Hidden Hunger……Some facts about food fortification

March 5, 2012 by · Comments Off
Filed under: Business Development, Healthcare General, Public Health 
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There is a rush to cash in on micronutrient deficiency in India through fortification of food. However, Health experts say fortification should be done though evidence-based strategies (Courtesy: Nandi Foundation).
Andhra Pradesh Foods, a state government enterprise, is ramping up its fortified food production capacity. It provides ready-to-eat and ready-to-cook foods like upma mix, sweet porridge and khichdi mix, fortified with iron, zinc and other vitamins, to infants and pregnant and lactating women under the Centre’s Integrated Child Development Scheme (ICDS).
The effort to double its production and increase the number of beneficiaries from three million to five million has come following its partnership with the Global Alliance for Improved Nutrition (GAIN). The Swiss NGO has offered it a grant of US $1.8 million. “It is also providing us technical support, for instance, to increase the shelf-life of fortified food products,” says P Satyanarayan Reddy, managing director of AP Foods.
Andhra Pradesh is not the only state where fortified food is the flavour of the times. Global NGOs, pharma companies and international donor agencies are all scrambling to provide aid, technology and partnerships to fight malnutrition, or hidden hunger, in India. According to UNICEF, one in every three children in the country is malnourished.
For instance, PATH, an international NGO, along with US pharma giant ABOTT, is pumping $1.5 million to introduce iron-fortified rice in the Indian market under brand name Ultra Rice. In 2009-10, PATH launched pilot projects in Rajasthan and Andhra Pradesh where it fed Ultra Rice to around 245,000 schoolchildren under the mid-day meal (MDM) scheme. When asked if the NGO studied the impact of the fortified rice on the children, Dipika Matthias, director of PATH’s Ultra Rice project, said, “As the introduction scheme was not a clinical trial, no biological data was collected from the children.” The project, also funded by the US Department of Agriculture, Bill & Melinda Gates Foundation and GAIN, plans to reach out to five million people over the next three years through government food distribution schemes like the Public Distribution System (PDS), MDM scheme and ICDS.
Let’s get it clear

Fortification: It is a process in which external nutrients (vitamins and minerals) are usually added in chemical forms to commonly consumed foods to increase the nutrition level.
Biofortification: It is a technology where a nutrient is either increased or added to a crop through conventional plant breeding or by tweaking the genes through GM technology.
How fortified
If you think eating fortified or bio-fortified food is enough to meet your micronutrient deficiencies, think again. Micronutrient availability to human body depends on three factors: quality and quantity of micronutrients and ability of the body to absorb a particular nutrient.
B S Ramakrishna, professor of gastroenterology, CMC Vellore, says micronutrients have a longer shelf-life in drugs than in fortified food. Minerals like iron and zinc do not get completely absorbed by the body. In a healthy person, 10 per cent of iron ingested gets absorbed. He cautions against excessive intake of vitamins. Fat soluble vitamins like A, D and E should be taken under guidance as body has no mechanism to get rid of the excess. They can get deposited in liver and lead to complications.
Even biofortified crops have limitations. “The nutrient content of added beta-carotene decreases with time in bio-fortified crops,” says K N Rai of ICRISAT. NIN experts say light sensitive and labile nutrients like Vitamin A, B-complex and iodine also degrade over time.
Although intentions behind fortification of food could be genuine, nobody knows what is going on. There is no monitoring on the safety issues associated with fortified food products. In several states pilot projects are going on through government schemes without any knowledge of the government.
In October 2011, while reviewing the implementation of MDM scheme, the world’s largest school feeding programme, a mission to Madhya Pradesh found that NGO Naandi Foundation was supplying fortified meal under MDM scheme but government officials remained oblivious of it. The mission received information that the Foundation was fortifying wheat flour with iron, folic acid and zinc on alternate days. “During our visit, we found there was no permanent nutrition expert posted in the centralised kitchen. We were told that the nutrition expert visits when required from the Foundation’s Hyderabad headquarters,” says Sachin Jain, a mission member and advisor to Supreme Court Commissioners for Madhya Pradesh. His team noticed several other irregularities, such as there was no transparency in purchase and procurement; machine-made chapattis would became so hard that children find them difficult to eat. The situation is likely to prevail in other states too, Jain adds.
Naandi Foundation, which has been providing mid-day meal to over a million children in five states since 2003, says it supplies fortified wheat and lentils. “We had experimented with fortified rice using PATH’s Ultra Rice. But we suspended it as it formed lumps on cooking. Children did not find it palatable,” says Leena Joseph of the Foundation. The non-profit claims a study by the All India Institute of Medical Sciences in 2010 showed haemoglobin levels in children rose by 10 per cent after consuming its fortified food for three months.
Studies by the National Institute of Nutrition (NIN), a body of the Indian Council of Medical Research (ICMR), however, showed an otherwise result. “Consumption of iron-fortified rice through MDM for eight months significantly raised the level of stored iron in body. But it has not made any significant additional impact on haemoglobin status, says K Madhavan Nair, micronutrient research scientist with NIN. It takes at least four to five years to observe the actual impact, he adds. Researchers with the institute say fortification should be done through evidence-based strategies.
ICMR has set guidelines in this regard. For example, a kg of wheat flour should be fortified with 60 mg of iron and 1,500 microgram of Vitamin A. But whether NGOs conform to the guidelines can only be monitored by the Food Safety and Standards Authority of India. FSSAI did not respond despite repeated communications asking whether it has rules and regulations in place for fortifying foods supplied under government schemes and whether it monitors the products.
The next big revolution is biofortification.
Unlike fortification, biofortification is a process where nutrients are increased in a food by tweaking the crop.
ICMR has already formed an Interagency Group on micronutrients to look into techniques to improve nutrition of food through biofortification.
K N Rai, principal scientist with the Internation Crops Research Institute for the Semi-Arid Tropics (ICRISAT), says biofortification is a better way than fortification. “This is a more natural way to improve nutrition. It solves the problem in a better way through the grains that people are already eating.” He added that at present ICRISAT is working on increasing iron and zinc in sorghum and pearl millet and beta-carotene in pigeonpea and groundnut in India (see ‘India set to grow biofortified crop’, Down To Earth, March 1-15, 2011). Nigeria, Mozambique and Zambia are already growing biofortified cassava, sweet potato and maize, he adds. B Sesikeran, director of NIN, says biofortification is still in the initial stage of scientific development. With time, it may become an ideal technology. But unlike fortication, it would not be suited for fortifying a food grain with multiple micronutrients, he adds. Loveleen Kaur Khera, a dietician in Chhattisgarh, says before deciding what is better, we must understand the Indian psychology. Vitamin pills are a good source of nutrients, but they are counted as medicine. Similarly, fortified food are not considered natural. Besides, stability of micronutrients in fortified food is a concern.
Biofortified food faces a bigger challenge. The commonly used technique to grow such crops is genetic engineering, which is under cloud on safety issues. Since colour and taste are important aspects of the Indian food, people would not accept any new product unless it is palatable, she adds.
For instance, people in West Bengal are complaining against the fortified wheat flour provided under PDS. It is red in colour and does not taste good. Its shelf-life is short. Khera says natural food is the best source of nutrition.
An Article by Jyotika Sood for Down to Earth (http://www.downtoearth.org.in/print/36038)
Contributed to HCIF By:  Deepa Pohankar (Right to Food Activist based in M.P)

