Unpacking the ‘Business Model’ for Fortification Initiatives in Low- and Middle-Income Countries: Stakeholder Identified Drivers of Success and Constraints to Progress

Abstract

Background: Initiatives to tackle micronutrient deficiencies (MNDs) in low-and middle-income countries (LMICs) have increased steadily in recent years. Commodities such as staple foods (e.g., cereals) and condiments (e.g., salt) have been targeted as ‘vehicles’ for industrial fortification through numerous projects and initiatives. However, mixed experiences with delivery, coverage and sustainability have been found. Methods: Using an online survey of 71 key stakeholders (from 35 countries) consisting of the public/private sector, academia and civil society, this study sought to unpack the ‘business model’ for fortification initiatives to identify the key drivers of success and constraints faced by stakeholders in LMICs. Bivariate analysis was conducted to identify factors associated with the coverage of the target market and the perceived success and sustainability of fortification initiatives. Results: We identified four key factors contributing to the success of fortification initiatives. The first involves the size of the firm. Large firms had a significantly higher (p < 0.05) self-sustaining index (perceived level of sustainability of the fortification initiative) than smaller sized firms. In addition, a higher perceived success score (p < 0.05) was associated with non-targeted initiatives compared to those specifically targeted at a certain cohort of the population, further illustrating the benefits of producing at scale. Secondly, a significant relationship was found between whether standards were enacted and the coverage of the target market by the project/firm (p < 0.05).). The third key factor relates to the ability to source adequate testing for the fortified produce in-house. A positive correlation was found for post-mix in-factory testing and the self-sustaining index (p < 0.05). Finally, delays to importation and high charges were cited as key constraints to the use of premix. Conclusions: We argue therefore that a successful ‘business model’ for industrial fortification initiatives invariably consist of: (i) the involvement of larger sized firms that have the advantage of benefiting from economies of scale; (ii) the availability and application of agreed standards by the producer; (iii) high quality assurance/compliance monitoring (including post-mix testing where relevant), and; (iv) the ability to procure premix in a timely/cost-effective manner. These criteria are likely to be important factors that contribute to the success of fortification initiatives in LMICs.

Examining Heterogeneity of Food Fortification and Biofortification Business Models: Emerging Evidence for a Typology

“…It has been well documented that an important contributor to success of fortification initiatives are standards and national level agents that are able to enforce necessary regulations [ 2 ]. Lalani et al [ 5 ] also showed in a study of stakeholders involved in industrial fortification from 35 countries that standards, large-scale production and in-factory testing were among the key factors associated with success/coverage of the target market in LMICs.…”

“…This is crucial to future uptake and success of food fortification initiatives because of the importance of viability (financial, technical, social) to achieving the desired public health impacts. This issue of viability is, to date, is largely absent from the literature [ 4 ] and evidently valued by practitioners [ 5 ]. Furthermore, [ 6 ] explains at a higher level the potential impact of food fortification on public health (e.g., please refer to the ‘Impact model’ developed by [ 6 ]).…”

Small and Medium Enterprises’ Perspectives on Food Fortification Amid the Growing Burden of Malnutrition

“…In the case of food fortification initiatives, PPPs can provide funding mechanisms and technical support, and advocate for the development of local government policies and regulations that can enable the environment for SMEs to be integrated as key change agents in the food supply chain. Crucial elements for effective food fortification include a business plan for self-sustainability, mandatory regulation and local standards, compliance monitoring, market research and the availability of premixes [78]. Private and public partners can support SMEs in these areas to help them optimize their food fortification practices (Figure 1) [79].…”