THIRD REGIONAL WORKSHOP:

HUMAN CAPACITY BUILDING TO MONITOR

NUTRITIOUS AND FORTIFIED FOODS IN THE

EAST, CENTRAL AND SOUTHERN AFRICA

(ECSA) REGION

14 – 16 June 2017

Centro Internacional de Conferencias Joaquim Chissano

Maputo, Mozambique

This workshop was made possible by the generous support of the American people through the United States Agency for

International Development (USAID). The contents are responsibility of GAIN and the ECSA Health Community, and do not

necessarily reflect the views of USAID or the United States Government.

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TABLE OF CONTENT

TABLE OF CONTENTS

ACKNOWLEDGEMENT .................................................................................................. 4

LIST OF ACRONYMS ..................................................................................................... 5

EXECUTIVE SUMMARY ................................................................................................. 7

1. BACKGROUND ........................................................................................................ 9

1.1: OBJECTIVES ...................................................................................................... 10

1.2: WORKSHOP PARTICIPANTS ............................................................................ 11

2: Official opening ......................................................................................................... 12

3: Updates from country teams ..................................................................................... 13

3.1: Production, QA/QC and Food Safety .............................................................. 13

3.2: Inspection and Enforcement ............................................................................ 15

3.3: Laboratory strengthening ................................................................................ 16

3.4: Consumption Monitoring and Program Impact .............................................. 19

3.5 Technical working groups discussions on key lessons, achievements ... 21

and challenges ....................................................................................................... 21

3.5.1. Production, QA/QC and food Safety Working Group .................................... 21

3.5.2 Inspection and Enforcement Working Group ................................................. 22

3.5.3 Laboratory Strengthening Working Group ..................................................... 24

3.5. 4. Consumption monitoring and Program Impact ............................................. 26

4.0 Recent Advances in Food Fortification .................................................................... 27

4.1 Key achievements of the Regional Initiative......................................................... 27

4.2 Updates from the International meeting on Compliance Monitoring ..................... 28

4.3: Updates from Regional Ring Testing .................................................................. 29

4.3: Advances in Testing Iodine in Salt ...................................................................... 30

4.4: Promising Practices of Private Sector Engagement: The Case of SUN

BUSINESS NETWORK in Tanzania .......................................................................... 31

5.0: Updates and Key Lessons from Regional Partners ................................................ 32

5.1: Key lessons and achievements from SAFE, PFS and related initiatives ............. 32

5.2: Updates from FFI works in ECSA Region ........................................................... 33

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5.3: Nutrition International Food Fortification works in the Region ............................. 33

5.4. Findings from mapping regional and global management information systems .. 34

5.5 Programmatic Monitoring of National Food Fortification: An Innovative Solution to

Improving Program Outcomes - Project Health Children ........................................... 35

5.6 Updates from World Food Programme Mozambique ........................................... 36

5.7 Progress towards Elimination of Iodine Deficiency in Eastern and Southern

Africa Region: lessons from UNICEF ......................................................................... 37

5.8 Fortification successes and priorities in Africa, Hellen Keller International........... 38

6.0: Sustaining gains from the ECSA FF initiative and planning for the next 12 months

...................................................................................................................................... 38

7.0 Launch of the Global Fortification Data Exchange .................................................. 39

8.0 Closing remarks ...................................................................................................... 40

ANNEXES .................................................................................................................. 422

ANNEX 1: CONCEPT NOTE AND AGENDA ...................................................... 423

ANNEX 2: WORKING GROUPS PLAN OF ACTION FOR THE NEXT 12

MONTHS .................................................................................................................. 51

ANNEX 3: PARTICIPANTS LIST ............................................................................... 57

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ACKNOWLEDGEMENT

The third Regional Food Fortification forum was organized by the ECSA Health

Community in collaboration with the Ministry of Industry and Commerce of the Republic

of Mozambique and Global Alliance for Improved Nutrition(GAIN).

On behalf of the organizers, ECSA-HC would like to sincerely thank the Governments of

the 13 project countries for their commitment towards the regional agenda and for

releasing the officers to participate and share country lessons in this workshop. Also

ECSA-HC extend gratitude to the partner organizations who we worked tirelessly during

the preparation and execution of this workshop including: Food Fortification Initiative (FFI),

CDC/IMMPaCt, SPRING project/Uganda, Techno Serve/Kenya and SGS Labs/Kenya.

Finally, ECSA HC convey its sincere gratitude to USAID for providing technical and

financial support for the initiative and specifically for making the regional meeting a

success.

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LIST OF ACRONYMS

AAS Atomic Absorption Spectrophometry

CDC Centre for Disease Control

COMESA Common Market for Eastern and Africa

CRM Certified Reference Material

DHS Demographic Health Surveys

ECOWAS Economic Commission of West African States

ECSA HC East Central and Southern Africa Health Community

ESARO East Southern Africa Regional Office

FACT Fortification Assessment Coverage Tool

FF Food Fortification

FFI Food Fortification Initiative

FRAT Fortification Rapid Assessment Tool

GAIN Global Alliance for Improved Nutrition

GFDx Global Fortification Data Exchange

GMP Good Manufacturing Practices

HACCP Hazard Analysis Critical Control Point

HPLC High-performance liquid chromatography

JKUAT Jomo Kenyatta University of Agriculture

KNFFA Kenya National Food Fortification Alliance

MI Micronutrient Initiative

MOH Ministry of Health

MNPs Micronutrient Powders

NFFA National Food Fortification Alliance

NWGFF National Working Group on Food Fortification

PT Proficiency Testing

QA Quality Assurance

QC Quality Control

SABS South Africa Bureau of Standards

SADC Southern Africa Development Commission

SAGCOT Southern Agricultural Growth Corridor of Tanzania

SBN SUN Business Network

SUN Scaling up Nutrition

TAHA Tanzania Horticultural Association

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TASPA Tanzania Salt Producers Association

TWG Technical Working Group

TOR Terms of Reference

UNICEF United Nation Children Fund

USAID United States Agency for International Development

USI Universal Salt Iodization

VAS Vitamin A Supplementation

WFP World Food Programme

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EXECUTIVE SUMMARY

Since 2015, ECSA-HC in collaboration with partner Global Alliance for Improved Nutrition

(GAIN) with the financial support from USAID have been working with 13 countries from

the ECSA region to strengthen the capacity for effective monitoring of fortified and

nutritious foods. The initiative complement other regional and countries efforts aiming at

accelerating the implementation of food fortification programs. The countries supported

under this initiative includes: Burundi, Ethiopia, Kenya, Lesotho, Malawi, Mozambique,

Rwanda, South Africa, Swaziland, Tanzania, Uganda, Zambia, and Zimbabwe.

Through this initiative, the human resource capacity of government official from various

institutions have been strengthened in line with four project thematic areas:

Production, Quality Assurance/Quality Control (QA/QC), and Food Safety;

Inspection and Enforcement; and

Consumption Monitoring and Program Impact

Laboratory Strengthening

The third regional workshop brought together participants from the project countries,

global and regional experts and development partners supporting food fortification and

related initiatives in the region. The workshops were designed to provide a platform for

countries to exchange experiences, discuss regional gaps and challenges, and share

solutions to build the capacity of local personnel involved in these areas.

The main objectives of the workshop were:

Review of working group progress and achievements towards stated goals and

roadmaps developed during the Second Regional Workshop.

Harmonization of activities and projects related to four thematic areas supported

by development partners at country and regional level for complementarity.

Discussion of next steps and targets for continuing progress and activities beyond

project completion in September 2017 at national and regional levels.

During this workshop, countries had the opportunity to present key lessons, achievements

and progress towards implementation of agreed actions from the second workshop. The

regional partners also presented their works, future plans and opportunities to continue

supporting capacity strengthening efforts at countries and regional level. Following the

discussions, each technical working group identified key priorities developed plan of

action for the next 12 months.

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WORKING GROUP KEY PRIORITIES:

Production, Quality Assurance/Quality Control (QA/QC), and Food Safety:

Improve Communication and advocacy

Engage with private sector in all steps of the processes (i.e elaboration of standards,

national action plans, etc).

Inspection and Enforcement:

Review and finalize the harmonized regional regulatory monitoring guidelines

Strengthen regulatory monitoring and evaluation

Improve communication and advocacy

Consumption Monitoring and Program Impact:

Support countries that developed a database/surveillance system and use it as an

advocacy tool

Build capacity on consumption monitoring and impact evaluation to working group

members

Provide technical assistance to the countries that want to implement consumption

monitoring and impact evaluation of fortification programs

Laboratory Strengthening:

Training and capacity enhancement of the working group

Improved competences and facilitate accreditation of laboratories

Support on procurement of equipments and reagents

Review and finalize ECSA laboratory guidelines/ manuals

Following the discussion and deliberations, the following recommendations and

way forward came up from the 3rd ECSA regional workshop:

1. Partners to continue supporting ECSA-HC and countries to address the capacity gaps

in the region

2. Support implementation of working groups plan of actions

3. Strengthen sharing of progress and knowledge generated at countries level through

ECSA nutrition hub

4. Sustaining communication and networking within and across the working groups

5. Increased commitment and collaboration with private sector

6. Mobilize resources to sustain the regional capacity building initiative

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1. BACKGROUND

The ECSA-HC1 is an intergovernmental organization established in 1974 to foster

cooperation in health and nutrition in the East, Central and Southern Africa (ECSA)

Region. Its mandate is to promote and encourage efficiency and relevance in the

provision of health services in the region through advocacy,6 capacity building,

coordination, inter-sectoral collaboration, and harmonization of health policies and

programs.

The countries of the ECSA Region have made tremendous progress in designing,

resourcing, and implementing programs which focus on making fortified and nutritious

foods widely available within recommended standards. Since 2003, the ECSA Health

Community (ECSA-HC) Secretariat, in collaboration with development partners in the

region, including USAID, MI, GAIN, UNICEF, and CDC/IMMPaCt, has continued to work

with its member states to introduce and implement food fortification initiatives. By 2011,

many countries in the ECSA Region had started and legislated mandatory fortification

programs on oil with vitamin A, and wheat and maize flours with iron, zinc, vitamin A, folic

acid, niacin and other B-vitamins. In addition, universal salt iodization programs continued

to expand and improve while sugar fortification with vitamin A was being implemented in

Malawi and Zambia. In addition, this regional effort led to improved coordination among

countries in the region, which resulted in harmonization of standards, several manuals for

food quality control and inspection, establishment of a regional laboratory proficiency

network, and capacity building of more than 100 government officials on the design and

implementation of food fortification programs.

Building on the successes of the first ECSA regional food fortification project, a new

regional initiative to build human capacity to monitor fortified and nutritious foods within

the ECSA Region began in June 2015 and is scheduled to close in September 2017. It is

co-implemented by ECSA-HC and GAIN with support from USAID. A first regional

workshop was held in Arusha, Tanzania in September 2015, which resulted in the

formation of 3 technical working groups with terms of references and priority activities to

be implemented at country and regional level. The three working groups were in the areas

of:

Production, Quality Assurance/Quality Control (QA/QC), and Food Safety;

Inspection and Enforcement; and

Consumption Monitoring and Program Impact.

The working groups are chaired by experts from various regional and international

partners with sound specialty and experiences in the thematic areas relevant to the

1 The nine active member states of the ECSA-HC are Kenya, Lesotho, Malawi, Mauritius, Swaziland, Uganda, United

Republic of Tanzania, Zambia, and Zimbabwe.

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working group. Each country has a national focal point represented in each working group

and development partners have also joined and contributed in their respective areas of

expertise.

A second regional workshop was held in March 2016 in Addis Ababa, Ethiopia. During

this workshop, countries had the opportunity to present their progress towards

implementation of agreed actions from the first workshop and developed national

roadmaps and action plans for the following year. The technical working groups also

developed roadmaps for regional-level actions over the following year. The workshops

were designed to provide a platform for countries to exchange experiences, discuss

regional gaps and challenges, and share solutions to build the capacity of local personnel

involved in these areas.

Through the initiative, ECSA-HC and GAIN have facilitated the working group

communications to share progress towards implementation of the agreed work plans.