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India may get the food security bill but not the food

September 9, 2011 by · 2 Comments
Filed under: Right to Food 

Long promised by the UPA government, the food security bill will be tabled in parliament in December this year. However, the National Advisory Council (NAC), which drafted the proposal, is tussling with the government over the “dilution and misdirection” of the Bill. The final Bill diverges from the original NAC draft on key issues: adoption of alternatives to the PDS such as cash transfers, the risk of inflation due to cash subsidies, the omission of legal guarantees and punishments for non-compliance, and the continued misidentification of the poor.

 

Providing food too expensive

It has been estimated by the ministry of food and public distribution that the total food subsidy bill will balloon to Rs1,10,600 crore if entitlements recommended by the NAC are incorporated into it. This amount, according to Union food minister KV Thomas, is for investments towards increasing productivity, PDS reforms, and improving storage capacity and transportation.
R Ramakumar, agronomist and professor at the Tata Institute of Social Sciences, believes that faulty identification and procedural missteps are increasing the cost. Vandana Shiva, environmental activist calls the Bill “economic disenfranchisement for political gain”. She adds, “The costs are being raised due to the wasteful allocation on the identification of the poor: pink and yellow cards [pink cardholders are entitled to rice; yellow cardholders draw rations other than rice] is bureaucratic nonsense.”

 

Cash transfers a weak substitute

While overdependence on a leaky PDS has failed to holistically address the problem of food security, it safeguards farmers’ interests. “This change is one of the most anti-farmer steps the government could have taken. This is being done primarily so that the rural sector is opened up to MNCs which want to buy directly,” says agrarian lobbyist Jagdish Manekar.
Another problem cited is that there is no guarantee that the cash transfer, as envisaged in the government draft, will be an antidote to the problems of the PDS. Food is controlled by women, and there is a strong possibility that it will reach the stomach of the child. In most families, however, cash tends to be controlled by men.
When pressed as to why the government wants to shift to cash transfers, Manekar admits that alternatives to the PDS do help. “Models of subsidy delivery other than the PDS, such as food stamps and cash transfers, should be looked into. Research has shown that the PDS provides low quality of grain and their availability is unpredictable,” he explains.
“The argument in favour of cash transfers is that they increase the resources available to households without ruining the market balance or even individual choice. A subsidy will result in both of these. Subsidies will reduce the market price, and cannot allow everyone to benefit.”

 

Who will watch the watchmen?

What of legal redressals, checks and balances, and supervision at the micro level? They have been wiped away. “In the NAC draft, there was a provision for a food commissioner who had the powers to impose penalties, much like a lokayukta. This has been removed,” says Ramakumar. “The minimalist perspective of the NFSA on food security has no space for legal guarantees to enforce the law’s provisions among groups that aren’t automatically included in the priority list.”

