Solutions for hidden hunger
SOLUTIONS FOR HIDDEN
HUNGER IN AFRICA
The Micronutrient Initiative (MI) works to ensure the most
vulnerable – especially women and children – in developing
countries get the vitamins and minerals they need to survive and
lead productive lives.
How MI Helps Stop Hidden Hunger
MI helps governments, food producers and partner organizations
to develop and implement culturally appropriate and cost-
effective micronutrient programs. The services offered by
MI experts include:
• situation assessment and program design
• technology development
• policy development
• capacity development
• technical assistance to countries
We are passionate about:
• helping developing nations save lives and improve livelihoods
through better nutrition
• developing and sharing the most appropriate solutions for
• reaching the people who need vitamins and minerals the most
We believe that:
• children have the right to a healthy start in life and should grow
up free from the preventable impairment of hidden hunger
• women have a right to the vitamins and minerals that will provide
for their full economic and social participation in society
• working in partnership with governments, the private sector
and civil society organizations is essential to success
• collectively we have the ability to implement existing, simple
and affordable solutions for hidden hunger – to the benefit of a
full third of the world’s population
MI thanks the following financial supporters,
without whom the work described in this annual report
would not have been possible:
Canadian International Development Agency (CIDA)
Christian Blind Mission International (CBMI)
DSM Nutritional Products
Government of Bolivia
Government of Bihar State, India*
Government of Indonesia
Government of Pakistan
Inter-American Development Bank (IADB)
International Centre for Diarrheal Disease Research
in Bangladesh (ICDDR,B)
The Izumi Foundation
The World Bank
World Food Programme (WFP)
*Through the MI India Trust
2 The Micronutrient Initiative Annual Report 2006-2007
FIFTEEN YEARS OF
Kul C. Gautam M. G. Venkatesh Mannar
Fifteen years ago, the Micronutrient Initiative (MI) was born out MI has also worked directly with national governments across
of a pledge by world leaders to protect children everywhere from three continents to help develop and implement national action
the tragic and preventable disease and impairment caused by plans to address hidden hunger. Examples this year included
hidden hunger. Since then, MI and its many partners have the India Micronutrient National Investment Plan, launched in
worked hard to protect some of the world’s most vulnerable October 2006, Senegal’s new push to iodize all of its salt, and
people. We have focused particularly on the poorest women Bolivia’s program to address childhood anemia, all of which are
and children in developing countries because they are already showing significant and lasting benefits.
disproportionately affected. By helping women and children
survive and thrive, our programs are helping to break cycles of To help ensure effective coordination between development
poor health and poverty and to build up the physical and partners, last year MI hosted the secretariats for the Network for
financial well-being of families, communities, and whole nations. Sustained Elimination of Iodine Deficiency (Iodine Network) and
for the newly formed Global Alliance for Vitamin A (GAVA). MI was
We estimate that last year alone MI also active in the Flour Fortification Initiative (FFI), the Initiative to
End Child Hunger and Undernutrition, the 10-year strategy to end
programs reached approximately micronutrient deficiencies co-ordinated by the Global Alliance for
Improved Nutrition (GAIN), as well as in the Partnership for
500 million people. Maternal Child and Newborn Health. MI worked particularly
closely with UNICEF, WFP, the World Health Organization (WHO)
We estimate that last year alone MI programs reached and the World Bank by seconding staff to these organizations to
approximately 500 million people. This, our greatest ever reach enhance program coordination and results.
in one year, has only been possible with the help, support and
commitment of national governments, non-government Over the years, MI has also become known for innovation and for
organizations, industries and individuals, and the many extending the boundaries of what can be achieved. MI recently
development partners who have worked jointly with MI to earned international recognition for its work on an award-winning
address hidden hunger. The ongoing support and commitment gravity operated fortification device in Nepal that extends the
of the Canadian Government through the Canadian International health benefits of flour fortification to rural people served by small
Development Agency (CIDA) deserves special mention. traditional mills. Other innovations featured in this report include
the use of GPS technology to map small-scale salt producers in
The success of the last year is also the result of tireless Senegal and work with them and the Government of Senegal to
advocacy over the last 15 years, keeping hidden hunger high on support iodization of the salt they produce.
