Monitor for Quality & Impact

If quality measures are followed routinely, results are analyzed, and problems are corrected, fortification will have the maximum health impact. The process includes food control and program monitoring.

Food control includes:

  • Internal: Flour millers use procedures such as recording the use of premix and conducting iron spot tests to provide quality checks.
  • External: Government authorities (such as food safety inspectors) test products at mills periodically to ensure that fortification meets the country’s specifications.
  • Commercial: Food safety inspectors check retail stores to be sure the fortified product is in the marketplace.

Program monitoring includes:

  • Intake: Household surveys confirm that fortified rice or food made with fortified flour is purchased, people are eating it, and that enough is eaten to have the desired effect.
  • Impact: If products are fortified at recommended nutrient levels and at least 80% of the population is consuming the products, then countries may want to consider an impact evaluation of biological and clinical outcomes. Data from routine Demographic and Health Surveys or birth defect surveillance programs can indicate a fortification program's impact.

Studies in select Asian countries show that without appropriate enforcement and quality assurance mechanisms in place, national legislation for fortification will not necessarily lead to the desired health outcomes. See more...

Likewise, experiences in Morocco, Uzbekistan, and Vietnam show that fortification programs must be continually monitored so they can be modified in response to performance issues and shifts in market structure and consumption patterns. See more...

Also, an assessment of the Dominican Republic's wheat flour fortification program highlighted several strengths and areas for improvements. See more...

The flour fortification monitoring systems, challenges and successes from three countries are highlighted in the following case studies:

For more information, refer to chapter eight of the Guidelines on Food Fortification with Micronutrients published by the World Health Organization and the Food and Agricultural Organization of the United Nations. Or e-mail us at

Noodles made with fortified flour are an example of foods that can be be expected to improve a population's nutrition if quality measures are in place and followed routinely.