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.
Where they work:
Rwanda | Burundi | Malawi | Zimbabwe | Liberia | Sierra Leone | Tanzania
Honduras (completed project)
What do they do?
Project Healthy Children (PHC) is focused on reducing micronutrient deficiencies by providing assistance to small countries as they design and implement food fortification programs
"In February 2015, PHC was working on national fortification programs in Rwanda, Burundi, Malawi, Zimbabwe, Liberia, and Sierra Leone,8 though the program in Sierra Leone had only recently started.9 Overviews of PHC's work with these programs are in the following footnote.10
For the remainder of this review, any discussion of PHC's national fortification programs should be understood to refer to the five established programs in Rwanda, Burundi, Malawi, Zimbabwe, and Liberia." (GW)
"fortify staple foods with essential micronutrients such as iron, folic acid and iodine, protecting populations from debilitating conditions caused by malnutrition. " (TLYCS)
"The majority of programs that PHC works on are large-scale, national fortification programs, where PHC works with a nation's government to help it pass and enforce laws mandating micronutrient fortification, among other activities. " (GW)
"More recently, PHC has also started a small-scale fortification initiative to reach people in rural and remote areas, who may not have access to centrally processed foods." (GW)
PHC may decide not to continue to operate under its current model after 2017. Instead, it may shift toward focusing on monitoring or other aspects of fortification programs.
"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 can vary based on the country and on regional standards.
In 2015, PHC said that all established national fortification programs 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." (GW)
(i) Large scale fortification - EnAct Monitoring programme works to monitor the compliance of nationwide food fortifcation programs.
"PHC told us that so far it has only worked in countries to which it has been invited; PHC believes that for fortification programs to be sustainable after its departure from a country, the government has to be ready to make the programs a priority.11 PHC told us that it has worked with small countries (typically populations of less than 15 million) that either do not have food fortification programs in place but are interested in developing them, or that have programs in place that are faltering in some way. " (GW)
"Before starting work in a country, PHC said that it conducts a high-level assessment, and if warranted, a more in-depth situation assessment to determine whether to work with the country.13 A situation assessment aims to analyze 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." (GW)
(ii) Sanku small scale fortification - flour.
"PHC has a small-scale fortification program called Sanku that works to help small- and medium-scale mills to fortify grain.25 This program 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.26
PHC told us that the international community has not focused on small-scale fortification because of perceived difficulties with monitoring and human error.27 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.28
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.29
We do not know how many people are being reached by these mills. Sanku has stated 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." (GW)
(iii) Refugee & at-risk communities (RAC) program - In 2017, they will expand their partnered program with the World Food Program within the Kenyan Kakuma Refguee Camp school feeding program, currently reaching 70,000 children.
Why are they recommended?
We believe that food fortification with certain micronutrients can be a highly effective intervention. However, we have not seen enough monitoring data for the fortification programs that PHC works on to have a strong sense of how effective its programs have been so far. This may be largely because the programs are just reaching the stage where official monitoring data is expected to be systematically collected. We discuss questions about PHC's effectiveness below. (
PHC is a global leader in micronutrient fortification, working with governmental and NGO partners to design, implement, scale, and monitor effective food fortification programs. PHC's initiatives are based on evidence from economic- and science-backed results. Most importantly, PHC’s mission is to ensure that they do not become a permanent part of a country's food distribution and health systems; they help launch successful initiatives and excel 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 programs, 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.