Since the second workshop, the following activities have been achieved:

Working groups have held several in-person and online trainings and discussions

to facilitate sharing of experiences and strengthen technical capacities;

A regional stakeholder mapping was finalized;

A fourth working group in the area of laboratory testing was established and chairs

were elected from among working group participants;

Working groups reviewed the ECSA regional manuals to propose updates and

revisions;

Assessments of regional laboratory capacity, regional and global management

information systems usage, and regional consumption monitoring systems have

been undertaken or are currently underway;

An advocacy toolkit for countries is under development; and

A regional laboratory proficiency testing scheme is underway.

1.1: OBJECTIVES

The Third Regional Workshop was organized with the main objective being to identify

mechanisms and strategies to provide sustainability to the efforts, as the initiative was

coming to an end in September 2017. During the workshop delegates reviewed the

advances made in implementation of developed action plans, including discussion of the

results, next steps, and dissemination of the learnings and achievements. The workshop

also provided a platform to share common challenges and solutions to learn from each

other and continue to strengthen local capacity for monitoring fortified and nutritious foods.

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The long-term goals for the initiative are:

To strengthen collaboration and coordination among countries and development

partners in the areas of food safety and quality control, enforcement and inspection,

food laboratory, and consumption monitoring.

To strengthen collaboration of the ECSA Health Community and other regional

organizations to spearhead capacity building and monitoring activities.

To harmonize training and experiential learning activities/platforms with

development partners and countries to build the capacity of local professionals.

To strengthen the industry quality control practices, government inspection and

laboratory practices for monitoring safety and quality of fortified and nutritious

foods, and the introduction of consumption monitoring practices.

The workshop’s main tasks and objectives included:

Review of working group progress and achievements towards stated goals and

roadmaps developed during the Second Regional Workshop.

Harmonization of activities and projects related to four thematic areas supported

by development partners at country and regional level for complementarity.

Discussion of next steps and targets for continuing progress and activities beyond

project completion in September 2017 at national and regional levels.

1.2: WORKSHOP PARTICIPANTS

The 3rd ECSA regional workshop was attended by 91 professionals working in the

production, regulation, inspection, enforcement, monitoring, surveillance, and evaluation

of fortified and nutritious foods programs.

Participants of the meeting included:

Representatives from 11 ECSA country governments2 (ECSA-HC member states

and non-member states), including ministries of health, agriculture, industries, and

trade and relevant departments and authorities involved in nutrition, food safety

and control, and standards and regulation.

Delegates from producers of fortified and nutritious foods from the ECSA region

as well as private sectors from outside the region.

Delegates from international development partners with expertise and operations

in the ECSA region.

United Nations Agencies including UNICEF and WFP

Individual experts on Food Fortification from ECSA region

2 Burundi, Ethiopia, Kenya, Lesotho, Malawi, Mozambique, Rwanda, South Africa, Swaziland, Tanzania, Uganda, Zambia, and Zimbabwe have been members of this initiative and was invited to participate as a national delegation; unfortunately delegates from Burundi and South Africa failed to attend the workshop.

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2: OFFICIAL OPENING

Dr Eduarda Mungoi from the Ministry of Industry and Commerce, Republic of

Mozambique welcomed all country delegates and participants of the 3rd ECSA regional

workshop. This was followed by the opening remarks by Mr. Edward Kataika, Director of

Programs at ECSA-HC on behalf of the Director General, Prof. Yoswa Dambisya. Mr.

Kataika drew attention on the current political commitment in the region to address

nutrition challenges through implementation for high impact interventions including

fortification. He further acknowledged the support of USAID and other partners in the

region to drive the food fortification agenda since 2002. He finally reminded the

participants on the importance of investing smartly on interventions which have high

return like food fortification and assured the commitment of ECSA to continue

coordinating the efforts at regional level.

The second remarks were given by Ms Katia Santos Dias, Country Director for GAIN

Mozambique. She pointed out that the regional initiative is covering over 300 million

populations in the ECSA region.

The third remarks were given by Amanda Fong, Economic Policy Team Leader at USAID,

Mozambique. She insisted on the importance of nutrition in day to day life and the

importance of increasing awareness on the importance of food fortification to the general

population.

The official opening was done by Honourable Dra. Cidália Chauque; Minister for Gender,

Children, and Social Welfare, Republic of Mozambique. Dra. Cidalia commended ECSA-

HC and development partners for supporting the countries to strengthen monitoring of

fortified and nutritious foods. She further reminded the delegates on the importance of the

opportunity to strengthen advocacy, compliance and knowledge management. Lastly she

assured the commitment of the government in the regional initiative and wish the

participants good stay in Maputo and fruitful deliberations.

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3: UPDATES FROM COUNTRY TEAMS

In this session, all the 11-countries had an opportunity to share experiences on the

current status at country level based on topic of selection. Zimbabwe, Tanzania and

Mozambique presented on Production, QA/QC and Food Safety; Zambia, Swaziland

and Lesotho- Inspection and Enforcement; Ethiopia, Uganda and Kenya- Laboratory

and Rwanda and Malawi- Consumption and Impact Monitoring.

3.1: Production, QA/QC and Food Safety

Zimbabwe

They have gazette standards and regulations for fortification of Maize meal, wheat flour,

salt, Edible Oil and sugar on 14 October 2016. Mandatory fortification of the mentioned

vehicles will be effected from 1st July 2017. They are using i-checks for monitoring food

fortification and external laboratories by HPLC. They also managed to train food

inspectors on food fortification monitoring.

Currently there are 6 large and 14 medium scale millers of wheat flour and maize meal,

5 large scale oil producers, 3 sugar companies and 5 certified premix suppliers.

Among the challenges presented are:

Inadequate laboratories at port of entry and field testing

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Low number of trained food inspectors

Fortification resulted into addition cost to industries- dossifiers and fortificants

Different regulations and fortification levels of imported foods

Zimbabwe recommended the following actions to strengthen food fortification programs:

Harmonization of standards at SADC and COMESA regions

Local support on calibration and maintenance of supplied equipments i.e i-checks

Facilitation of proficiency testing across the region

Training of inspectors involved in food fortification.

Tanzania

Developed their standards and regulation in 2011. The food fortification program was

officially launched in 2013 by the previous president HE Jakaya Mrisho Kikwete.

Currently there are 5 companies and 7 millers fortifying wheat flour, 6 companies and 7

mills fortifying edible oil and 1 large scale miller fortifying maize flour. Some of the small

scale hammer millers are voluntarily fortifying maize meal. The country also gives tax

exemption to fortificants/premix hence facilitated the millers/companies to absorb the cost

without adding the commodity price.

The country also managed to review food fortification regulations, developed QA/QC

guidelines, installed WYD Iodine checkers in 12 sentinel sites and organized refresher

trainings on QA/QC.

The major challenges pointed out were:

low compliance of fortified foods to the national standard

exclusion of small and medium scale millers in national food fortification regulation.

Mozambique

The country passed a regulation for large, medium and small-scale fortification of wheat

flour, maize flour, edible oil, sugar and salt on 18th April 2016. They have managed to

train staff from various government agencies/ authorities from 11 provinces in QA/QC.

They have also managed to establish QA/QC system for monitoring locally produced and

imported foods in various public authorities. The country has also established an

approved list of premix suppliers and monitors the process of premix supplies.

Mozambique have developed and approved a national food fortification strategy (2016-

2021) and food fortification communication strategy (2016-2020) and published 4 QA/QC

guidelines for internal and external monitoring based on ECSA-HC food control manuals.

Among the challenges which the country is facing are:

scaling up of small scale fortification

Total dependency of importation of fortificants/ premixes and maintenance of

equipment

Inadequate capacity of laboratories to monitor compliance of fortified foods.

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3.2: Inspection and Enforcement

Zambia

The country has regulation in place under food and drugs act chapter 303 for enforcement

approaches. The ministry of health and ministry of local government are responsible for

regulation and enforcement of regulations. The companies which comply benefit from

trainings, supportive visits and awards and recognition as incentives. They use both

qualitative and quantitative methods to determine iodine in salt. The country also imports

salt from Botswana.

Amongst the challenges mentioned during the presentation include:

Weak inspection and monitoring at production and market levels

Poor coordination and collaboration among stakeholders

Inadequate enforcement

Inspection data and reports are shared with other stakeholders on quarterly, annual

meetings and stakeholder’s meetings.

Swaziland

In Swaziland, inspection and enforcement activities are carried out at production, import

and market level. There are no incentives given for compliance. There is a standard tool

(checklist) which guides compliance monitoring.

Main challenges:

Food fortification is not mandatory

Limited supplies of test kits by the government

Absence of accredited national laboratory for testing fortified foods

Test kits are not locally available

The priority activities in the next 12 or so months are; strengthening the national food

fortification alliances and advocacy for domestic financing to support food fortification

program.

Lesotho

Inspection and enforcement activities are carried out by Ministry of Health and

Environmental health inspectors at Maseru Municipality at port of entry and market level.

The country has salt regulation in place with defined iodine level. All the salt is imported

from South Africa. Salt that does not comply is confiscated and sent to the Department of

roads, where is used to melt the snow on the roads in the mountains during the winter

season and the owner is penalized as per regulation.

Challenges:

Absence of food fortification policy and legislation

Low capacity of national laboratory to monitor fortified foods

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Inadequate human resources and technical capacity (number of environmental

inspectors and laboratory technicians.

Among the recommendations moving forward are facilitation of regulatory monitoring

and inspection and harmonization of standards with regional ones.

The 4 working groups had time to meet and discuss key lessons, achievements, and

challenges as well as any deliverables completed since the 2nd Regional Workshop.

3.3: Laboratory strengthening

3.3.1: Ethiopia

Strategies for the control of micronutrients deficiencies have been developed including

dietary diversification, food fortification and supplementation. The country has undertaken

National Food Consumption Survey in 2013 (8000 HHS) to generate baseline information

on food consumption patterns of the population. The survey has also provided data on

identification of suitable food vehicle(s) for micronutrient fortification, through comparison

on the food consumption patterns between various populations. Hence to identify to what

extent food fortification could be used to address micronutrient deficiencies. The major

nutrients anlaysed during the National Micronutrient Survey of 2015 were Iron, zinc,

vitamin A, folate, Vitamin B12, iodine

Ethiopia has been using ECSA-HC manuals for the laboratory methods to analyze

fortified oil, salt and flour samples this has created an opportunity for most labs to

participate in ECSA PT scheme. The laboratories have been instrumental in testing

adequate levels of vitamins and minerals throughout a country’s flour fortification

program. Laboratory analysis plays an important role both in external and internal

regulatory monitoring.

Challenges in the Ethiopia Laboratory network:

• Investment of laboratory resources per sample is high

• Lack of trained skilled laboratory personnel

• Quantitative tests for vitamins and minerals consume time

• Most of the laboratory are not accredited

• Most of labs lack some basic equipment’s and supplies

• Lack of PT in fortified foods

The following were recommended

• Update the ECSA methods

• Include other new parameters into the revised ECSA laboratory manuals

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• Method validation is required before execution of the manual

• Reviving regional PT scheme

• Capacitate laboratory personnel

3.3. 2 Uganda

Fortification is among the national strategies for combating Micronutrient deficiencies in

Uganda. It is mandatory for wheat flour, Maize flour, Edible oil, and salt. The Ministry of

health coordinates the food fortification program through the National Working Group on

Food Fortification (NWGFF). A multisectoral approach has been adopted to implement

fortification programs where the Laboratories from National Drug Authority is responsible

for quality and safety of fortificants and fortification mixes, Uganda National Bureau of

Standards responsible for quality and safety of fortified foods (standards, testing,

compliance monitoring and regulation, Others stakeholders supporting food fortification

at various capacities includes Uganda Industrial Research Institute (UIRI), Makerere

University, Local government and development partners .

Challenges faced by Uganda include;

Analytical methods like HPLC are time consuming especially when having large

number of samples to analyze.

High cost of the high purity analytical reagents

Training cost for analysts,

Inadequate equipment e.g limited HPLC and UV/Vis spectrophotometer,

High cost of equipments and related maintenance

High number of samples submitted especially during routine monitoring

The consumables (test kits) are expensive and thus make the analysis cost high,

Inconsistences of the results obtained from some test kits.

