How African nations are fighting to enforce nutrition laws

Ugali and Chapati, made from maize and wheat flour respectively, make up the most popular sources of carbohydrates in Kenyan homes. Since 2012, the Kenyan government has made it mandatory for millers to fortify these two products with vitamins and other micronutrient minerals in a bid to fight micronutrient deficiency. Micronutrient deficiency is a public health problem in Africa that leads to growth retardation, morbidity, mortality, brain damage, and reduced cognitive and working capacities among children and adults. In West Africa, 19 million children under 5 years old — almost one-third of this population — are stunted, nearly half of all women of reproductive age have anemia, and 47% of children aged 6–59 months have vitamin A deficiency. So far 29 African countries have made food fortification mandatory. In Kenya, this has resulted in an increase in maize flour fortified with three mandated micronutrients — from 51% in 2018 to 70% in 2022. But experts believe this is only the first step as compliance by food manufacturers remains a huge challenge. Jonathan Gorstein, deputy director of nutrition at the Bill & Melinda Gates Foundation, said the foundation is currently focused on creating an enabling environment for governments to support food fortification and “ensure there is good compliance to standards that exist.” The Gates Foundation has been supporting large-scale food fortification programs in Africa since 2008 through grants to the Global Alliance for Improved Nutrition and UNICEF. It has also been providing scientific evidence to encourage governments to consider certain food vehicles for fortification, Gorstein said. Though this has helped to improve the adoption of food fortification, he said more needs to be done to ensure that countries have a rigorous compliance monitoring system. “Once there are standards in place, it is to make sure that there is ongoing measurement of food processes to ensure that they are in compliance with the standards,” he said. “Having the capacity in place to visit factories to ensure that the production procedures are acceptable and that most importantly the fortificants are in line with the standards.” A 2021 study that analyzed the micronutrient content of maize procured from the market in Kenya found compliance to be at 28%. The study recommended looking into the root cause of the low levels of compliance. “This should include further analysis of all the possible barriers to effective fortification process including an understanding of the industries processes and an analysis of the quality of premix used in the exercise,” it stated. A study conducted in Nigeria found that imported premixes — commercially prepared blends of vitamins and minerals — generally had strong quality standards while local blends presented a mixed bag with some below standard. Johnson Kiragu, the East Africa regional program director for Partners in Food Solutions — a nonprofit that has been helping maize and wheat flour millers in Africa get funding for food fortification infrastructure — said he is also concerned about the compliance to standards among the millers and suppliers of the premixes in East Africa. “The challenge is ensuring that the suppliers of micronutrient premixes are not cutting corners, providing the right fortifications and ensuring that the millers are using the right micronutrients and the right personnel and the regulators, like the Kenya Bureau of Standards, are doing their job and doing it well,” he said. “The law is there, whether it is being enforced sufficiently is a different question.” Gorstein added that compliance with food fortification should also be distinguished from food safety. “A lot of regulation monitoring systems are set up really as a measure of food safety looking at contaminants and potential harm, whereas in food fortification, we are measuring whether or not the nutrients that are being added to the foods are adequate,” he explained. “So, fortification tends not to get as high of a priority in terms of regulatory monitoring as it potentially should.”