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Healthcare
Uzbekistan Receives US$2.8 Million Grant for Flour Fortification Project
By GAIN
Mar 29, 2005, 00:33

The Government of Uzbekistan launched today a Flour Fortification Project to address iron deficiency anemia among women and children in the country. The project is financed by a three-year US$2.8 million grant from Global Alliance for Improved Nutrition (GAIN), for which the World Bank serves as trust agent. Uzbekistan is the fourth country to obtain a grant for large-scale food fortification efforts from GAIN.

The project, which is expected to benefit around eight million Uzbekistan people, will increase the number of mills fortifying wheat flour with vitamins and micronutrient from 14 to 48. Total production of fortified flour will likely double to 1.25 million tons per year by 2010.

�Food fortification is a proven, cost effective way to protect large populations, particularly mothers and children, against the devastating consequences of vitamin and mineral deficiency. Our approach is to bring together the government, food industry and consumer advocates and to create the conditions for sustainable, national fortification efforts,� said GAIN Chairman Mr Jay Naidoo.

It is expected that this project will reduce iron deficiency anemia among childbearing age women by 20 percent. Currently, iron deficiency anemia affects over 60 percent of women of childbearing age and one-third of children under five years in Uzbekistan, according to recent damage assessment reports by UNICEF and the Micronutrient Initiative. This causes health risks to mothers during childbirth, and increases the number of underweight babies, and children with learning difficulties.

The project will assist Uzbekistan in its efforts to meet the UN Millennium Development Goals of reduced poverty, improved maternal health and child mortality. Fortification of flour with iron and other micronutrients has been successful in countries such as Venezuela, the USA, UK, Canada, Sweden and Chile.

The Ministry of Health, Joint Stock Company �Uzdonmahsulot,� and other ministries and institutions will implement the project as part of a five year �National Flour Fortification Program.� A Project Implementation Unit (PIU) has been established under the joint project implementation bureau of the Ministry of Health to carry out daily management of project and to coordinate the different agencies involved. The project budget, including government and industry contribution, totals US$6 million, and aims to create the basis for long-term flour fortification throughout the country.

The Program builds upon an Asian Development Bank-funded pilot project - �Improving Nutrition of Poor Mothers and Children in Asian Countries in Transition� - which introduced fortification to 14 large urban mills. The new project extends fortification efforts to mills using locally produced flour which is consumed by poorer households in Uzbekistan.

Background Information:

More than 2 billion people throughout the world suffer from vitamin and mineral deficiencies, debilitating minds, bodies, energies and the economic prospects of nations. The problem can be brought under control in a relatively short time and at relatively low cost.

The Global Alliance for Improved Nutrition�s goal is to contribute, by 2007, to the improved nutritional status of at least 600 million people in up to 40 developing countries, primarily through fortification of commonly available and consumed local foods. GAIN provides resources to countries for the implementation of large-scale food fortification programs, led by �national fortification alliances�, which reach low-income, at-risk populations.

GAIN is a not-for-profit Swiss Foundation funded by the Bill and Melinda Gates Foundation and several bilateral donors. It is managed by a Secretariat based in Geneva, with support from the United Nations Development Programme and other UN agencies. The World Bank acts as its Trustee.

For more information contact:
Tim Higham, Communication Director, GAIN, Geneva, phone (+41) 22 749 1864,
[email protected]

Or, Dilnara Isamiddinova, World Bank, Uzbekistan, phone (+998-71)-1385950,
[email protected]



30 March 2004 - Geneva, Switzerland

200 Million More People to Benefit from Healthier Food
The Global Alliance for Improved Nutrition - GAIN announces second round of grant awards to six national food fortification programs.

The Board of the Global Alliance for Improved Nutrition � GAIN, meeting in Geneva, announced today it is providing grant awards of approximately US$ 10.7 million to support vitamin and mineral fortification programmes over the next three years in Bolivia, C�te d�Ivoire, the Dominican Republic, Mali, Pakistan and Uzbekistan.

GAIN Executive Director, Rolf Carriere said �Public-private partnerships, such as the National Fortification Alliances promoted by GAIN are investments not only in health, but also in the building of sustainable national economies. Vitamin and mineral deficiency affects 2 billion people worldwide, causing birth defects, impaired mental development, poor health, low work capacity and premature death.�

The United Nations International Children�s Fund (UNICEF) and Micronutrient Initiative (MI) Global Damage Assessment Report, (released at the UN Standing Committee on Nutrition in New York last week), stresses that efforts to eradicate poverty, reduce child mortality and improve maternal health, all hinge on ensuring better access to vitamins and minerals.