Following recommendations were suggested

Review of some of the reagents like triflouro acetic acids, in the ECSA laboratory

manuals which have lengthy clearance criteria at border points.

Organize trainings in analysis including: - the component of assurance of quality

of analytical results, method validation, and estimation of uncertainties in

measurements.

There is need for sponsoring proficiency testing participation because of the cost

implication.

Need to review ECSA manual of test methods to include use of modern

equipments like ICP-OES, ICP-MS and LCMS/MS etc.

There is need to expedite the validation exercise of the icheck test kits

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There is need to sponsor benchmarking attachment trainings to lab staff and

inspectors.

There is need to sponsor basic maintenance courses to staff since the

maintenance cost of bringing service engineers is high.

There is need for facilitating procurement of rapid test kits and related

consumables to enhance capacity to test for other micronutrients.

3.3.3 Kenya

Food Fortification is coordinated by the Ministry of Health at the Nutrition and Dietetics

Unit. The country is also Implementing FF programs using a multi-sectoral approach/

Public Private Partnership that brings together stakeholders to form the Kenya National

Food Fortification Alliance (KNFFA). Kenya passed mandatory legislation for fortification

of salt, maize flour, wheat flour and fats & oil. Sugar and Margarine are fortified on

mandatory basis.

Kenya has achieved the following milestones:

2005: Establishment of Kenya National Food Fortification Alliance

2006: Standards for fortified oils & fats developed

2006: Food fortification logo was developed

2009: Standards for fortified wheat and maize flour developed

KS 2571: 2014: Food fortification Premix-Requirements for supply in Kenya

Attained the Universal Salt Iodization (USI) status >90% households consuming

adequately iodized salt

The role of laboratory in food fortification has remained very vital to generate data which

aims to ascertain:

Whether fortification process at factory level is working properly with micronutrient

levels within specified requirements

If fortified foods are reaching the retail stores with expected conditions of

fortification

Whether imported foods contain micronutrients in levels required by national

regulations & standards.

If fortified foods reach the households with the expected micronutrient levels

Information generated is utilized by stakeholders for decision making, planning and

coordination of FF activities. The support of testing fortified foods comes from the

government, private sector and development partners in:

Equipment, supplies and upgrading

Laboratory infrastructure (space)

Training and sensitization of laboratory personnel

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Development of test methods and monitoring guidelines

External Quality Assessment (EQA) through participation in related Proficiency

Testing

Some achievement of the program:

Formation national technical working group for laboratories involved in testing of

fortified foods- forum for exchange of information

Establishment of a structure where laboratories have defined testing levels along

the fortified foods chain.

Laboratory capacity to test the main micronutrients of public health importance in

Kenya achieved

New reference laboratories to be established at JKUAT in collaboration with the

Ministry of Health to build synergies.

Key challenges and recommendations presented were: Strengthening of the lab quality

management systems-ISO/IEC 17025 accreditation for the micronutrients of interest.

Establishment of ECSA proficiency testing scheme which will include holding the

training & evaluation forums

Update ECSA laboratory manuals to include method for determination of Zinc.

Establish of validation criteria for rapid micronutrient test methods such as i Checks,

iodine checkers etc.

3.4: Consumption Monitoring and Program Impact

3.4.1 Rwanda

Rwanda has made some significant progress in nutrition indicators of under-fives wasting

has decreased from 5 % in 2005 to 2.2% in 2015, underweight from 18% in 2005 to 9%

in 2015, stunting from 51% in 2005 to 38% in 2015, anemia from 57% in 2005 to 37% in

2015 for children between 6-59 months, anaemia has from 26% in 2005 to 19% in 2015

for women of reproductive age. The good progress has been supported by enabling

environment such as: political will, commitment from industries, consumer acceptance,

availability of premixes and establishment of National Fortification Alliance.

The key interventions implemented includes;

1. Home fortification with MNPs

2. Bio fortification (Beans and sweet potato)

3. Voluntary large scale fortification of Maize flour, Wheat flour, Vegetable oil

The country has adopted multisectoral approach between the public and private sector to

strengthen coordination, monitoring and evaluation. It has further established four work

stream to work with;

1. Packaging and Communication

2. Quality Control and Testing

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3. Supply Chain and Logistics

4. Monitoring and Evaluation

Each work stream had developed indicators which are integrated into the HMIS

(growth monitoring indicators, laboratory indicators for anemia, Vitamin A deficiency and

Iodine deficiency)

Some of the challenges faced in Rwanda are;

1. Lack of fortification legislation and tax exemption

2. Lack of consumer awareness on benefits of fortified foods

3. Food fortification is still voluntary

4. Fortification Monitoring tools are not standardized with ECSA food control manuals

The following were recommended for Rwanda to improve its FF programs

Strong sensitization in private sector on the magnitude of malnutrition and

demonstrate the role industry could play to address micronutrient deficiencies

through food fortification

Reduction of import duties, equipments and premix by the Government

Industry capacity building and establishment of Private sectoral working group

(PSWG)

3.4.2 Malawi

Micronutrient deficiencies are consistently high in Malawi and is a public health concern

that needs to be addressed. According to the Micronutrient Survey data between 2000 &

2010; prevalence of Vitamin A deficiency (22% in children <5 years), Iron Deficiency

Anaemia (51 in children<5), Iodine Deficiency (29% in School aged Children). Among

other interventions food fortification has therefore been taken as a national priority in order

to increase micronutrient intake among the general population.

Fortification of salt has been in place since 1995 following enactment of the Salt Iodization

Act. Currently the country has put in place mandatory fortification of sugar, oil and wheat

flour which commenced in January 2017. Maize flour (when packed for sale) is also

subject to this mandatory fortification.

Sentinel surveillance has been undertaken to determine uptake of fortified products at

household level. The exercise involved 13 districts based on the location/risk factors. The

results revealed that many households were consuming inadequately fortified sugar. For

salt iodization results indicated fortification program is effective as there was correlation

between bio-maker & salt samples. Vitamin A levels in oil was also found to be low.

Malawi underscored the following challenges

National Micronutrient Survey is costly and mainly done through donor support

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HIS does not provide adequate data as it focuses on a few indicators therefore

difficult to inform fortification program

The surveys lack dietary intake indicators

Sentinel surveillance is funded for samples collection and report

Recommendations for improvement:

Capacity building on consumption monitoring tools such as Fortification

Assessment Coverage Tool(FACT), Fortification Rapid Assessment Tool (FRAT)

regional harmonization of food fortification standards

Organizing training of country teams on consumption and program impact

monitoring by members benefited from ECSA

Document and implement working group discussions and recommendations

3.5 Technical working groups discussions on key lessons, achievements

and challenges

3.5.1. Production, QA/QC and food Safety Working Group

The chair of the TWG Jonathan Thomas from Technoserve moderated the discussions,

the following were the key issues raised by members:

Key issues and experiences from the TWG

Producers in a country explore the option of buying premix in bulk and share

amongst themselves to reduce further the cost of production.

Need for subsidized equipment used for fortification

Need for the Government to strengthen effective communication with private

stakeholders on all fortification matters to ensure transparency and trust amongst

all players.

Develop plans to create platforms like, “ASK THE EXPERT”. This platform brings

together producers and experts and hence interaction in real time for any questions

that they may have are responded to.

A call for Ethiopia to develop National food fortification action plan. This has been

possible due to open communication between government and private

stakeholders. So far mapping of 267 millers has been completed.

Aflatoxins-In flour and maize fortification as the vehicle is susceptible to Aflatoxin

contamination. Hence there is need to address this issue through use of rapid test

kits for Aflatoxins and also harmonization of standards on Aflatoxins in the ECSA

region.

Food producers have to ensure adherence to food hygiene and production

environment to reduce contamination.

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There is need for fortificants to adhere to set standards. Kenya has standard(s) for

fortificants. It is not enough to rely on certificates of analysis only, but rather import

counties need to these to ensure that what is being declared is true.

There is need to ask the countries that are testing fortificants for compliance to

provide information how this program and lesson on how it is working in their

countries.

Challenges

It was noted that there is poor communication amongst members of the group.

The stakeholder mapping was done however it has not yet been finalized and

countries were urged to provide the feedback as soon as they are requested

through ECSA.

Recommendations

Members suggested the communication via group emails is much more convenient

but also a whatsApp group should be created for quick communication

National Fortification Alliance needs to be strengthened and supported in all

countries to facilitate the fortification programs

3.5.2 Inspection and Enforcement Working Group

The chair of the TWG Ms. Bwengye Miriam Kisamba from Spring Uganda opened the

session by informing members that the group has been communication virtually through

teleconferences which were being coordinated from the ECSA office. Each country has

the focal person and hence they need to be active to remind their country members to

participate and contribute to the discussion.

3.5.2.1 Key issues discussed

Develop TORs for the group and circulate to the WG members for inputs and

finalization.

Review and input to the revised ECSA internal and external monitoring manuals

by the TWG.

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The regulatory monitoring framework is under review the consultants are finalizing

the work which will be shared by GAIN through ECSA for inputs by the TWG.

3.5.2.2 Updates from countries

Ethiopia reported that the micronutrient survey has been completed and Industry

mapping is on-going and being conducted with the support from development partners.

The training of industry is on-going but more training will be needed when the food

fortification Standards are complete.

Kenya reported that the sampling protocol was developed and ready for printing and the

sampling form was improved and customized to capture food fortification data. The

Market surveillance was conducted recently.

Lesotho reported that they have a food and nutrition policy and workshops were held at

all level on this policy and now have draft legislation on food fortification.

Malawi has engaged the Ministry of Health district heads advocate on food fortification

especially providing a budget line. The quarterly progress reports are shared with the

Nutrition Committee and Micronutrient Technical WG.

Mozambique’s national Food fortification strategy was approved and capacity building

of industries was done. The food control manuals were developed in line with ECSA

manuals and approved and the Legislations and standards disseminated to Companies.

Rwanda reported that they established the Food and Medicine Authority and this will take

over regulatory monitoring and inspection activities.

Swaziland reported that the debriefing on fortification program was done only for MOH.

However, coordination across different ministries is poor especially with the Ministry of

Commerce.

Tanzania reported that FF monitoring tools were updated and capacity building for

inspectors was conducted in January 2017. There are now FF focal persons at each

district level. They further reported that laboratory technicians were trained in the new

tools e.g. I-check. However, they have not done the training of district inspectors due to

limited budget, most of the district do not plan and budget for food fortification related

activities.

Uganda reported that Market surveillance was conducted and results are yet to be shared

with Nutrition Working Group. The National Food fortification strategy is yet to be

launched by MOH as it is at printing stage. However, a challenge has remained on

organized inspection of fortificants which calls for more coordination by the Uganda

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National Bureau of Standards, Environment Health department and National Drugs

Authority.

Zambia reported that training of Inspectors on legal enforcement has been done at

provincial level and those trained are expected to roll it out to districts. Manual for

monitoring fortified foods has been developed and is at printing stage.

Zimbabwe reported that Mandatory legislation has been in place since October 2016 and

there is a document that clearly defines roles and responsibilities for each agency

involved in fortification. The communication strategy was launched in June, 2017 and the

regulatory Inspection and Monitoring was developed.

3.5.2.3 Election of Chair and Co-chair persons

The groups agreed that Spring Uganda remains the Chair and Malawi was voted as co-

chair of the working group.

3.5.3 Laboratory Strengthening Working Group

The chair Kabbis Cyprian from SGS Labs in Kenya informed members that their working

group is meant to increase sharing learning and experiences in laboratory analysis of

fortified and nutritious foods. The group has met once in December 2016 currently

reviewing the ECSA testing methods and the validation of the different test kits for vitamin

A, iodine and iron.

3.5.3.1 Updates from countries

Tanzania reported they are experiencing challenges with the ECSA methods for Vit. A

analysis using HPLC which requires the introduction of nitrogen gas during saponification

and this was due to the fact that they are other things that were not yet in place like

nitrogen gas. Further reported they received the PT samples but did not work for them

due to the challenges with the method and the HPLC was down. They indicated the need

to get iCheck reagents

Ethiopia reported that there is no food fortification testing programmes running in the

country and are only able to analyze Iodine in salt using the WYD test kits. Therefore,

only iodine is being monitored at the market level as it is mandatory for salt to be fortified

with Iodine.

