India: Scaling up to Save Lives

FFI has been a key partner for the north Indian state of Haryana since 2015, helping to plan, implement, monitor, and now scale-up fortification efforts across the state.

Out of all Indian states, Haryana has one of the highest percentages of children and women with anemia—72% and 63%, respectively.1 At least 2,400 children are born each year in Haryana with birth defects of the brain and spine.2 Wheat flour fortification provides Haryana with an opportunity to address these serious health challenges.

Photo: Adam Cohn/ Flickr
Photo: Adam Cohn/Flickr

 

Through our support in 2019, the Government of Haryana significantly strengthened its wheat flour fortification program, expanding the distribution of fortified flour through the state’s public distribution system (PDS), India’s largest social safety net program, from two blocks of one district to five entire districts. We also provided millers with technical assistance to increase their production capacity and meet the state’s demand for fortified flour.

As a result, the program is poised to continue expanding across the state and reach 1.4 million more people. Haryana is in the midst of increasing the distribution of fortified wheat flour in five more districts 50% of the state—with plans to scale to 100% by the end of 2020.

The Haryana model

We started our work in Haryana by identifying where people bought their food. By mapping Haryana’s supply chain for wheat flour, FFI found that the government could provide essential vitamins and minerals to those who need it most in the most effective way through PDS. Using these findings, we supported the government to complete a pilot project that provided fortified, stone-ground wheat flour called atta through the PDS in two large towns, or blocks. The pilot garnered enthusiastic support from public, private, and civic stakeholders. After it proved successful among beneficiaries, the government decided to scale-up the program.

As the Haryana project expanded to more blocks and districts, it also started providing fortified atta to children through the state’s Mid-Day Meal program (MDM) and Integrated Child Development Scheme (ICDS) in six districts of Haryana, currently reaching around 382,000 school children through MDM and 290,000 ICDS beneficiaries.

Photo: Atta, stone-ground wheat flour, is used to make flatbread called chapati. Bartosz Hadynia
Photo: Atta, stone-ground wheat flour, is used to make flatbread called chapati. Bartosz Hadynia

 

Scale-up to save lives

A senior government official and a key partner in Haryana’s wheat flour fortification program commented, “As a public health professional, it is humbling to know that this intervention will let children live up to their potential because they are not anemic, women will be more productive because they are not exhausted from iron deficiency, and over the years, perhaps babies will be born without devastating birth defects.” With plans for implementation across all of Haryana’s 22 districts in 2020, FFI and the government’s efforts will improve nutritional status—and the future—for 12.6 million people.

Using lessons learned from the Haryana model, we plan to assist 17 other states in India who have potential and demonstrated the need for the fortification of wheat flour and rice in multiple market channels. We are currently conducting supply chain analyses in Maharashtra, West Bengal, and Himachal Pradesh to determine the next steps needed to implement a fortification program in each state.

If wheat flour or rice fortification is implemented through PDS and the open market in all 17 prospective states, we estimate the potential to reach greater than 400 million people otherwise vulnerable to vitamin and mineral deficiencies. With its monumental potential for fortification, India’s efforts to enhance grains will enhance lives.

 

1.International Institute for Population Sciences and ICF. India National Family Health Survey (NFHS-4), 2015-16. 2017.

2. Verma, I.C. and S. Bijarnia. The burden of genetic disorders in India as a framework for community control. Community Genetics. 2002.