Fortifying flour, sugar, oil, condiments, or other common foods is an effective way to get essential vitamins and minerals into food for the benefit of large numbers of people. It can save lives, prevent disabilities and, in general, build health and productivity. It is a small investment (a few cents per person per year) and produces measurable results. Fortification has been used for over 80 years in industrialized countries and there is more than a decade of experience with salt iodization worldwide. However, most developing societies are still deprived of the benefits of fortified food.

Jay Naidoo, Chairman of the GAIN Board of Directors, at the Civicus World Assembly in Gaborone, Botswana 21 � 25 March, presenting compelling data on the large returns in health, productivity and national intellect that can result from investments in food fortification, said �the successful implementation of these awards depends on the work of National Fortification Alliances in which private sector companies play a leading role. I am confident that we will be able to build strong communities of interest in food fortification, bringing together the business sector who produces fortified foods and civil society on whom we count to support us in widely communicating the benefits of fortified staple foods.�

Bolivia, C�te d�Ivoire, the Dominican Republic, Mali, Pakistan and Uzbekistan are the second group to receive grant awards since GAIN made US$ 14.5 million available in 2003 to China, Morocco, South Africa and Viet Nam. The GAIN grant awards are made to countries with active, multi-sectoral National Fortification Alliances that show the most promise of bringing fortified foods to market that can improve the nutritional status of significant poor and deficient population segments within 18 months of the award. Detailed criteria for application can be found on the GAIN website. GAIN�s goal is to contribute, by 2007, to the improved nutritional status of at least 600 million people in up to 40 developing countries, primarily through fortification of commonly available and consumed local foods.

Bolivia
Food fortification is not new to Bolivia with salt iodization having already been started in 1981. The grant award will expand and improve the wheat flour fortification programme by providing for a legal framework, measures for the reinforcement and distribution of fortified foods and a food control and monitoring mechanism.

The overall goal is to have, by 2006, achieved fortification according to national standards of all the domestically produced wheat flour, vegetable oil and milk. The First Lady of Bolivia together with the Ministry of Health are paving the way for this initiative and a major milestone at the end of the first year will be to have wheat flour, vegetable oil and milk available to consumers according to national regulatory standards.

C�te d�Ivoire
The NFA aims to promote the consumption and production of fortified refined vegetable oil and wheat flour blend. Within 3 years of startup 80% of households should be consuming vegetable oil fortified with vitamin A. Within 5 years of startup 80% of households should be consuming wheat flour blend fortified with iron and folic acid. These foods will provide at least 50% of the daily vitamin A needs and 30% of daily iron and folic acid needs.

Dominican Republic
The grant to the Dominican Republic aims to strengthen the national fortification programmes, which includes a new effort to fortify sugar with Vitamin A, and expand and improve a voluntary programme in wheat flour (initiated in the early 1990s), which will now not only use iron, but also folic acid, Vitamin A and several B vitamins as added nutrients. Wheat flour and sugar are widely consumed in the country. The objective is to reduce the prevalence of iron and Vitamin A deficiencies in children under 5 and women of reproductive age, as well as reduce the incidence of neural tube birth defects among newborns. The programme also aims to raise consciousness at the consumer level of the value of fortified foods.

Dr Jos� Rodriguez Soldevila, Minister of Public Health and Social Assistance, Dominican Republic, said, � Our Government is very pleased that the country has been awarded with this generous grant to implement a project to improve the nutritional situation of the population. Dominican Republic is committed to the effective implementation and sustainability of the program with the partnership and support of the private sector, the civil society, and the international community. The GAIN project grant is an important contribution and a major step towards making this possible."

The Lead Implementing Agency for the programme in Bolivia and the Dominican Republic is the Pan American Health Organization (PAHO).

PAHO�s Director Dr. Mirta Roses said, �The Pan American Health Organization has been actively promoting food fortification programs in the Americas for many years. Twenty-two countries are presently adding micronutrients to cereal flours; all of the Central American countries are fortifying sugar with vitamin A; and more than 90% of the population has access to salt fortified with iodine. Nevertheless, further work is necessary in order to ensure the sustainability of the programs and to avoid setbacks of successful programs. Public-private sector interaction has to be enhanced, systems of quality assurance must be in place, and adequate monitoring systems must provide timely information, and all of this must be part of national strategies to combat malnutrition contributing to the achievement of the Millennium Development Goals. �

PAHO serves as the Regional Office for the Americas of the World Health Organization and as the health organization of the Inter-American System.

