End malnutrition in our lifetime.
Project Healthy Children (PHC) aims to reduce micronutrient deficiencies by providing assistance to small countries as they design and implement food fortification programs. GiveWell guesses that PHC generally works in countries with relatively high levels of micronutrient deficiencies, since it tends to work in countries where the average income per person is very low and major health problems are relatively common. GiveWell believes that food fortification with certain micronutrients can be a highly effective intervention.
Africa: Rwanda | Burundi | Malawi | Zimbabwe | Liberia | Sierra Leone | Tanzania
Project Healthy Children (PHC) aims to reduce micronutrient deficiencies by providing assistance to small countries as they design and implement food fortification programmes.
GiveWell has reviewed PHC's five established national fortification programmes in Rwanda, Burundi, Malawi, Zimbabwe, and Liberia. These programmes aim to fortify staple foods with essential micronutrients such as iron, folic acid and iodine, protecting populations from debilitating conditions caused by malnutrition.
Most programmes that PHC works on are large-scale, national fortification programmes, where PHC works with a nation's government to help it pass and enforce laws mandating micronutrient fortification, among other activities.
PHC typically works to add the following micronutrients to staple foods:
- Iodine is added to salt
- Iron, zinc, folic acid, and vitamins A, B1, B2, B3, B6, and B12 are added to flour
- Vitamin A is added to cooking oil and sugar
The specific micronutrients and staple foods used vary by country and regional standards.
In 2015, PHC said that all established national fortification programmes that it was working on had drafted or adopted fortification standards that include the iodization of salt, fortification of both wheat and maize flour with iron, zinc, folic acid, and vitamins A, B1, B2, B3, and B12, and fortification of cooking oil and sugar with vitamin A. The small-scale fortification initiative Sanku provides mills with a micronutrient premix that PHC told us is based on national nutrient standards and needs.
Large scale fortification
EnAct Monitoring programme works to monitor the compliance of nationwide food fortifcation programmes.
Before starting work in a country, PHC conducts a high-level assessment, and if warranted, a more in-depth situation assessment to determine whether to work with the country. A situation assessment aims to analyse whether deficiencies exist and what foods are good candidates for fortification, and assesses the functionality of government, industry structure, and how the cost of foods could be impacted.
Sanku small scale fortification (flour)
PHC has a small-scale fortification programme called Sanku that works to help small- and medium-scale mills to fortify grain. This programme aims to reach people in rural and remote areas that do not consume the centrally processed foods that are fortified through large-scale fortification programs.
PHC told GivelWell that the international community has not focused on small-scale fortification because of perceived difficulties with monitoring and human error. PHC's programs use a device that PHC believes overcomes these problems by sitting on top of small-scale mills and automatically dispensing a micronutrient premix.
PHC told us that 56 of these devices have been installed in three regions in Tanzania, as part of a pilot program funded by USAID.
GiveWell did not know how many people were being reached by these mills. Sanku says that a single dosifier can fortify flour for up to 100,000 people daily, and that the cost of each Sanku Dosifier can range from $0 to $4,000.
Refugee & at-risk communities (RAC) programme
In 2017 OHC expanded its partnered programme with the World Food Program in the Kenyan Kakuma Refguee Camp school feeding programme, currently reaching 70,000 children.
GiveWell believes that food fortification with certain micronutrients can be a highly effective intervention. However, it has not seen enough monitoring data for the fortification programmes that PHC works on to have a strong sense of how effective its programmes have been so far. This may be largely because the programmes are just reaching the stage where official monitoring data is expected to be systematically collected.
TLYCS sees PHC as a global leader in micronutrient fortification, working with governments and NGOs to design, implement, scale, and monitor effective food fortification programmes. PHC's initiatives are based on evidence from economic- and science-backed results. PHC aims to ensure that it does not become a permanent part of a country's food distribution and health systems; it helps launch successful initiatives and excels at finding sustainable ways for the governments to continue that work without a permanent presence. Given the current phase of PHC’s large-scale fortification programmes, emphasis is on establishing strong regulatory monitoring structures to ensure that fortified products contain correct amounts and types of vitamins and minerals needed for nutritional impact on target populations.