FLOUR POWER

What We’re Learning: Lessons from one country can make a big difference for others.

Most children in Ghana don’t get the vitamins and minerals they need to grow up healthy and strong. To take just one example, more than 80 percent of Ghanaian children under 5 suffer from anemia. This kind of undernutrition exists throughout the developing world, and it is devastating to the health and economic well-being of millions of people.

We are among the partners involved in the Global Alliance for Improved Nutrition (GAIN), a public-private effort to make sure people in developing countries get the nutrients they need. In 2007, GAIN and Ghana reached an important milestone together: All the wheat flour in Ghana is now fortified with eight different micronutrients, including iron.

The success in Ghana is based in part on lessons GAIN learned from some of the other countries in which it’s been working, where progress has been slower.

GAIN has learned how important it is to fortify foods for which processing activities are centralized. In Ghana, there are only four flour mills in the whole country. Compare that to the iodization of salt, which can be produced in hundreds of different locations in a given country. Logistically speaking, zeroing in on four sites is significantly easier.

It is critical to pick the right foods to fortify. They have to be cheap, so the poorest people who tend to suffer the most from micronutrient deficiencies can afford to buy them. These foods also have to be a common and predictable part of people’s diets. Otherwise, there is a danger that some people won’t get enough of the nutrients, while others will get too much.

Wheat flour is very common in Ghana, but still, some of the poorest people who live in the most remote parts of the country eat a diet of maize instead. Ghana is working with the country’s flour companies to build awareness about the health benefits of fortified products and ultimately to create more demand for them. Ultimately, however, fortification won’t reach everybody, and it must be complemented by other health and nutrition initiatives.

GAIN is an excellent example of the potential of public-private partnerships to achieve health successes that neither sector could engineer on its own. The government of Ghana works on two things. First, it passes regulations to make sure that no company has an advantage in the marketplace by not fortifying foods. It also conducts extensive monitoring and evaluation to understand what impact the fortification efforts are having on the health of the population, including the poorest people in the country.

Meanwhile, the private sector does what it does best: It produces, distributes, and markets the product.

The success in Ghana—the smooth public-private collaboration and the wise planning that went into its fortification program—suggests that GAIN can meet its goal of improving the nutrition and health of 1 billion people.