The Bill only provides for a system of commissions which are weak due to their inability to make binding recommendations.  “The NFSA needs to link redressals to the criminal justice system, outlining penalties and punishments for non-compliance and neglect of duties,” he advises.

 

Who’s really poor?

Jean Dreze, the developmental economist who conceptualised the first draft of the NREGA, quit his membership of the NAC in June over the food security issue. A vocal critic of the UPA leadership’s views on the proposed Food Security Bill, Dreze is one of the key architects of the social security programme that has led to a public battle between the council on one side and the PMO and the Planning Commission on the other.
The biggest problem, seen by Dreze as a “continuation of the worst of the pre-existing policies”, is that of identification. The poverty line, already set at an abysmally low level of Rs20 daily for the urban poor, has been reshaped into Priority, General and Excluded Classes. “Beyond this renaming, there is no change in the approach to classification,” says Ramakumar. “The present system’s ideology of exclusion is continued here.”

 

Staging a legislative intervention

How can the Bill be saved? “The PDS needs to be made universal, barring from it only those that meet the simple and transparent exclusion criteria of owning property worth more than 10 lakh, motor vehicles, and working in the government,” says Dreze. “The excluded category should be expanded and in turn, the priority category should also be increased.” The universal system of PDS is one that enables a time-based and differential system of allocation to people both above and below the poverty line.

Economists weighing in during the preparation of the draft have opined that the idea of universal PDS in the poorest 200 districts needs to be reinstated. The Bill was then referred to an empowered group of ministers, which in turn asked the Planning Commission to rework the contours of the legislation.
However, NAC, at its last meeting on July 1, insisted that the entitlement should be universal. The Plan panel subsequently reworked the draft Bill accepting in principle the concept of universalisation but insisted on differential pricing — one for BPL and another for above the poverty line — through PDS. “We should look at the system of identification in Kerala for an example of an alternative. They use nine parameters such as no house, no regularly employed family member, no access to water, and so on, and if the family doesn’t match up to four or more, they are identified as poor,” explains Manekar. “Failing this, the government should look at decentralised solutions which can be implemented at a micro-level, such as entrusting gram panchayats with funds.”

This article is authored by Apoorva Dutt for DNA, September 4, 2011 and can be accessed here.

Further Reading:

 

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PDS vs Cash Transfers: What is our take?

July 27, 2011 by · 4 Comments
Filed under: Healthcare General, Right to Food 

 

“The Government provides subsidies, notably on fuel and food grains, to enable the common man to have access to these basic necessities at affordable prices. A significant proportion of subsidised fuel does not reach the targeted beneficiaries…We have deliberated for long the modalities of implementing such subsidies…To ensure greater efficiency, cost effectiveness and better delivery for both kerosene and fertilisers, the Government will move towards direct transfer of cash subsidy to people living below poverty line in a phased manner.” ( The Finance Minister’s budget speech )

This clearly indicates that the government is moving towards a system of cash transfers that will replace the Public Distribution System (PDS) for food grains, as has already been done for kerosene and fertilizers. The scheme is already being piloted in some parts of Delhi and has received negative criticisms from many concerned groups in the country, including the Right to Food Campaign. The much awaited National Food Security Bill is feared to be moving in a counterproductive direction if this is implemented. The PDS is one of the most important measures currently available to provide not only food security to people, but also income support by freeing some wages to buy other essentials.

The Arjun Sengupta committee identified 77% of the country’s population as being vulnerable since they live on less than Rs. 20 per day. It is well known that almost half the children in the country are malnourished, 70% of women are anaemic and one-third of all adults have a low body mass index. In this scenario, the need of the hour is to ensure food security through tested measures and schemes and not to hob-nobble with fancy programs that might have delivered results in a better off context.

The following are some of the issues with cash transfers. Some continue from the PDS and some are specific to the system of cash transfers, which basically proposes transferring of a certain fixed amount of cash into the accounts of the beneficiaries from the government, in lieu of their food-grain entitlements:

  • Problems of identification will remain; governments own surveys have shown identification remains the biggest issue in any targeted system. the NSS data reveals that about 50% of BPL households (the demarcation of which is also doubtful and undermines the actual numbers) do not have ration cards in India and this number rises to almost a shocking 80% in states like Bihar. These issues are likely to magnify in a cash transfer system.
  • Leakages will remain; there are no guarantees or plugs to ensure that the fallacies of the previous system will be tackled here, in a more liquid form of transferring entitlements.
  • Banking infrastructure is limited, especially in the targeted beneficiary group
  • Cash does not guarantee food security
  • No protection from inflation and fluctuation of market prices of food, since a fixed amount will be given to the beneficiary
  • Adverse impact on agriculture, as the government will stop procuring grain
  • Lack of transparency and accountability of privately owned shops; this has already been evidenced in the pilot schemes.

We at the Health Care Intelligence Forum stand in solidarity with the Right to Food Campaign and demand that the Government reverse its cash transfer policy and ensure universal coverage of the PDS.

Compiled from: A Note on Replacing PDS with Cash Transfers, by the Right to Food Secratariat

Further reading:

What is PDS?

Why cash transfers won’t work in India?

The Right to Food Act

BPL Census 2011

RTF India


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