The Zimbabwe Demographic and Health Survey 2010-2011 reports widespread anemia among all populations including more than half of children less than 5 years of age and 28% of women of reproductive age. Data from the 1999 National Micronutrient Survey indicates a vitamin A deficiency prevalence of 36% among children 6-59 months. Based on an analysis of zinc intake for Southern African region published in the Lancet, 24% of children less than 5 years of age may be zinc deficient. These findings indicate a severe public health problem according to standard definitions of the World Health Organization (WHO). Such micronutrient deficiencies threaten urban and rural Zimbabweans from all socio-economic segments since, for example, among women and children there is virtually no difference in anemia prevalence from the poorest to the richest income group.
Understanding Zimbabwe’s Needs and Government Readiness
Prior to PHC engagement in Zimbabwe in 2013, multiple industries had already initiated voluntary fortification. Therefore, a key part of the mandate given to PHC by the Department of Nutrition within the Ministry of Health and Child Welfare was to assess how to ensure such efforts were updated and consolidated into a mandatory program and harmonized with other nutrition-specific interventions. In 2013 and 2014, PHC worked with the MoHCW, UNICEF, and other stakeholders to understand past efforts and current national strategies to address malnutrition, local food production, voluntary fortification, cross-border trade flows, and general consumption patterns.
Current consumption patterns suggest a portfolio including fortification of cooking oil, wheat flour, maize meal, and sugar have potential to reach 90% of the population with significant added nutrition protection. With development of a mandatory regulatory framework and modest investment in start-up and capacity building for food industries and government monitoring, it has been projected that a national fortification program could be launched within only a few years.
Throughout 2014 and 2015, a team of external consultants was hired by the Government of Zimbabwe to conduct feasibility and industry assessments, draft standard regulations, and finalize a national fortification strategy. As of 2016, Zimbabwe’s fortification standards have been adopted and approved by relevant bodies. Drafted legislation that would make fortification mandatory throughout the country is currently in the approval process within the Attorney General’s office. It is anticipated the program will be mandatory before the end of the year.
Many of Zimbabwe’s staple food producers had been voluntarily fortifying in the past. As a result, these facilities had little in the way of additional scale-up to begin fortification again. Other facilities are currently in the process of obtaining the necessary equipment so that, once legislation is passed, they will be ready to start production. For the most part, Zimbabwe’s staple food producers are eager to begin the fortification process and are awaiting further government approval regarding specific authorized premix suppliers and tax exemption status for fortification inputs.
As there are many domestic staple food producers throughout Zimbabwe, an industry snap-shot is not provided here. Please contact us if you would like further information on the scale-up status of Zimbabwe’s industries.
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.
PHC is working closely with Zimbabwe’s Government Analyst Lab (GAL) to incorporate key fortification monitoring indicators from our Fortification-specific Management Information System into Zimbabwe’s already-existing DHIS (District Health Information System) system. This is a unique opportunity that has the potentially to be extremely effective in tracking fortification compliance at a national level. We hope such a system will prove to be an example for other programs to replicate.
With multiple stakeholders involved in this program, PHC’s focus will remain centered on building a solid monitoring structure including the streamlining of sampling protocols, completion of inspector trainings, procurement of equipment both for inspectors and the national laboratory, and the creation of a comprehensive monitoring system to ensure program compliance can be captured and acted upon in a meaningful way.