Large-scale food fortification: West Africa can lead the way toward sustainable improvements in micronutrient intakes

BY: Melchior Athanase Joël C. Aïssi and Natasha Kofoworola Quist 

West Africa understands the importance of food fortification as a proven and cost-effective approach to prevent micronutrient deficiencies, i.e., “hidden hunger.” Nearly two decades ago, countries in West Africa analyzed the diets of vulnerable populations across the region to better understand and address gaps in nutrition. They found that a handful of staple foods and condiments—like vegetable oil, wheat flour, and salt—were eaten by over 70% of the target population, regardless of where they lived or household budget. These foods were to be used for the region’s fortification program—one of the most ambitious in Africa’s history. 

Today, as we face growing health, food and nutrition security, and economic crises, West Africa has a critical opportunity to build on this legacy and renew our commitment to improve food diversity and micronutrient intake. 

Despite some progress, the prevalence of micronutrient deficiencies—caused by a lack of essential vitamins and minerals in diets—remain high across the region, with devastating impacts. Approximately half of women ages 15-49 suffer from anemia, and 15% of children are born with low birth weight and potential birth defects due to micronutrient deficiencies. This significant public health problem has only been made worse by the concurrent crises.

The West African Health Organization (WAHO), the official health agency of the Economic Community of West African States (ECOWAS), has a strong history of leadership on food fortification—galvanizing public-private partnerships, collaborating with global partners and NGOs, to support food fortification. To date, all Member States of ECOWAS have national policies and regulations to support the fortification of widely consumed foods, such as edible oils, cereals, salt, milk, and sugar. These policies and regulations are critical to bringing micronutrient-fortified staples to millions across West Africa, and we have seen promising results.

In Nigeria, between 2017 and 2020, coverage of wheat flour fortified with iron and folic acid—which helps protect against anemia and serious birth defects—increased from 54% to 92% to reach 73.5 million additional Nigerians. Coverage of sugar fortified with vitamin A—which promotes eyesight and strengthens the immune system—has more than tripled to reach 96% of the population. Salt iodization levels have remained constant at an impressive 95%. The Promoting Rice Fortification in Nigeria (PRIFN) project aims to build a roadmap to fortify another staple of Nigerian diets and expand local production of fortified rice—boosting health and local economies. 

New initiatives like PRIFN are critical to growing the impact of fortification. Today, we are on the brink of further progress.  

This May, with broad support from ECOWAS Member States, the Bill & Melinda Gates Foundation, and many partners, the Assembly of the World Health Organization passed a landmark resolution to strengthen food fortification programs. Following this assembly, stakeholders from the West African region came together to recommit to food fortification as a leading strategy for nutritional policy and committed to establishing a regional Alliance for food fortification. 

In doing this, we have sent a clear signal to the international community: “we have the political will and desire to expand and improve food fortification programs.” It is time to turn this momentum into action, set responsible regional goals, measure our impact, and make real progress on fortification.

Today, West African leaders are at a crossroads. The impact of climate change, inflation and general cost of living have made healthy diets even more expensive and inaccessible. Therefore, it is paramount that we prioritize programs that support the nutritional needs of all people, especially the most vulnerable. Despite the challenges, we can reinforce capacity and develop effective support systems, facilities, and tools to help standardize the fortification processes. We can establish strong external monitoring and regulatory systems.

We look forward to collaborating with others across Africa, and especially here in West Africa, to continue this important work. We all have a role to play in making our vision of fortification a reality. By seizing this opportunity, West Africa can ensure the food and nutrition security of its population and, above all, improve their health and well-being.

Dr Melchior Athanase Joël C. Aïssi is the Director General of the West African Health Organization (WHO) and Natasha Kofoworola Quist, is the Regional Director,  West and Central Africa for the Bill & Melinda Gates Foundation