The nutrition situation in Burundi is staggering. This country, slightly smaller than the state of Maryland, is considered to have the highest rate of growth retardation in all of Africa. All but two provinces are considered to be in a severe / chronic nutrition condition with 81% of the population living on less than $1.25 / day.
According to IFPRI (2011) Burundi classifies as “extremely alarming” on the Global Hunger Index (GHI). The Index combines three equally weighted indicators into one score: the proportion of people who are undernourished, the proportion of children under five who are underweight, and the under-five child mortality rate.
According to the most recent WHO data, rates of under-five stunting (58%), underweight (29%), and maternal mortality (970/100,000) are particularly high. Similarly, micronutrient deficiency indicators included anemia and iodine deficiency in children at 56% and 61% respectively, anemia in pregnant women at 47%, vitamin A deficiency in pregnant women at 28%, and a 47% risk of zinc deficiency throughout the population.
Understanding Burundi’s Needs
In December 2011, upon the request of Burundi’s Ministry of Health, PHC conducted a preliminary fact finding mission to explore the nutrition policy context and staple food industry environment, and to gauge government willingness to begin a national food fortification program. As a result of findings, in 2012, PHC signed a Memorandum of Understanding with the Burundi government to assist in the design and implementation of a nationwide food fortification program. In terms of dominant staple food consumption patterns, recent food consumption surveys indicate that cassava flour followed by maize flour are the main staple products used in daily meals. Additionally, palm oil, sugar, and salt are staple condiments used almost universally on a daily basis.
Significant political momentum existed in Burundi around food fortification prior to PHC engagement. In order to address the alarming nutrition situation, the Government, with backing from a number of UN agencies, decided that a national food fortification program was required as a means of attacking the problem. To date, Burundi has adopted the East Africa Community (EAC) fortification standards and included fortification in current national policy forums and policy writing agendas.
Since 2011, PHC has worked with government stakeholders to:
- Create a National Task Force, a key set of leaders with the goal of ensuring urgent fortification-specific issues can be addressed on short-notice;
- Draft a decree to ensure a mandatory program and level playing field for the industry, which in 2015, was signed by the President ushering in a national mandatory program;
- Design a national logo and logo guidelines;
- Engage Burundi’s staple food producers to scale-up their production;
- Train industry and regulatory inspectors on sampling and testing methods to ensure compliance with adopted standards; and
- Adapt PHC’s Fortification-specific Management Information System to the Burundi context and train Bureau of Standard staff on its use.
Burundi currently has two large maize and two large wheat flour producers. Both wheat flour producers are producing fortified flour. Further support is being provided to scale-up the maize flour facilities. Burundi also has one large, government owned sugar facility, Sosuma, and one cooking oil facility, Savonor. In Q2 2015, Savonor began producing fortified cooking oil, the first industry to do so in the country. Initial tests indicate the oil meets the national fortification standard established by the government. Sosuma is eager to start once they obtain approval from their Board of Directors.
While much of the responsibility for the fortification of food products is given to the industries, the government must ensure that the foods that are being sold in the country meet the standards for safety and quality, including that the right types and amounts of micronutrients are present. To that end, government officials are responsible for monitoring foods that are locally produced and imported at production sites, at borders, in markets and shops, and in households.
Following an inspectors training workshop that took place in April 2015, PHC supported Burundi’s Bureau of Standards (BBN) to harmonize collection forms used by inspectors and to adapt the Fort-MIS to the Burundian context. The system will allow for efficient and effective regulatory decisions to be made and actions taken based upon pooled fortification data from all levels and stages of the national monitoring system. Staff have been trained on its use. BBN will populate the system with regulatory monitoring results by Q3 2016. This first set of data will provide a snapshot of where further industry and regulatory monitoring support are needed.
PHC will continue to work with the Bureau of Standards to streamline the regulatory monitoring process, map the inspection and testing process, secure required equipment both for the national laboratory and private industry, and refine the Fort-MIS for Burundi. Joint support from country partners will be sought for national consumer advocacy campaigns.