the world’s agenda, and bringing together key partners to both
create the conditions for action, and to make it happen. As the 2006-2007 year ended, MI underwent a strategic visioning
Through these efforts, MI has learned that leadership by process to evaluate the lessons of the past 15 years, and to
countries and well coordinated support from development develop a new strategy for the next 5 years. This will see MI
partners are essential for sustained success. strengthen its presence and efforts in core countries, further
increase collaborative programs that complement the strengths of
The global vitamin A effort is a perfect example of success its partners, and strengthen its focus on programs that accelerate
through nationally led programs. For over 10 years, a major the achievement of the Millennium Development Goals.
thrust for MI has been its work with UNICEF in over 70
countries to support nationally led programs to improve child In the coming years as we put MI’s new strategy into action, we
survival through vitamin A supplementation. Best estimates look forward to the power of your support and partnership.
indicate that these national programs had saved the lives of Working together, we can implement the simple and affordable
more than 2.5 million preschool children by December 2005. As solutions that will protect women and children around the world
you will see in the pages that follow, vitamin A programs from hidden hunger and fulfill that leadership pledge – both
continue to be a major priority for MI. ambitious and admirable – that gave rise to MI 15 years ago.
Universal Salt Iodization efforts are another area where MI,
throughout its 15-year history, has had a key role in stimulating
national plans and action. Last year we launched a major new
partnership with the World Food Programme (WFP) to help 6 Kul C. Gautam M. G. Venkatesh Mannar
key countries with high rates of iodine deficiency increase their Chair, Micronutrient Initiative President, Micronutrient Initiative
supply of high quality iodized salt. Deputy Executive Director, UNICEF
FOCUS ON PARTNERSHIP
His Excellency, David Malone, Canadian High Commissioner to
India, and Mrs. Deepa Jain Singh, Secretary, Women and Child
Development, Government of India at the launch of the India
Micronutrient National Investment Plan. The Investment Plan
seeks to provide micronutrient protection to 206 million people.
Joint Efforts Speed Progress toward the Partnering with National Governments
Elimination of Iodine Deficiency Disorders The Micronutrient Initiative launched the India Micronutrient
MI and WFP launched a new salt iodization partnership in May National Investment Plan (IMNIP) for 2007-2011 on 19
2006. Together WFP and MI are strengthening local salt October 2006 in New Delhi. The plan examines specific
producers’ ability to iodize salt in 6 countries where iodine programs and investments needed – in addition to the
deficiency rates are high: India, Pakistan, Sudan, Ghana, significant infrastructure and programs that have been
Senegal, Haiti. These six countries are home to over 40% of established by the government and its partners to date – to
the world’s people who are not yet protected against iodine adequately address micronutrient malnutrition in India. The plan
deficiency. This new partnership has the potential to protect up was prepared and launched in response to the Government of
to 740 million previously unprotected people in these countries, India's increased priority towards combating malnutrition,
including approximately 19 million newborn babies. It is a specifically micronutrient malnutrition. The government at the
significant step toward the overall global goal of extending salt level of the Prime Minister encouraged the development of such
iodization to the 30% of the developing world still lacking it, and a plan. It was prepared as a joint endeavour by a task force
eliminating iodine deficiency disorder by the year 2010. MI’s consisting of representatives from government departments,
work toward this global goal is conducted within national plans, academic institutions, non-governmental organizations, private
led by governments and salt producers, and coordinated with sector, and international organizations concerned with
the work of a variety of important partners such as UNICEF, the micronutrient malnutrition in the country. It advocates an
International Council for the Control of Iodine Deficiency investment of approximately 14 US cents per capita per year.
Disorders (ICCIDD) and other members of the Iodine Network. Micronutrient deficiencies cause an estimated per capita loss to
Gross Domestic Product that is 50 times higher than the
Stable Funding Fosters Innovation and Impact investment advocated, so the return on investment is clear in
economic terms as well as human terms.
As a long-term supporter of MI’s core operations, CIDA has offered
the stable funding that has empowered MI to develop
expertise, build capacity, expand the micronutrient knowledge
base, bring together partners and stimulate action throughout
the past 15 years. Furthermore, this stable long-term funding has
been essential for developing and supporting stable, reliable
programming. Programming that yields high impact results such as
reaching over 500 million people in one year.
