale mills have achieved limited success. The risk of human error and the challenge of monitoring and sustaining the program once the implementing partner leaves, means that these programs have never been scaled up past the initial pilot stage.
Sanku has overcome this challenge by developing a game changing technology that has proven to be an effective and low-cost solution to combat micronutrient deficiencies in rural populations. The 2013 Grand Prize winner in the Ashoka Changemaker’s Nutrients for All competition, the fully automatic Sanku Dosifier was developed with the aim of meeting specific key criteria: low-cost yet accurate and robust, lightweight and easily transportable, and the ability to be installed on the majority of small-scale flourmills. Currently, no other fortification device available meets all of these criteria.
By reducing capital and operating costs and developing a sustainable scale-up model, Sanku aims to provide the global nutrition community with the technology and know-how to reach the millions of people who still do not have adequate access to centrally processed fortified foods.
Each project and program we aim to partner with is unique. Depending on the business model chosen, the Sanku Dosifier can range from US$0 – $4,000. Other dosifiers on the market cost US$7,000 – US$10,000.
The advantage of a fortification program at small and medium scale mills compared to other nutrition initiatives like supplementation, RUTF or Sprinkles, is its low cost implementation and high coverage impact. A single dosifier has the potential to fortify flour for 100,000 people daily, and yet the increase in flour cost is negligible when considering that the cost of premix per person is less than US$1 a year.
Designing an Automated System
The Sanku Dosifier functions similar to an electronic scale and consists of a fortificant dispenser and weight sensitive grain hopper. This hopper sits on four load cells that detect the loss in weight as grain pours into the mill.
A simple yet robust electronic controller takes into consideration the weight of grain flowing into the mill to activate the fortificant dispenser, where a high torque motor drives a feed-screw to release a predetermined quantity of nutrient premix, ensuring accurate dosing every time.
Programmable firmware allows for continuous checking of the weight change, adjusting the premix-dosing rate to always match the milling rate. The dose threshold can be easily adjusted according to the specified addition rate of the premix being used.
The thorough mixing of premix and grain within the mill, as well as the additional step of packing, ensures homogeneity of the end product.
An LED on the electronic controller displays the weight reading as well as useful data that can be collected (hours of operation, total grain milled, and premix consumed). This stored and displayed data enables the accuracy of doses to be monitored either locally or remotely if sent via SMS, substantially lowering ongoing monitoring costs.
Sanku is also the supplier of the high-grade micronutrient premix that is specifically formulated for use with the Sanku Dosifier. The nutrients are sourced only from companies that adhere to good manufacturing practices and are certified by the Global Alliance for Improved Nutrition (GAIN). After 5 years of rigorous testing, in 2014, GAIN officially approved and recommended the use of the Sanku Dosifier for small and medium scale applications.
National nutrient standards are used in each market Sanku supplies. Based on current consumption patterns, deficiency rates, and approved bioavailable nutrient forms, Sanku’s formulated premix ensures enough nutrients are absorbed to fill the identified gap.
Currently 82 countries globally have legislation to mandate cereal grain fortification, leading to increased local government compliance and rural awareness of the benefits of fortified foods. Sanku is able to leverage this momentum by being positioned on the front lines of fortification, working closely with village millers, NGOs and governments to help equip at-risk communities with dosifiers and nutrient premix.
Through the implementation of a scalable, cost effective, and proven business model, Sanku’s goal is to provide fortified foods to over 200 million people by the year 2020.