Mozambique reported that they participated in the PT scheme using iCheck Test kits

methods only and not the ESCA methods. Lack of equipment like the AAs, HPLC and

ICPU is one of the challenges. They further reported that they have two strategic plans in

place and these are Food Fortification Strategy and Communication strategy.

Fortification is currently on Wheat and Maize flour with Iron, Sugar and Oil are fortified

with Vitamin A only and Salt with Iodine.

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Uganda reported that they participated in the PT Scheme and have done all the analysis

requested for all the samples. For analysis of iodine they used both the iCheck method

and titrimetric methods, for sugar the used the iCheck only due to lack of adequate

reagents for other methods. iCheck and UV-Vis methods were used in the analysis of Oil

and iCheck and ICPU was used to test for iron. However, they had an issue with amount

of sample to take when using the iCheck in the analysis of Vitamin A in Sugar. Lack of

consistence in the levels fortificants in the industries.

Zimbabwe reported that they just acquired ICP MS, GC and Elisa but have not yet gotten

the HPLC and indicated that iCheck reagents are expensive and there are no local

suppliers for reagents. There is no funding from the central government and that they do

not charge for analysis of samples from the Environmental Health Inspectors. However,

there are CRMs for fortified foods and food vehicles being fortified are Sugar, Oil, Wheat

flour, Maize flour and Salt. They have recommended for laboratory accreditation with

ISO17025.

Lesotho are only able to test for Iodine in Salt as it is mandatory for Salt to be fortified

with Iodine. The Strategic plan has been approved which will allow employment of more

Laboratory Technicians. The team requested through this initiative to be supported to

purchase the iChecks Test Kits.

Malawi reported laboratory is not yet accredited to ISO 17025, however, HPLC is being

used for analysis of Vitamin A but the consumables are expensive.

Zambia the Bureau of Standard also participated in PT programme. There is need for

capacity building for Laboratory Technicians on the analysis of fortified foods and

accreditation of the laboratories although ZABS have some methods accredited but not

in fortified foods. Further, indicated that there is need to acquire iChecks Chroma for Iron

and reagents for the iChecks.

Kenya have managed to install WYD Iodine Checkers in all counties and also have

trained some of the Laboratory Technicians, nutritionist and Public Health Officers that

will act as ToTs on creation of demand for salt iodine testing using the iodine Checker at

counties levels Laboratories. They are doing analysis for fortified foods and have also

started testing for aflatoxins in flour but ELISA kits are expensive. However, they have

not participated in the just ended PT scheme. They are now starting construction of Food

Fortification laboratory at JKUAT and SGS will provide analytical data for Fortified Foods.

There are no issues with old and current analytical methods. They mostly use the AOAC

methods of analysis. SGS has good collaboration with the public sector, currently training

(2) Tanzania Bureau of Standards Laboratory technicians in Chromatographic analysis

and also will be training (7) Kenya Bureau of Standards laboratory technicians and are

yet to start training programmes with the Uganda Bureau of Standards.

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3.5. 4. Consumption monitoring and Program Impact

The WG chair, Helena Pachon from FFI led the group into discussions. The chair updated

the group on the following activities undertaken for the past one year:

Development of Regional Consumption Monitoring Framework –work in progress.

A draft is expected by end of July 2017. It will be used in the planned training for

the Working Group scheduled for August 2017

Online training was conducted in September 2016 however the participation was

very low. And most of the countries were challenged of having good connectivity.

Participants were advised visit the FFI website and familiarize themselves with the

training, and bring questions during the working Group training workshop in

Rwanda.

3.5.4.1 Updates from the countries

Malawi has conducted sentinel surveillance the sites could be adopted by other countries

such as Zambia instead of the National Surveys which are very costly and where it takes

time to mobilize a lot of resources

Rwanda highlighted the complementary nature of the three types of fortification i.e. Home

fortification – MNPs, Bio-fortification and food fortification in their country context. All

children 6 to 23 months receive MNPs.

Mozambique was trained in FORTIMAS now just needed to operationalize their findings,

this will now be done with Ministry of Health where data will be collected at all levels from

Community to National Level. Indicators to be collected have already been identified.

Tanzania used the FACT Tool to assess coverage of fortified foods including salt which

gave the proportions of the population accessing the fortified foods

Malawi highlighted how the Vitamin A Deficiency prevalence was remained higher yet

supplementation with vitamin A was taking place. But clear reduction (DHS 2015) has

been seen from the time sugar fortification with vitamin A in was introduced in 2011.This

reduction can be attributed by Fortification. Even though Malawi has now very low vitamin

A deficiency – 3% all the interventions will continue being implemented as not all the

districts are at the same level, some districts might suffer if some of the vitamin A

interventions were to be stopped. However, it is important that monitoring be continued

so that there are no excessive intakes

Swaziland has conducted an iodine consumption survey and is planning to conduct a

micronutrient survey.

Zimbabwe has almost eradicated goitre through salt iodization which started in 1990s

Tanzania a study was undertaken where folate in the blood of women was found to be

low following consumption of wheat flour fortified with folic acid

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3.5.4.2 Election of Chair and Co-Chair

The TORs for the WG has been developed and shared to the members of the WG. The

Chair will be responsible for working directly with ECSA to coordinate communication with

other WG members, gather capacity needs etc

Tanzania, Mozambique and Uganda volunteered to be voted into Chairmanship. The

members voted Uganda as Chair and Tanzania as the Co-Chair. The partner FFI who

was chairing handed over to Uganda but will continue to provide technical guidance and

support to the WG.

4.0 RECENT ADVANCES IN FOOD FORTIFICATION

4.1 KEY ACHIEVEMENTS OF THE REGIONAL INITIATIVE

Ms Rosemary Mwaisaka from ECSA-HC presented on key achievements following

implementation of the regional initiative. She first presented about ECSA-HC governance

structure and the previous works on food fortification. She further presented the following

key achievement of the current initiative:

Coordination and facilitation of the regional workshops

Establishment of 4 regional technical working groups

Facilitation of the development priority areas and implementation of workplans

Conduct stakeholders mapping and facilitating engagement of countries and

partners through the technical working groups.

Facilitation of the knowledge generation- regulatory monitoring assessment,

consumption monitoring and surveillance system and support to build country

laboratory capacity

ECSA also facilitated networking, learning and exchange within the region

Revitalization of regional laboratory working group

Capacity building of WG members- online training on consumption and program

impact monitoring; regional QA/QC trainings in collaboration with FFI

Facilitate review and harmonization inspection and laboratory guidelines

Redesigning of ECSA website and creation of regional nutrition hub/ repository

Development of advocacy tools

Sharing of regional lessons in global micronutrient forum

Challenges encountered includes:

Virtual engagements with WG members- difficulties internet and telephone

connectivity

Minimal focus on nutritious foods

Inadequate human and financial resources for effective coordination

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Short duration of the project to address the identified capacity gaps

Inadequate face to face engagements of working groups

As a way forward ECSA outlined the following opportunities to strengthen the regional

food fortification program;

Existence of functional working groups

Countries commitment to the regional agenda

Increased momentum in implementation of food fortification program

Existence of partners at country and regional level

Placement of nutrition desk in SADC

Increased commitment and collaboration with private sector

Commitment of the countries to input to the regional repository- sharing of key

reports and documents

Potential of ECS-HC to influence decision through the existing regional high level

meetings

4.2 UPDATES FROM THE INTERNATIONAL MEETING ON COMPLIANCE MONITORING

Ms Corey Luthringer from GAIN presented on key recommendations from the

internation compliance monitoring meeting. She started by reminding the participants on

the formation of the global thematic working group during the 2015 #Future Fortified

Global Summit on Food Fortification. The thematic Working Groups included: Advocacy,

Evidence and Guidelines, Rice Fortification and Regulatory Monitoring

The recommendations and joint priorities for fortification in low- and middle-income

countries formed the Arusha Statement. Proceedings and recommendations from the

working groups were published in Sight and Life’s 2016 Supplement. The first Regulatory

Monitoring WG report identified barriers and potential solutions to regulatory monitoring

challenges from published literature and anecdotal experience from program

implementers. The three areas that were identified as needing urgent attention included:

Simplifying the process of compliance data collection for inspectors.

Identification of motivating factors for government to ensure compliance.

Identification and putting in place enablers for industry.

She further emphasized that legislation and standards alone cannot bring the targeted

nutritional impact and therefore there is need to ensure the correct amounts of vitamins

and minerals are being added per the national standard. It was noted also that the

nutritional impact of programs is jeopardized if the quality is not monitored and maintained.

In compliance, poor quality data exist on whether or not programs are adding the correct

amount of vitamins and minerals. There is need to harmonize efforts and update

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procedures and manuals with new thinking, innovative models, and realistic approaches

that take into account limited resources and universal challenges.

There was a meeting in London for Fortification Compliance Technical Consultation which

included around 35 technical experts, private sector, and national program leaders of low-

and middle-income countries (ECSA Region, Latin America, Asia). The objective of the

meeting was review existing practices and propose a standardized approach to

compliance that is flexible enough to take into account relevant variation and robust

enough to ensure the program stays on track. At the end the goal is to develop Global

Guiding Policy Document to provide standardized global guidance on how to obtain and

act upon fortification monitoring and quality data by September 2017.

Some key recommendations from the global technical consultation meeting were:

Use a systems approach and combination of technical auditing and product

laboratory testing to determine compliance

Include fortification monitoring indicators into HACCP/GMP protocols already used

by industry. Inspectors should audit these protocols to ensure they are happening

and being documented within industry.

Proper equipment - installation, calibration, use, and maintenance.

Premix procurement and storage.

Fortification process controls – check weighing and timing, feed rates.

Record keeping – quality assurance/quality control sheets in a log book

Use the Premix Usage Reconciliation Calculation in lieu of quantitative nutrient

testing on a frequent basis.

4.3: UPDATES FROM REGIONAL RING TESTING

Mr Philip Randal highlighted on the purpose of establishing the current laboratory

analytical capability of selected laboratories whose function includes the analysis of

fortified food vehicles. He briefly described the methodology applied and Labs were

required to provide feedback results within 30days. Laboratories used their existing

functional analytical methods and identified the existing methods and results were kept

confidential Individual laboratories were to be informed of their own data analysis at the

conclusion of all 3 rounds and final report was expected to be presented in the next ECSA

laboratory WG meeting.

A total of 18 Laboratories from 6 ECSA countries participated, 3 International accredited

laboratories and 3 laboratories outside ECSA. 1,500 samples involving 5 food vehicles

and 3 micronutrients was circulated for analysis. These includes wheat and maize flour

spiked with vitamin A and iron, sugar spiked with vitamin A, samples of edible oil spiked

with vitamin A and salt spiked with iodine. In each round different concentrations of

micronutrient(s) were applied for each round.

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The presenter highlighted that 8 analytical techniques that have been used by the

participants HPLC, ICP-MS, ICP-OES , AAS (Shimadzu), Titration , Photometric [Sandell-

Kolthoff] , iCheck (BioAnalyt) and Spectrophotometry (UV/Vis) (Jenway)

He also indicated that data were compared within and between methods, assessing the

recovery and precision, measurements uncertainty for methods, vehicles and

micronutrients being calculated and data has been compared against results from

accredited international laboratories.

He ended the presentation by reminding the participants that there are some labs that

haven't reported their results, the analysis is not yet completed. once all the labs submit

results; information showing the realistic accuracy delivered by existing methodologies in

the participating laboratories will be compiled. Although this is not yet concluded the

presenter observed that protocols were not well followed and there was mixing of units to

express different concentration as well as confusion from the spread sheets data reported.

Variability within sample coefficient of variation (CV) was generally good with very few

outliers. Micronutrient Recovery was found to be a significant factor.

4.3: ADVANCES IN TESTING IODINE IN SALT

Mr. Phillip Makhumula presented the findings of the study he worked on. The study

focused on assessing the performance of methods commonly used for salt iodine

testing. The main objectives of carrying out the study were:

Compare performance of field colorimetric methods for quantifying Iodine in

comparison with titration (Traditional gold standard method in laboratories) by

considering the following equipments WYD (Chinese), iCheck (Bioanalyt –

Germany), iReader (Thailand) and UV/VIS Spectrophotometer.