Even as MI broadens its base of partnership and funding
agreements, it is often the core funding from CIDA that provides
MI with the capacity to build on lessons learned, react rapidly
and develop innovative solutions to problems encountered in the
field. Solutions such as those described in the Innovations
section of this report. Solutions that are often scaled up with the
support of a wide variety of partners so that CIDA core funding
serves as the catalyst not only for innovation but also for A Kenyan mother cooks with fortified edible oil
after partners collaborated on the first ever food fortification
ongoing progress through partnership.
Rapid Results Initiative in Africa to speed the product to market.
Within the framework of this powerful and effective long-term
Working with the Food Industry
partnership with CIDA, an interim evaluation of MI’s progress
was conducted by CIDA in 2006. The central finding of the Since its inception MI has partnered with private corporations to
evaluation was that “MI continues to be highly successful in test and scale up interventions. Our partners have included
areas of coverage, innovativeness, entrepreneurship, hundreds of domestically owned food processing companies
advocacy and partnering in the cause of addressing across Asia, Africa and Latin America and a number of
micronutrient deficiency across the developing world, and transnational corporations. For example, in the 2006-2007 fiscal
that its creative leadership in this cause is recognized year, MI worked with small-scale salt producers in 52 districts in
globally.” As MI expands its programs to serve even more of Pakistan to support salt iodization there. MI also worked with 53
the hardest to reach people, the team is also incorporating roller millers in 4 Indian states. These millers now fortify wheat
feedback from the CIDA interim evaluation in order to enhance flour with iron as a result of MI efforts. Another example of
the key functional areas that will support this growth. In innovative work including the private sector is the Rapid Results
particular, communications, human resource development, and Initiative to get edible oils fortified with vitamin A to market within
results based management are key areas addressed in the 130 days. See the Highlights in Africa section on page 11 for
organization’s new 5 year strategy. more details.
4 The Micronutrient Initiative Annual Report 2006-2007
Overcoming Challenges in the Field
with New Solutions for Hidden Hunger
A village miller shows a new gravity powered
flour fortification device developed by MI to work with
small, traditional mills and extend the health benefits
of flour fortification to rural Nepal.
First of its Kind, Gravity Powered Flour implementation partner Imagine Lalitpur successfully undertook
Fortification Device to Improve Health and final pilot testing of the device in small village watermills in the
Lalitpur district of Nepal. This pilot testing was the culmination of a
Physical Productivity in Rural Nepal comprehensive development and refinement process carried out
A majority of Nepalese suffer from iron deficiency anemia (IDA) with funding support from the Government of Canada through
due to poor traditional diets. Although the World Bank has CIDA. MI has since won the World Bank’s Development
identified food fortification as one of the “short routes” to Marketplace award to expand the project and extend the benefits
improved nutrition and health, most rural Nepalese do not have to 22,000 rural villagers through 100 mills.
access to centrally produced fortified flours that could help
prevent IDA because rural Nepalese villagers mill their own Because the new fortification device is simple to use and does
grains at small, local mills. In order to extend the proven health not require electricity, the Micronutrient Initiative plans to adapt it
benefits of flour fortification to rural villagers, MI has developed for use in additional countries and extend the benefits to many
a simple, gravity powered new device to fortify flours with more rural populations. MI’s experience with small millers
essential vitamins and minerals at the village level. throughout Asia, Africa, and the Americas indicates that there is
significant potential for adaptation and expansion.
The device does not require electricity or significant additional
workload and it automatically adds correct doses of iron, folic acid,
and vitamin A to grains being milled. In 2006-2007, MI and
New Use of GPS Technology Helps the
Hard to Reach
In 2006-2007 MI concluded an innovative program to map all
the small-scale salt producers in Senegal and Bangladesh using
a Global Positioning System (GPS) platform. This exciting
exercise allowed MI to identify salt producers to receive support
in both countries, including those producers to receive
assistance in the early stages of a joint MI-WFP-Government of
Senegal project. The results of the mapping survey were also
used to design and procure custom-built equipment to enable
salt iodization by small-scale producers.