Mali
In Mali, the �Doumouni Nafama� programme (�Healthy Foods� in the Bambara language) aims to fortify edible cottonseed oil with Vitamin A to overcome deficiency in women of reproductive age and young children. Because 70% of the oil consumed in Mali is cottonseed oil, and a single local producer supplies this, coverage of the target population is expected to increase (over the three-year period) from 25% to 70% for children and from 25% to 90% for women. More complex fortification of other foods will follow in the medium term.

The Lead Implementing Agency in Mali is Helen Keller International (HKI). Shawn K. Baker, Vice President and Regional Director for Africa HKI says; �In West Africa, it is estimated that over 41% of children are at risk of vitamin A deficiency and that correcting this deficiency can save over 245,000 children�s lives a year. Fortification of cooking oil with vitamin A will make a major contribution to sustained control of the deficiency. The Mali food fortification program is a model of cooperation of private sector, public sector, donor and non-governmental and consumer partners to advance the control of vitamin A deficiency. We hope that this will be the first of many such programs in West Africa.�

Helen Keller International is among the oldest international nonprofit organizations devoted to fighting and treating preventable blindness worldwide. HKI has been active in West Africa since 1997, and established an office in Mali in 1999.

Pakistan
In Pakistan, the National Wheat Flour Fortification programme aims to reduce iron deficiency anemia in children from 30% to 10% and in women of reproductive age from 50% to 18%, and halve the occurrence of neural tube defects among newborns, through universal fortification of wheat flour by the year 2013. The objectives over the three-year programme covered by the grant are to also develop monitoring guidelines and operations; to strengthen the capacity of the public and the private sectors to fully implement the programme; and to design and implement effective advocacy and behavior-change communication activities. The first part of this ambitious programme aims to fortify wheat flour produced in roller mills, consumed by 70 million people while the second phase will address the fortification of wheat flour milled in small �chakki� mills, to reach the entire population.

The Lead Implementing Agency is the Nutrition Wing, Pakistan Ministry of Health.

The Nutrition Wing of the Ministry of Health in Pakistan has been driving existing food fortification programmes and building the capacity of the National Fortification Alliance with the support of the Pakistan Flour Millers Association. It is responsible for policy directions, strategic planning, programme development, technical assistance and coordination of country-wide nutrition related activities in the public and private sectors.

Uzbekistan
In Uzbekistan, the National Flour Fortification Programme aims to decrease the prevalence of anemia among pregnant women from 70% to 50% through the fortification of flour with iron by the year 2008. It is estimated to reach 44% of the at-risk group within 18 months of the launch. Within 3 years, fortified flour will be consumed by close to 4 million people. The program also plans to develop a new law on fortification as well as measures to promote consumer demand for fortified flour.

The successful submissions from Pakistan and Uzbekistan were based on planning work initiated and supported by the Asian Development Bank (ADB). ADB Vice President Geert Van der Linden welcomes the grant announcement from headquarters in the Philippines. "The potential for food fortification to save lives and enhance the growth and development of children throughout the world is both exciting and critical. We must act immediately to support countries in their efforts and ADB is proud to be part of this international effort."

In addition to the agencies responsible for steering the above projects through to this stage, GAIN wishes to acknowledge the contribution of MOST, the Micronutrient Program of USAID and MI, the Micronutrient Initiative in the preparation of proposals in general and to the development of national food fortification programmes. The World Bank also plays a key role in co-administration, project development, management and evaluation.



GAIN was incorporated as a Swiss Foundation in March 2003. The United Nations Development Programme (UNDP) is the administrative host agency for GAIN, and the World Bank serves as its interim trustee. Founding donors to GAIN are: The Bill & Melinda Gates Foundation, The United States Agency for International Development (USAID), The Canadian International Development Agency (CIDA), the Micronutrient Initiative (MI), and the governments of Germany and The Netherlands. On a global level, GAIN collaborates closely with UNICEF, the World Health Organization (WHO), the US Centers for Disease Control and Prevention (CDC), the International Business Leaders Forum (IBLF), Consumer Voice, MI, the World Food Programme (WFP) and other UN agencies and NGO�s. GAIN�s Board of Directors includes representatives from private sector companies, non-governmental and governmental agencies, and academic institutions from both the northern and southern hemispheres.