Compare test methods using same solutions to remove effects of sample size of

salt (developers of methods use different amounts of salt)

Determine effect of different iodine concentrations

The study highlighted the chemistry of iodine and common compounds for salt iodation

namely iodide(I2) and iodate (KIO3). For tropical countries KIO3 is commonly used

because of its stability. All methods use a common blue colour in which the intensity of

such blue colour reflects the quantity of iodine present in salt. However, for titration

method there is additional step after getting blue colour for determining the iodine levels.

Following the results of the study, the presenter came up with the following Conclusion

and recommendations:

All methods provide acceptable results within the range of 10-60 ppm iodine, if well

managed and understood.

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Although the titration method continues being the most accurate and precise of all

(at iodine contents larger than 10 ppm), UV/Visible/ spectrophotometric methods

could replace it because of their lower cost, acceptable reliability, and simplicity to

implement.

If the laboratory already has an UV/Vis spectrophotometer, the implementation of

this method is recommended due to its low cost, reliability, and larger linear iodine

range. Solutions for WYD method or the ireader (Thai) method can work

Although all methods are able to estimate iodine contents in a direct manner, use

of iodine standard curves are highly recommended due to variation in the response

of the instruments during time, as well variations in the intensity of the blue color

that may be produced by different types of starch.

Only the UV/Vis and the i-Reader (Thailand) are able to determine iodine content

in salt below 10 ppm. These two methods and titration are able to determine iodine

contents above 60 ppm; i-Check and WYD will need dilutions.

The WYD apparatus must be calibrated using a solution made with 50 ppm iodine;

the glass-calibrator included with the equipment is not ideal.

If using iodine standard curves, the WYD (Chinese) could use the Thai-

chromogenic reagent up to 60 ppm iodine and vice versa.

For field work, the Thai-apparatus combined with its chromogenic reagent is the

most practical and easiest method.

It is important to emphasize that for any method, the solution of salt must be

prepared by dissolving 50 grams of salt in 250 milliliters of water. Once in solution,

using small volumes is fine as the content of iodate is homogeneous.

4.4: PROMISING PRACTICES OF PRIVATE SECTOR ENGAGEMENT: THE CASE OF SUN

BUSINESS NETWORK IN TANZANIA

Mr. Enock Musinguzi representing the SUN business network in Tanzania, highlighted on

how Tanzania 5-year National Multi sectoral Nutrition Action Plan (NMNAP) identifies the

roles of multiple sectors and stakeholders. The plan emphasizes on Multi sectoral,

evidence-based, Country-led, common results and coordination framework. SUN

Business Network (SBN) is the focal point for private sector engagement on nutrition in

Tanzania by mobilizing businesses to act and invest in nutrition to increase the

affordability and accessibility of clean and safe foods to consumers. About 90 private

sector companies signed up with commitments to address malnutrition, including:

Increasing availability of nutritious foods

Increasing consumer awareness of nutrition

New product development

• SBN has partnerships with 4 national business association

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• Promotion of nutrition through local association of farmers and networks: TAHA,

SAGCOT, TASPA, NFFA

The strategic priority actions for the SUN business network are to ensure;

• Developing a strong SBN membership & community profile

• Improving nutrition policies & regulations

• Facilitating meaningful partnerships & investment options in nutrition

• Improving nutrition sensitivity along the agricultural value chain

• Increasing the availability of fortified products & supplements

• Improving consumer awareness

To date the SBN has achieved good collaboration and partnership with the Government

through various decision making offices including the focal person of nutrition at the Prime

Minister’s office who is key to coordination of matters related to Nutrition.

• The SBN was well involved in development of costed implementation plan for the

National Multisectoral Nutrition Action Plan (NMNAP)

• Alignment of SBN members to Government priorities and commitments

• Development of a 3-year SBN strategy for fundraising

Involvement of Tanzania Private Sector Foundation as host for SBN

5.0: UPDATES AND KEY LESSONS FROM REGIONAL PARTNERS

5.1: KEY LESSONS AND ACHIEVEMENTS FROM SAFE, PFS AND RELATED INITIATIVES

Mr. Jonathan Thomas from TechnoServe spoke about the SAFE project which aims at

expanding and increase competitiveness of the African food processing sector. This is a

5-year project (Oct 2012 – Sept 2017) with US$10.4 million funding from USAID for

Ethiopia, Kenya, Malawi, Tanzania and Zambia it targets 100 small and growing food

processors with customized technical assistance and about 700 food processors targeted

through sector wide training.

The second project is PFS which aims to improve competitiveness of food processors

and improve compliance within mandated fortified staple foods to ensure intake of

essential nutrients. 4-year project (Nov 2016 – Oct 2020) worth US$10 million funding

from BMGF for Nigeria, Kenya and Tanzania it targets 100 leading African food

processors (>70% market share) with customized technical assistance. 200 additional

food processors targeted through sector wide training workshops and building an

enabling environment by mobilizing industry champions and CEOs, consumer groups and

crucial Gov’t institutions & strengthening regulatory and monitoring systems.

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About 1000 food processors are being trained, 340+ capacity-building projects in place

and increase in sales of improved nutritious food.

Key lessons from the projects:

Opportunity to meet rapidly growing demand for processed foods

Challenges of reaching low income mass market

Innovative distribution and marketing models

Dual focus on business and technical challenges

Even playing field to ensure fair competition for fortified v non-fortified food

Compliance monitoring/enforcement

5.2: UPDATES FROM FFI WORKS IN ECSA REGION

Mr. Ronald Afidra presented on the regional works of FFI in line with their vision. FFI

reported the following achievements:

In collaboration with Smarter Futures and other partners; FFI conducted Regional

Capacity Building on QA/QC.

Development of various tools including the cost benefit analysis to create evidence

for decision making and support on fortification activities.

FORTIMAS tool has also been introduced to ensure monitoring and evaluation for

the household or individual levels of consumption. The tool helps to track trends in

the effectiveness of a flour fortification programme over time in populations

documented to regularly consume fortified flour

Development of Africa Maize Fortification Strategy 2017-2027

Development of Africa Rice Fortification Feasibility Strategy

Conduct Africa Experts training on Food Fortification, Abuja 2016:

The presenter also alluded to some challenges which are facing implementation of

fortification programs in the region including

Protective national rice and maize self-sufficiency policies

Unofficial trade across porous land borders

In-sufficient internal compliance (Ownership) and regulatory monitoring.

Importation of premixes and equipments

5.3: NUTRITION INTERNATIONAL FOOD FORTIFICATION WORKS IN THE REGION

Dr Abdulaziz Adish from presented the works of NI in the region related to food fortification.

He elaborated that NI provides technical assistance into national programs in areas of

Integration of FF with VAS, USI & SUN initiatives, influence domestic fortification policy,

provide technical assistance to design/establish national programs, support evaluation of

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ongoing programs, finance large scale fortification activities, address gaps in program

support and financing of national implementation.

Among other models NI has adopted a business model RIGHT START – which is an

initiative to scale up packages of interventions in high burden countries for adolescent

girls, pregnant women, newborns and young children that will reduce anaemia, low birth

weight, mortality and stunting.

Currently NI coverage areas in Africa includes projects Ethiopia (Flour), Ethiopia, Kenya,

Senegal, Tanzania (Salt), Kenya (Maize), Ethiopia, Senegal (Oil) as well as ENRICH

project for micronutrient powders in Tanzania.

In long run NI is committed to continue supporting high-level policy work to make

fortification mandatory and enforcement effective in all countries of its presence.

5.4. FINDINGS FROM MAPPING REGIONAL AND GLOBAL MANAGEMENT INFORMATION SYSTEMS

Ms Stella Ngere presented on the assessment done with the support from GAIN and PHC.

The assessment was mean to reviewing documenting systems used for fortification

monitoring so as to draw lessons, identify constraints and develop recommendations that

will improve efficiency, effectiveness and a sustainable system in the region

Table 1 below present the key findings from the assessed countries:

Country Pros Cons

Kenya Producers input production volumes

directly into the system

The system is unable to generate

alerts to facilitate corrective actions

Tanzania Number of samples that comply is

captured by the system

System is unable to generate alert

to facilitate corrective action

Malawi The system auto generation of charts

and trends

Manual data entry is very laborious

and time consuming

Zimbabwe Data validation is possible

Geographic visualization of sample

origin by compliance

Inadequate information to build up

the drop down box to avoid

misspelling

Limited resources at entry point

hinder compliance for imports

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South Africa Production volumes of fortified

products is available

There is no linkage between data

captured from the millers and SABS

Recommendations from the assessment were

Development of a standardized global system (Need to emphasize and

guarantee data security).

Autonomy needs to be given to the users so that they are able to use the

system without seeking permission from the administrators.

Training of more inspectors as the trained few are overburdened.

Adjusting QC/QA protocol to include compulsory reporting using the system.

Adequate resource allocation for the food fortification program in different

countries.

5.5 PROGRAMMATIC MONITORING OF NATIONAL FOOD FORTIFICATION: AN INNOVATIVE

SOLUTION TO IMPROVING PROGRAM OUTCOMES - PROJECT HEALTH CHILDREN

Mr Arthur Pagiwa from PHC spoke about the EnAct Monitoring initiative and GAIN’s

Enable initiative. He further updated the participants about a joint effort underway to

design an online Management Information System (MIS) specific to fortification. The

developed MIS will provide a data aggregation solution for country-specific use, more

efficiently and effectively track product compliance to better understand whether or not

fortified foods actually contain the correct amount of vitamins and minerals per national

standards; and to enable countries to act upon identified gaps to improve the program’s

outcome in a timely, cost-effective, and sustainable manner.

In conclusion the presenter informed countries the full roll out of the programme will start

in Oct 2017, therefore countries who are interested are welcomed to seek further

information on adopting the MIS and MIS trainings, in long run the system will be able to;

Drive change in key program behaviours

Address the ‘compliance gap’ by streamlining real time data entry and subsequent

follow-up action

Dual purpose improvement in data aggregation and decision-making for

fortification but also for general industry food safety (i.e. HACCP/GMP) indicators

as well.

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5.6 UPDATES FROM WORLD FOOD PROGRAMME MOZAMBIQUE

Ms. Berguete Mariquele from WFP Mozambique Country Office presented on the WFP

works related to Food Fortification. WFP together with other UN agencies in Mozambique

is supporting to accelerate progress towards MDG 1c in Mozambique. By Strengthening

the regulatory framework, monitoring systems and compliance mechanisms to ensure

success of fortification of wheat flour and edible oil and expand to other products (maize

flour, sugar and cassava flour)

WFP has been leading efforts of the UN agencies by providing

Technical assistance for the formulation of the law enforcing mandatory

fortification.

Develop national fortification standards and guidelines for sugar, maize flour,

cassava flour, wheat flour, edible oil and instant porridge fortification.

Support the development of an updated CONFAM national strategy on food

fortification.

Support enterprises on fortification Standard Operating Procedures (SOP)

compliance and Good Manufacturing/Hygiene Practices through training and

technical advice.

Technical Assistance for Government to develop a monitoring plan.

Upgrading existing laboratory facilities to ensure proper quality control;

Training of food inspectors (INAE, Customs and other government staff) on food

fortification monitoring, compliance and quality control.

Future plans for support to Mozambique

Strengthen the Capacity of Industry to comply with National Standards

Strengthen Capacity Inspection institution to Monitor fortification programs

Implement voluntary small scale maize fortification (to generate knowledge and

evidence)

Define a “sustainable” mechanism for small scale maize fortification

Assessment of the effectiveness and the impact of programme

Continue to raise awareness

Feasibility of locally produced fortified products E.g. Local production of a fortified

instant porridge

37

5.7 PROGRESS TOWARDS ELIMINATION OF IODINE DEFICIENCY IN EASTERN AND SOUTHERN

AFRICA REGION: LESSONS FROM UNICEF

Ms Juliawati Untoro from UNICEF ESARO presented on their regional works to combat

iodine deficiencies. She explained that the UNICEF ESARO regional office supports 21

countries in the region in reducing stunting. She further presented the findings of the study

on IDD/USI situation in Eastern and Southern Arica region which revealed that regional

progress has been very limited; only 5 countries (Burundi, Kenya, Malawi, Rwanda,

Uganda) achieved USI and 11 countries have HHIS consumption between 50-89%. The

regional average on HHIS remains at around 50-60% and about 6.7 million infants in the

ESA region born every year unprotected against iodine deficiency. Only 12 countries have

adequate iodine nutrition status and 5 countries iodine-deficient.

The key challenges presented in the UNICEF study include;

Salt producing countries have more challenges in ensuring high coverage of

household consumption of adequately iodized salt.

Countries that have remained stagnant or declined and/or low coverage of the

HHIS generally faces the following issues:

– Lack of legislation and/or its enforcement.

– Limited capacity of small salt producers to adequately iodizing salt.

– Limited quality assurance and quality control.

– Lack/limited monitoring system.

– Countries are in emergency or conflicts.

Achievement of USI is attributed with good enabling environment such as;

Strong government and salt industry commitment.

USI Legislation and improved regulatory monitoring

Effective monitoring systems

Strategic advocacy and communications

Strong partnership with salt producers.

As the way forward the presenter urged countries to institutionalize guiding principles that

are crucial to achieve and/or sustain success:

National ownership and political leadership

Legislation and enforcement

Public-private partnership

Availability of adequately iodized salt (supply)

Advocacy, communications and public education.

Strengthen the Monitoring systems

Accelerate/sustain USI programme as part of the national priorities in the context

of the broader nutrition landscape

38

5.8 Fortification successes and priorities in Africa, Hellen Keller International

Mr Fred Grant from HKI spoke about HKI works in west Africa through the Regional

Economic Commission ECOWAS and how they advocated for mandatory fortification.

Currently 14/15 countries of the ECOWAS are implementing mandatory FF of wheat flour

which have coverage of about 232 million and Oil 225 million. All countries have followed

the similar path in food fortification though in different order. Success in mandatory

fortification journey has been contributed by;

Adoption of harmonized ECOWAS fortification standards and logo by all member

states

Strengthened quality management

Monitoring compliance, coverage, and impact

Re-examination of fortification policies, vehicles, technologies, and micronutrients

6.0: SUSTAINING GAINS FROM THE ECSA FF INITIATIVE AND PLANNING FOR THE NEXT 12

MONTHS

Prior to development of working group plans; the workshop moderator allowed countries

to give one or two top of the list priority area for sustaining the initiative, countries

delegates recorded their list as follows;

Table 2: Countries priorities for sustaining the regional initiative

Country Identified Priorities

1. Malawi

More engagement of the private sector to advance the

fortification agenda

2. Lesotho Finalize the fortification legislation and develop an

implementation plan

3. Swaziland Strengthen intersectoral collaboration with other

stakeholders

Identify key champions within the Government

Conduct national micronutrient assessment for evidence

based programming

4. Tanzania Enforcement of regulations and standards for effective

fortification programs

Identify local agent for premix for both medium and small

scale fortification

5. Zambia Increase food vehicles to be fortified

39

Strengthen monitoring of food fortification program

6. Kenya Continue strengthening collaboration partnership amongst

food fortification stakeholders

7. Mozambique Strengthen monitoring system at all entry points

8. Rwanda Fast track the legislation approval process

Develop manuals and guidelines in fortification

Implement the fortification regulatory framework

Improve communication and coordination between

stakeholders

9. Uganda Strengthen the MIS and looking forward to use the findings

from ECSA study which is being finalized

Enhancing the testing capacity for the entire chain that is,

Industry level, Regulatory labs and implementation points

and inspection

10. Zimbabwe Strengthen collaboration with all stakeholders especially

private sector

11. Ethiopia Strengthen link with the National Food Fortification

Alliance

6.1 The working group discussed and agreed action plans for the next 12 months

plans (attached as annex 1)

7.0 LAUNCH OF THE GLOBAL FORTIFICATION DATA EXCHANGE

Corey Luthringer, GAIN, and Helena Pachon, FFI

The final technical presentation of the workshop was a debut of the Global Fortification

Data Exchange (GFDx), found at www.fortificationdata.org. The GFDx is an initiative led

by a Core Group from the Food Fortification Initiative, GAIN, Iodine Global Network, and

Micronutrient Forum, with concurrence and consensus from several other partners within

the Global Fortification Technical Advisory Group, formed after the 2015 Arusha Summit.

The GFDx answers the call to improve data availability and accountability as one of the

recommendations from the Arusha Summit.

The GFDx is an analysis and visualization tool that provides free access to data on food

fortification, including in its first iteration, data on the following for over 230 countries and

territories:

Legislation from 1942 to the present;

Available standards and required nutrient levels;

40

Food availability for fortifiable foods; and

Food intake.

The presenters gave a live demonstration of the GFDx website, including the interactive

features of the data visualizations and some of the fortification program planning and

implementation questions that might be answered with these data. The GFDx allows

individuals to generate custom maps, charts, and tables with the tool, or download data

for offline analysis. Currently data for five food vehicles is included (edible oil, salt, wheat

flour, maize flour, and rice), however, within the next 18 months, additional food vehicles

are planned for inclusion as well as new indicators on monitoring, coverage, and quality

data. The presenters distributed small cards as reminders of the website link to

participants and encouraged countries to have a look at their data and engage with the

GFDx to provide updates on a regular basis.8.0 Closing remarks

Closing remarks were first given by Ms. Rosemary Mwaisaka, manager NCDs, Food

security and Nutrition at ECSA-HC. She extended sincere appreciation and gratitude

to the Government of Mozambique and all the partners for making the event a success.

On behalf of the Director General she appreciated the commitment of the participants and

the trust countries have in ECSA to lead nutrition efforts in the region and urged countries

to keep the same commitment to improve their nutrition situation. Furthermore, ECSA

pledged support to countries and promised to mobilize resources to support countries

and is looking forward to active participation of the working groups. Last but not least,

ECSA indicated that there will undertake country visits to some priority for advocacy on

food fortification

41

The Senior Manager on Food Quality, Safety and Procurement from GAIN, Mr

Penjani Mkambula shared his closing remarks by appreciating the support provided by

Government of Mozambique implementing partners; ECSA-HC in the organization of the

workshop. Further appreciation was directed to the partners who were involved in the

organization of the workshop which included GAIN and USAID who gave financial support

for the success of the workshop. The manager further commented on the robust working

plans presented by the different TWGs and urged members to ensure that these plans

are executed for the success of the region.

The team leader Nutrition USAID/Mozambique, Ms Maureen Malave thanked the

Government of Mozambique for hosting the workshop and further appreciation was sent

to ECSA-HC, GAIN and other partners for organizing the workshop. USAID further

indicated that the organization assist in the development of policies to ensure that all in

needy are reached to improve the quality of life.

Director of Industry and Commerce, Dra. Eduarda Mungoi represented the

Mozambique government to sincerely express the country’s appreciation for being

selected by ECSA-HC to host this important event. Further gratitude was extended to all

member countries who attended the workshop. Special thanks were forwarded to ECSA,

GAIN and USAID for their support towards the success of the workshop. The

representative further urged partners for more support to countries in need to drive the

nutrition agenda forward. Participants were further invited to visit tourist attraction places

in Mozambique which included the bay and the markets

42

ANNEXES

ANNEX 1: CONCEPT NOTE AND AGENDA

Third ECSA Regional Workshop:

Human Capacity Building to Monitor Nutritious and Fortified Foods in the East, Central,

and Southern Africa Region

14-16 June, 2017

Maputo, Mozambique

Concept Note

43

The Background and Rationale

The ECSA-HC 3 is an intergovernmental organization established in 1974 to foster

cooperation in health and nutrition in the East, Central and Southern Africa (ECSA)

Region. Its mandate is to promote and encourage efficiency and relevance in the

provision of health services in the region through advocacy, capacity building,

coordination, inter-sectoral collaboration, and harmonization of health policies and

programs.

The countries of the ECSA Region have made tremendous progress in designing,

resourcing, and implementing programs which focus on making fortified and nutritious

foods widely available within recommended standards. Since 2003, the ECSA Health

Community (ECSA-HC) Secretariat, in collaboration with development partners in the

region, including USAID, MI, GAIN, UNICEF, and CDC/IMMPaCt, has continued to work

with its member states to introduce and implement food fortification initiatives. By 2011,

many countries in the ECSA Region had started and legislated mandatory fortification

programs on oil with vitamin A, and wheat and maize flours with iron, zinc, vitamin A, folic

acid, niacin and other B-vitamins. In addition, universal salt iodization programs continued

to expand and improve while sugar fortification with vitamin A was being implemented in

Malawi and Zambia. In addition, this regional effort led to improved coordination among

countries in the region, which resulted in harmonization of standards, several manuals for

food quality control and inspection, establishment of a regional laboratory proficiency

network, and capacity building of more than 100 government officials on the design and

implementation of food fortification programs.

Building on the successes of this first ECSA regional food fortification project, a new

regional initiative to build human capacity to monitor fortified and nutritious foods within

the ECSA Region began in June 2015 and is scheduled to close in September 2017. It is

co-implemented by ECSA-HC and GAIN with support from USAID. A first regional

workshop was held in Arusha, Tanzania in September 2015, which resulted in the

formation of 3 technical working groups with terms of references and priority activities to

be implemented at country and regional level. The three working groups were in the areas

of:

Production, Quality Assurance/Quality Control (QA/QC), and Food Safety;

Inspection and Enforcement; and

Consumption Monitoring and Program Impact.

3 The nine active member states of the ECSA-HC are Kenya, Lesotho, Malawi, Mauritius, Swaziland, Uganda, United

Republic of Tanzania, Zambia, and Zimbabwe.

44

The working groups are chaired by experts from various regional and international

partners with sound speciality and experiences in the thematic areas relevant to the

working group. Each country has a national focal point represented in each working group

and development partners have also joined and contributed in their respective areas of

expertise.

A second regional workshop was held in March 2016 in Addis Ababa, Ethiopia. During

this workshop, countries had the opportunity to present their progress towards

implementation of agreed actions from the first workshop and developed national

roadmaps and action plans for the following year. The technical working groups also

developed roadmaps for regional-level actions over the following year. The workshops

were designed to provide a platform for countries to exchange experiences, discuss

regional gaps and challenges, and share solutions to build the capacity of local personnel

involved in these areas.

Through the initiative, ECSA-HC and GAIN have facilitated the working group

communications to share progress towards implementation of the agreed work plans.

Since the second workshop, the following activities have been achieved:

Working groups have held several in-person and online trainings and discussions

to facilitate sharing of experiences and strengthen technical capacities;

A regional stakeholder mapping was finalized;

A fourth working group in the area of laboratory testing was established and chairs

were elected from among working group participants;

Working groups reviewed the ECSA regional manuals to propose updates and

revisions;

Assessments of regional laboratory capacity, regional and global management

information systems usage, and regional consumption monitoring systems have

been undertaken or are currently underway;

An advocacy toolkit for countries is under development; and

A regional laboratory proficiency testing scheme is underway.

This Third Regional Workshop is being organized with the main objective being to identify

mechanisms and strategies to provide sustainability to the efforts, as the initiative is

coming to an end in September 2017. During the workshop delegates will also review the

advances in implementation of developed action plans, including discussion of the results,

next steps, and dissemination of the above learnings and achievements. Countries and

technical working groups will work to measure progress against their commitments made

during the Second Regional Workshop and identify their priority areas for the next 12-18

months. The workshop will also provide a platform to share common challenges and

45

solutions to learn from each other and continue to strengthen local capacity for monitoring

fortified and nutritious foods.

The Workshop

Logistics

Time and Venue: 08:00 to 18:00 on 14-16 June 2017, Centro Internacional de

Conferencias Joaquim Chissano in Maputo, Mozambique

Accommodations: Maputo AFECC Gloria Hotel

Workshop Meals and Refreshments: Two refreshment breaks and a buffet lunch will

be provided during the workshop from 14-16 June.

Objectives, Activities, and Deliverables

The long-term goals are:

To strengthen collaboration and coordination among countries and development

partners in the areas of food safety and quality control, enforcement and

inspection, food laboratory, and consumption monitoring.