21 January 2004 - Davos, Switzerland

How Vitamins Could Change the World
New Study Finds Billions of People�s Lives could be Drastically Improved if Basic Vitamins and Minerals were Added to Foodstuffs

A new report from UNICEF and the Micronutrient Initiative finds that lack of basic vitamins and minerals in the diet is damaging the health of one-third of the world's people and holding back the economic development of virtually every country in the southern hemisphere.

Few outside specialist circles are aware of what vitamin and mineral deficiency means for individuals and nations. But the report, released today at the World Economic Forum�s Annual Meeting in Davos, finds that a lack of key vitamins and minerals is responsible for impairing intellectual development, compromising immune systems, provoking birth defects and consigning some 2 billion people to lives below their physical and mental potential.

The report summarizes the findings of nutrition "damage assessment" studies in 80 nations, throwing new light on vitamin and mineral deficiency levels that are almost impossible to detect without laboratory tests.

The report finds that:

* Iron deficiency impairs mental development in young children and is lowering national IQs. It also undermines adult productivity, with estimated losses of 2% of GDP in the worst affected countries.

* Vitamin A deficiency compromises the immune systems of approximately 40% of children under five in the developing world, leading to the deaths of 1 million youngsters each year.

* Iodine deficiency in pregnancy causes as many as 20 million babies a year to be born mentally impaired.

* Severe iron deficiency anaemia causes the deaths of an estimated 50,000 women a year during childbirth.

* Folate deficiency causes approximately 200,000 severe birth defects every year and is associated with roughly 1 in 10 adult deaths from heart disease.

The report states that the effects of vitamin and micronutrient deficiency (VMD) on adults, particularly on women, are subtle and insidious. The effects on nations, and on economic development, are only just beginning to be measured. But at the heart of the VMD problem is the fact that it is in the vital, vulnerable, earliest months of life that poor nutrition has its most devastating and durable effects.

"It's no longer acceptable to simply identify symptoms of micronutrient deficiency in individuals and then treat them," said UNICEF Executive Director Carol Bellamy. "We have to protect entire populations against the devastating consequences of vitamin and mineral deficiency, especially children. In the industrialized world we've been doing it for years. There is no excuse for not reaching every human being with these simple but life-saving micronutrients. We know what needs doing, we just have to do it."

The Solutions

The report says that whole populations can be protected against vitamin and micronutrient deficiencies by tested and inexpensive methods. Those solutions include:

Food Fortification: Adding essential vitamins and minerals to foods that are regularly consumed by most people (such as flour, salt, sugar, cooking oil and margarine). This measure costs only a few cents per person per year.

Supplementation: Reaching out to vulnerable groups (particularly children and women of childbearing age) with vitamin and mineral supplements in the form of tablets, capsules and syrups. This measure costs only a few cents per person per year.

Education: Informing communities about the kinds of foods that can increase the intake and absorption of needed vitamins and minerals.

Disease Control: Controlling diseases like malaria, measles, diarrhoea and parasitic infections, which can also help the body absorb and retain essential vitamins and minerals.

These are the methods that brought the VMD problem under control in industrialized nations decades ago. But UN goals to bring vitamin and mineral deficiency under control in the developing world will not be achieved, the report concludes, without a more ambitious, visionary and systematic commitment to "deploy known solutions on the same scale as the known problems."

The Global Alliance for Improved Nutrition (GAIN) was set up to foster private-public projects to fill the micronutrients gap.

According to Jay Naidoo, Chairman of the Board of the Development Bank of Southern Africa as well as the current chair of GAIN: "The nutrition gap is one we can close immediately, simply and relatively cheaply." Naidoo commented, as an example, that if wheat flour in the 75 most needy countries were fortified with iron and folic acid, iron deficiency could be reduced by 10%, and birth defects could be lowered by a third. Such fortification would cost approximately US$ 85 million, which is about 4 cents per person.

"As a result, we estimate these countries would gain US$ 275 million in increased productivity and US$ 200 million from the enhanced earning potential," Naidoo said. "There are many other examples to emphasize that public-private partnerships to invest in food fortification are investments not only in health, but also in national economies."

The report concludes: "When so much could be achieved for so many, and for so little, it would be a matter of global disgrace if vitamin and mineral deficiency were not brought under control in the years immediately ahead.�

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