To strengthen collaboration of the ECSA Health Community and other regional

organizations to spearhead capacity building and monitoring activities.

To harmonize training and experiential learning activities/platforms with

development partners and countries to build the capacity of local professionals.

To strengthen the industry quality control practices, government inspection and

laboratory practices for monitoring safety and quality of fortified and nutritious

foods, and the introduction of consumption monitoring practices.

The workshop’s main tasks and objectives will include:

Review of working group progress and achievements towards stated goals and

roadmaps developed during the Second Regional Workshop.

Harmonization of activities and projects related to four thematic areas supported

by development partners at country and regional level for complementarity. The

production, Food safety & QA/QC working group is technically supported by

Technoserve; the Inspection & Enforcement and the Laboratory working groups by

SPRING Uganda; and the Consumption Monitoring & Program Impact by

CDC/IMMPaCt. Other development partners will be encouraged to provide support

in their areas of competence.

Discussion of next steps and targets for continuing progress and activities beyond

project completion in September 2017 at national and regional levels.

Workshop Deliverables:

46

Broader agreement and commitment to continued capacity and process

improvement in the four working group areas at national and regional levels.

National and regional products/ achievements by end of September 2017 and

regional plans of action for the next 12-18 months.

Identification of the support that would be provided by development partners to

continue capacity strengthening efforts within the region.

Strategy to operationalize a knowledge platform under coordination of ECSA-HC.

Participants

60-80 high-level and technical participants will be invited to join the workshop.

Participants will include:

Representatives from the ECSA Country Governments4 (ECSA-HC Member States and

Non-Member States), including Ministries of Health, Agriculture, Industries, and Trade

and relevant departments and authorities involved in nutrition, food safety and control,

and standards and regulation.

Delegates from regional health, industry, and trade organizations and research

institutes, such as East African Community (EAC), Common Market for Eastern and

Southern Africa (COMESA), South African Development Community (SADC), and

African Union Commission (AUC).

Delegates from producers of fortified and nutritious foods from the ECSA Region as well

as producers’ associations or cooperatives.

Delegates from international development partners with expertise and operations in the

ECSA Region.

4 Burundi, Ethiopia, Kenya, Lesotho, Malawi, Mozambique, Rwanda, South Africa, Swaziland, Tanzania, Uganda, Zambia, and Zimbabwe have been members of this initiative and will be invited to participate as a national delegation.

47

Programme Agenda

Time Wednesday, 14 June 2017

08:00-08:30 Registration

08:30-10:00 Opening Session

Welcome: Ministry of Industry and Commerce, Dra. Eduarda

Mungoi

Opening Remarks

ECSA Health Community, Mr. Edward Kataika, Director of

Programmes

GAIN, Katia Santos Dias, Mozambique Country Director

USAID Mozambique, Amanda Fong, Economic Policy Team

Leader

Welcome and Opening Address:

Mozambique Ministry of Gender, Children and Social

Welfare, Honorable Minister Dra. Cidalia Chauque

Facilitator:

Jane Badham

Rapporteur:

Zimbabwe

10:00-10:30 Group Photo

Health and Refreshment Break

10:30-13:000 Meeting Goals and Objectives, Felistus Mutambi, GAIN

(20min)

Introductions, Health and Safety Briefings: Jane Badham

(20min)

Session 1: Updates from Country Delegations (Each country

is to select one of the four subjects for sharing their national

experiences (15min each with Q&A and Discussion)

Production,

QA/QC and

Food Safety

Inspection

and

Enforcement

Laboratory

Strengthening

Consumption

and program

impact

1. Zimbabwe

2. Tanzania

3. Mozambiq

ue

1. Zambia

2. Swaziland

3. Lesotho

1. Ethiopia

2. Uganda

3. Kenya

1. Rwanda

2. Malawi

Moderator:

Jane Badham

Rapporteur:

Malawi

13:00-14:00 Lunch Break

48

14:00-15.30 Session 2: Working groups discussions & Reporting

The 4 working groups have time to meet together to discuss key

lessons, achievements and challenges as well as any

deliverables completed since the 2nd Regional Workshop.

Each working group will prepare a report to present in the

plenary after the health and refreshment break. Working groups

will also choose local co-chairs to take forwards the activities in

the future.

Partners are to divide themselves into the working group where

they have the most relevant expertise to serve as resources.

Moderator:

Working Group

Chairs

Rapporteur:

Zambia

15:30-16:00 Health and Refreshment Break

16:00-17.00 Session 2: Working Group Reports by WG Chairs

Each working group chair or designee will present updates from

the working groups, followed by Q&A

Moderator:

Jane Badham

Rapporteur:

Ethiopia

Time Thursday 15 June 2017

08:30-09:00 Recap of Day one sessions.

Planning for the day.

Facilitator:

Jane Badham

9.00- 10.30 Session 3: Recent advances:

ECSA-HC report of achievements, including advocacy

tools, Rosemary Mwaisaka, ECSA-HC (15 min)

International meeting on recommendations for

Compliance Monitoring, Corey Luthringer, GAIN (15 min)

Regional Ring testing, Philip Randall, PCubed (30 min)

Advances in testing of iodine in salt, Philip Makhumula-

SPRING Consultant (15 min)

Best or promising practices on private sector

engagement, Enock Musinguzi, SUN business network,

Tanzania (15 min)

Moderators:

Jane Badham

Rapporteur:

Tanzania

10:30-11:00 Health and Refreshment Break

49

11:00-12:30 Session 4 : Presentation from development partners-

(Reports of work, Future plans & Opportunities)

Key lessons and achievements from SAFE, PFS and related

initiatives and partnership BMGF and other partners,

Jonathan Thomas (15 min)

Progress in the ECSA region, Ronald Afidra, FFI (15 min)

Specific support of food fortification in countries of the

region, Abdulaziz Adish, Nutrition International (15 min)

Findings from regional and global management information

systems, Stellah Ngere, Consultant and Arthur Pagiwa, PHC

(15 min)

Q&A (30 min)

Moderators: Jane Badham Rapporteur: Uganda

Moderators:

Jane Badham

Rapporteur:

Uganda

1230- 13.30 Lunch Break

13:30-15:00 Berguete Mariquele, WFP(15 min)

Juliwati Untoro, UNICEF (15 min)

Fred Grant, HKI (15 min)

Q & A (30 min)

Moderators:

Jane Badham

Rapporteur:

Rwanda

15:00-15:30 Health and Refreshment Break

15:30- 17:00 Session 5:

Panel Discussion and Q&A with Fortification Experts

Moderators: Jane Badham Rapporteur: Swaziland

Moderators:

Jane Badham

Rapporteur:

Swaziland

19:00- 21:00 Workshop Dinner, Gloria Hotel

TIME FRIDAY 16 JUNE 2017

8:30- 09:00 Recap of Day two sessions.

Planning for the day.

Facilitator:

Jane Badham

09: 10:30 Session 7: Planning Next Steps - Ideas and commitments

for next steps and sustainability

(Breakout Sessions for each Working Group)

Moderators:

WG chairs

50

- Plan to sustain the gains made by the initiative (ECSA-

HC)

- Development of plan action for the next 12 months with

key sustainability and resourcing considerations

identified.

- Identify key partners to support the implementation

- Monitoring and reporting mechanisms

Rapporteur:

Mozambique

10:30- 11:00 Health and Refreshment Break

11:00- 12:15 Session 7: Working group presentations (Plenary)

(working group chairs or their designees report back on their

plans with Q&A)

Moderators:

WG chairs

Rapporteur:

Lesotho

12:15- 12:30

Launch of the Global Repository on Food Fortification – GF-TAG

Core Group, represented by Helena Pachon, FFI and Corey

Luthringer, GAIN

Moderators:

WG chairs

Rapporteur:

Kenya

12:30-13:00 Closing Session

Closing Remarks:

ECSA Health Community, Rosemary Mwaisaka, Manager,

Food Security, Nutrition and NCDs Programme

GAIN, Penjani Mkambula, Senior Manager, Food Quality,

Safety and Procurement

USAID Mozambique, Maureen Malave, Nutrition Team

Leader and ECSA-HC

13.00-14.00 Lunch and Participants Departures

51

ANNEX 2: WORKING GROUPS PLAN OF ACTION FOR THE NEXT 12

MONTHS

PRODUCTION, QA/QC AND FOOD SAFETY WORKING GROUP

Identified

Priorities

Proposed

Activities

Responsible Proposed

Timeline

Remarks

Improve

Communicatio

n

and advocacy

Creating WhatsApp

group for the

working group

Zimbabwe

Tafadzwa

Mkungugwa

June 2017 Add all WG

members from

all the

countries

Identify key

topics/agendas for

discussion and list of

experts from the

different areas of

expertise

Share information

on compliance,

premix supply

processes

Working Group

Chair

- Tanzani

a

Monthly

Identify and

add contacts

of NFA/SUN

business

contact

persons and

the private

sector

Keep Mailing

list/group and use it

for formal

communications

Working Group

Chair

- Tanzani

a

July 2017

onwards

Add

representative

s from the

other WGs/

ECSA-HC,

GAIN and

other partners

Engage with private

sector in all steps of

the processes (e.g.,

elaboration of

standards, national

action plans, etc).

July 2017

onwards

52

CONSUMPTION MONITORING AND PROGRAM IMPACT WORKING GROUP

Identified

Priorities

Proposed

Activities

Responsible Proposed

Timeline

Remarks

Support

countries that

developed a

database

system and

use it as an

advocacy tool

Countries to share

information/reports

for uploading in

ECSA nutrition hub

Working Group

Chair

All countries

July

onwards

Build capacity

and provide

technical

assistance to

the countries

that want to

implement

consumption

monitoring and

impact of the

progress

Consumption

monitoring and

Impact

Evaluation training

in Rwanda

Working Group

Chair

August

2017

ECSA-HC and

partners to

coordinate the

training

Identification of

needs ad areas of

priorities in relation

to thematic area and

seek for support to

implement

All countries July

onwards

Partners to

continue

support the

initiative based

on their areas

of interest and

coverage

INSPECTION AND ENFORCEMENT WORKING GROUP

Identified

Priorities

Proposed

Activities

Responsible Proposed

Timeline

Remarks

Review and

finalize the

harmonized

regional

regulatory

monitoring

guidelines

- Circulation of

the draft

guidelines to

the working

group

members

- Review and

input to the

draft by the

technical

ECSA-HC

Technical

working group

members

Consultants

End of

June 2017

July 2017

August

2017

The activity to

be supported

by the current

arrangement

between

ECSA-HC and

GAIN

53

working

group

- Incorporation

of inputs and

finalization of

guidelines

- Disseminatio

n of the

revised

guidelines

and

uploading on

ECSA-HC

website

ECSA-HC

Septembe

r 2017

Strengthen

regulatory

monitoring and

evaluation

- Harmonizatio

n of

monitoring

and

evaluation

framework for

fortified foods

- Development

of

standardized

protocols for

undertaking

regulatory

monitoring

Working group

members

ECSA-HC

January

2018

ECSA-HC to

mobilize

resources

Establish clear

linkage and

feedback

mechanisms with

all WG

Working group

chair

ECSA-HC

July 2017

onwards

Engage with

all WGs to be

updated in

their activities

Engage WHO

and other

regional and

54

global

organizations

in all activities

Develop a proposal

for capacity building

on compliance

monitoring of

fortified foods in the

region

ECSA-HC

Working group

members

End of

Septembe

r 2017

-Capacity Building of

the food

inspectors/regulator

s on the adoption of

harmonized

monitoring

guidelines

- TOT on (Advances

on QA/QC)

-Validation of testing

methods

Inspection

guidelines (TOT)

Monitoring

Framework

ECSA-HC

Working group

chair

April -

June 2018

ECSA to

mobilize the

resources for

TOT and

countries to

mobilize

resources for

orientation

Improve

communication

Create Email group

– for formal

communications

- WhatsApp group

- Initiate

Teleconferences

- Others (skype,

loop up etc)

Working group

chair

ECSA-HC

Septembe

r onwards

The working

group

members to

initiate needs

and topics for

discussions

55

LABORATORY STRENGTHENING WORKING GROUP

Identified

Priorities

Proposed

Activities

Responsible Proposed

Timeline

Remarks

Training and

capacity

enhancement

Improved

competences

and facilitate

accreditation

Procurement

and reagents

Update previous

laboratory capacity

assessment and

establish current

needs

Working group

chair

Countries

Partners

Annually Resources to

be mobilized

from

government

and partners

Establish knowledge

gap through gap

assessment of

laboratory analysts

in countries labs

Organize regional

technical capacity of

working group

members

Assessment of

training impacts

through PT schemes

and onsite

assessments

Individual

laboratories

Partners

February

2018

Advocacy for

engagement of top

management of

individual

laboratories

Advocacy for

uniform donor

supports to all

laboratories involved

in testing

micronutrients

Individual

laboratories

July

onwards

All country

teams to share

progress in the

working group

56

Develop and share

procurement plans

in on time with

suppliers

Completion of

revised ECSA

laboratory

guidelines/

manuals

Organize workshop

to review the draft

manuals

Perform method

validation in each

country based on

updated ECSA

laboratory manual

ECSA-HC

GAIN

Working group

chair

Septembe

r 2017

December

onwards

Resources to

be mobilized

Activate Proficiency

Testing (PT)

Scheme for

micronutrients in

ECSA region

Develop PT plan

with budget

Evaluate laboratory

performance and

share feedback

Working group

chair

All WG

members

ECSA-HC

March

2018

Resources to

be mobilized

from individual

laboratories,

partners

57

ANNEX 3: PARTICIPANTS LIST

Organization Name Position Email

ECSA Health Community

ECSA-HC Edward

Kataika

Director of

Programmes

ekataika@ecsa.or.tz

ECSA-HC Rosemary

Mwaisaka

Manager;

Food Security,

Nutrition, &

NDCs

Programme

rmwaisaka@ecsa.or.tz

ECSA-HC Doreen

Marandu

Program

Officer; Food

Security,

Nutrition, &

NCDs

Programme

dmarandu@ecsa.or.tz

National Government Representatives

ETHIOPIA

- Ethiopian Food, Medicine,

and Health Care

Administration and

Control Authority

(FMHACA)

- Ethiopian Public Health

Institute (EPHI)

Seyoum Kere

Adamu

Tessema

Belay

Director, Food

Control

Directorate

Laboratory

Head

seyawolde@gmail.com

adamu_bel2000@yahoo.com

KENYA

- Ministry of Health, Food

Safety and Quality

Control Unit

- Ministry of Health,

National Public Health

Laboratories

Brendah

Obura

Nancy Njine

Chief Public

Health Officer

Head Food

Safety and

Nutrition

Laboratory

sikolobrendah@gmail.com

nancynjine@yahoo.com

LESOTHO

- Food and Nutrition

Coordinating Office

Masekonyela

Sebotsa

Director

Nutritionist

masekonyelasebotsa@yahoo.com

mmmojakhomo@gmail.com

58

Organization Name Position Email

- Food and Nutrition

Coordinating Office

- Ministry of Health

- Ministry of Trade and

Industry

Molulela

Mojakhomo

Motsamai

Mahahabisa

Lesala Lazaro

Nts’oeu

Senior Health

Inspector

Laboratory

Analyst

mahahabisa@yahoo.co.uk

ntsoeulazy@gmail.com

MALAWI

- Bureau of Standards

- Bureau of Standards

- Ministry of Health

- Ministry of Health

Enoch

Kamwala

Wanangwa

Sindani

Catherine

Tsoka

Flora Dimba

Scientific

Officer

Certification

Manager

Principal

Nutrition

Officer

Principal

Environmental

Health Officer

enochkamwala@mbsmw.org

wanangwasindani@mbsmw.org

walinanetsoka@gmail.com

fkamdonyo@yahoo.com

MOZAMBIQUE

- Customs Bureau

- Ministry of Health

(MISAU)

- Ministry of Health

(MISAU)

- Ministry of Health

(MISAU)

- Ministry of Health

(MISAU)

- MISAU National

Laboratory

- Ministry of Industry and

Trade

- Ministry of Industry and

Trade

- Ministry of Industry and

Trade

- Ministry of Industry and

Trade

- National Inspectorate of

Economic Activities

Rangel

Enoque

Macheche

Francisco

Mbofana

Helga

Mudanisse

Marla Amaro

Rosa Marlene

Monjane

Arsénia

Mabunda

Aurora Come

Claudia Langa

Eduarda

Mungói

Nilsa

Miquidade

Veronio

Gaspar

Duvane

National

Director of

Public Health

Nutritionist

Head of

Nutrition

Department

National

Director of

Public Health

Laboratory

Analyst

National

Directorate of

Industry

Technician

National

Directorate of

Economy

Director

raenoque32@gmail.com

helgamudanisse@gmail.com

marlaamaro80@gmail.com

marlene.cuco@gmail.com

anhamona@gmail.com

auromcome@gmail.com

cclaudialanga68@gmail.com

eduardamungoi268@hotmail.com

nmiquidade@yahoo.com

veronioduvane@yahoo.com.br

bcesarino@gmail.com

marta.francisco@setsan.gov.mz

59

Organization Name Position Email

- National Institute of

Standards and Quality

- SETSAN - Food and

Nutrition Security

Technical Secretariat

Cesarino

Benjamim

Marta

Francisco

Food Science

Specialist

Deputy

National

Director of

Industry

Inspector

Standards

Technician

Technician of

Food Security

Promotion

RWANDA

- Food and Drugs Authority

- Ministry of Health

Alex Gisagara

Alexis

Mucumbitsi

National

Medicines

Regulation

Officer

Nutrition

Officer

Agisa2006@gmail.com

Mucumbitsi2002@yahoo.fr

SWAZILAND

- Infant Nutrition Action

Network

- Ministry of Health

- National Nutrition Council

Kwanele

Simelane

Dudu Emmah

Dube

Glorious

Dlamini

Director

Environmental

Health

Department

Officer

Head of

Programs

skssimelane@yahoo.com

Duduzilegrace63@gmail.com

gloriousdlamini12@gmail.com

TANZANIA

- Bureau of Standards

- Bureau of Standards

- Food and Drugs Authority

- Food and Nutrition Center

- Ministry of Health and

Social Welfare

Salama

Shekilango

Zena Issa

John Mwingira

Celestin

Martin Mgoba

Vincent Assey

Quality

Assurance

Officer

Standards

Officer

Coordinator of

National

Fortification

Program

salama.shekilango@tbs.go.tz

mumythu@yahoo.com

mwingira2011@hotmail.com

celestinmgoba@yahoo.co.uk

vdassey@gmail.com

60

Organization Name Position Email

Assistant

Director

UGANDA

- Ministry of Health

- National Bureau of

Standards

- National Bureau of

Standards

- Uganda Drug Authority

Sarah

Ngalombi

Johnson Ssubi

Richard

Jonathan

Namakajjo

Irene

Wanyenya

Senior

Nutritionist

sngalombi@yahoo.com

ssubia1@yahoo.co.uk

nrichardjonathan@gmail.com

iwawenya@nda.or.ug

ZAMBIA

- Bureau of Standards

- Food and Drugs Control

Laboratory

- Ministry of Health

- National Food and

Nutrition Commission

Victor Mpundu

Janet Katongo

Clevinah

Ilambe

Mizanda

Gladys

Kabaghe

Assistant

Standards

Officer

Senior

Laboratory

Technician

Environmental

Health

Practitioner

Chief

Nutritionist

and Head of

Public Health

and

Community

Nutrition Unit

Vmpundu@zabs.org.zm

Janet.katongo@yahoo.com

Cimizanda11@gmail.com

gladysckabaghe@yahoo.com

ZIMBABWE

- Government Analysis

Laboratory

- Ministry of Health and

Child Care

- Standards Association of

Zimbabwe

Rupere

Gamuchirai

Ancikaria

Chigumira

Tafadzwa

Mkungunugwa

Principal

Technologist

Deputy

Director

Chemical and

Foods

Technology

Lab Manager

grupere@gmail.com

Ancikaria53@gmail.com

tmukungunugwa@saz.org.zw

Private Sector Partners

61

Organization Name Position Email

BASF, Germany Andreas

Bluethner

Director, Food

Fortification &

Partnerships

Andreas.bluethner@basf.com

Bioanalyt GmbH, Germany Anna

Zhenchuk

Technical

Director

Anna.zhenchuk@bioanalyt.com

DSM Nutritional Products,

South Africa

Craig Roelf Craig.roelf@dsm.com

Faffa Foods Share

Company, Ethiopia

Woldemariam

Haile

Deputy

General

Manager

hailewg@yahoo.com

Muehlenchemie, Uganda Melanie

Nikschat

Technical

Applications

Manager,

Flour

Fortification

mnikschat@stern-wywiol-gruppe.de

SGS Laboratories Cyprian

Kabbis

CRS and

Food

Business

Manager

Cyprian.kabbis@sgs.com

Development Partners and Donors

African Nutrition

Leadership Programme

Johann

Jerling

Johann.jerling@nwu.ac.za

Food Fortification Initiative

Helena

Pachon

Senior

Nutrition

Scientist

Helena.pachon@emory.edu

Ronald Afidra Africa

Network

Coordinator

afidron@yahoo.com

Global Alliance for

Improved Nutrition

Corey

Luthringer

Senior

Associate,

Food

Fortification

cluthringer@gainhealth.org

Enock

Musinguzi

Tanzania

Country

Director

emusinguzi@gainhealth.org

Felistus

Mutambi

ECSA

Regional

fmutambi@gainhealth.org

62

Organization Name Position Email

Fortification

Coordinator

Genet

Gebremedhin

Ethiopia

Country

Director

ggebremedhin@gainhealth.org

Katia Santos

Dias

Mozambique

Country

Director

ksdias@gainhealth.org

Mduduzi

Mbuya

Senior

Technical

Specialist,

Monitoring,

Learning, and

Research

mmbuya@gainhealth.org

Penjani

Mkambula

Senior

Manager,

Food Quality,

Safety, and

Procurement

pmkambula@gainhealth.org

Sanne

Jensen

Project

Manager,

Large-Scale

Food

Fortification,

Mozambique

sjensen@gainhealth.org

Svenja

Jungjohann

Senior Project

Manager;

Monitoring,

Learning and

Research

sjungjohann@gainhealth.org

Helen Keller International

Fred Grant Regional

Nutrition Lead

fgrant@hki.org

Osvaldo Neto Fortification

Adviser,

Mozambique

oneto@hki.org

Nutrition International

Abdulaziz

Adish

Regional

Nutrition

Adviser

aadish@micronutrient.org

63

Organization Name Position Email

ProConsumers –

Consumer Defense

Association Mozambique

Alexandre

Bacião

Executive

Director

proconsum@hotmail.com

Project Healthy Children

Arthur

Pagiwa

Country

Coordinator

Zimbabwe

apagiwa@projecthealthychildren.org

SPRING/Uganda

Miriam

Bwengye

Program

Officer,

Industrial

Food

Fortification

bmkisamba@spring-nutrition.org

TechnoServe

Balayneh

Nekatibeb

Program

Manager,

Ethiopia

bnekatibeb@tns.org

Jonathan

Thomas

Chief of Party,

Solutions for

African Food

Enterprises

(SAFE)

Program

thomasj@tns.org

UNICEF Juliwati

Untoro

juntoro@unicef.org

USAID/Mozambique

Amanda

Fong

Economic

Policy Team

Leader

afong@usaid.gov

Eunice

Chichava

Program

Management

Assistant

echichava@usaid.gov

Maureen

Malave

Nutrition

Team Leader

mmalave@usaid.gov

Tamara

Ramos

tramos@usaid.gov

World Food Programme Berguete

Mariquele

Food

Technologist

berguete.mariquele@wfp.org

Independent Consultants in

Health/Nutrition

Hezbourne

Ouma

Ongelleh

hezongelleh@gmail.com

64

Organization Name Position Email

Jane Badham

JP

Consultancy,

Facilitator

jane@jbconsultancy.co.za

Phillip

Makhumula

Pmakhumula@yahoo.com

Philip Randall P. Cubed P3away@mweb.co.za

Stellah Ngere stelangere@gmail.com