Many of the small-scale salt production units across Africa and
Asia are not surveyed or assessed because they are located in
remote areas and do not have physical addresses. This has
presented a barrier to successfully advancing final stages of the GPS technology helps MI and partners survey rural and remote
push for universal salt iodization. The new approach to salt producers to better understand their needs and support
their efforts to iodize the salt they produce. This image is taken
surveying small-scale salt producers with GPS technology can
from a GPS survey of salt producers in Senegal.
help alleviate this difficulty. It presents a promising opportunity to
identify and provide technical support to the small-scale
producers that supply salt for people in rural and remote areas This use of GPS technology also enables MI or local partners
throughout Africa and Asia that would otherwise be at high risk to gather accurate estimations of the size of salt works
for iodine deficiency disorders. MI has therefore been expanding surveyed. This critical piece of information allows MI to better
the use of this model in additional countries. advise on the type of iodization equipment that will work best for
a particular salt operation. The GPS technology can further be
GPS technology is particularly promising for further use in combined with Geographic Information Systems (GIS) and
projects similar to that done in Senegal and Bangladesh databases to provide a powerful platform that can be used for
because the technology is easily accessible, free to use and can program planning, monitoring and evaluation and can be linked
be used to not only initially mark the position of salt sites but to to a range of data to draw analyses and trends in performance.
also navigate back to the sites using GPS units by personnel
who are not familiar with the area.
PATHWAYS OUT OF POVERTY:
Hidden Hunger and the
Millennium Development Goals
A young girl in Ethiopia receives a vitamin A supplement as part
of a national child health program. In 2006-2007, MI programs to
avert child deaths by controlling vitamin A deficiency included
arranging for supplies of enough vitamin A capsules and syrup
to meet the needs of 347 million children in over 70 countries.
About Hidden Hunger Zinc deficiency contributes to approximately 800,000 child
deaths per year. Zinc supplementation for children during
Hidden hunger is unlike the hunger that comes from a lack of
diarrhea episodes can significantly reduce child mortality
food. It is a chronic lack of vitamins and minerals that often has
associated with diarrhea. In 2006-2007, MI worked with The
no visible warning signs, so that people who suffer from it may
Zinc Task Force and IZiNCG to advocate for accelerating the
not even be aware of it. Its consequences are nevertheless
implementation of WHO Guidelines on incorporating zinc
disastrous: hidden hunger can lead to mental impairment, poor
supplements into diarrhea treatment for children. MI also
health and productivity, or even death. One in three people in
convened a Latin American regional advocacy workshop that
the world suffer from hidden hunger. Women and children from
led to the adoption of these guidelines in Guatemala and
the lower income groups in developing countries are often the
Ending Hidden Hunger. Achieving the
Millennium Development Goals.
Growing recognition of the importance of micronutrient
programming for achieving the Millennium Development Goals
(MDGs) has been reflected in recent publications such as the
World Bank’s 2006 book Repositioning Nutrition as Central to
Development. It recognizes food fortification in particular as a
short route to development success. As the 2015 deadline for
achieving the internationally agreed upon MDGs draws nearer,
the importance of finding and seizing such short routes becomes
increasingly clear to all in the development field. Micronutrients
will continue to play a central and increasingly important role in
the push to achieve the MDGs. With this in mind, MI is
increasingly tying its micronutrient programs and advocacy
efforts directly into a framework based on the MDGs. The Workers in Sri Lanka package salt that has been iodized to help
majority of MI’s work will directly enhance efforts to reduce prevent mental impairment and promote healthy development.
MI programs led to the production of enough additional
child mortality and improve child development at global,
iodized salt to reach 267 million people globally last year.
regional, national, and subnational levels. MI programs will
also support improvements in women's health and empowerment
and help efforts to eradicate extreme poverty and hunger and Child Development
lessen the impact of HIV/AIDS, malaria and other diseases. MDG#2: Achieve universal primary education
MI works to improve cognitive development and
Child Survival educational outcomes among children through increased
MDG #4: Reduce Child Mortality intake of iodine and iron.
MI works to prevent the deaths of children under 5 by Iodine deficiency causes intellectual impairment in newborn
increasing sustained vitamin A and zinc intake. babies and is the world’s leading cause of preventable mental
impairment. In 2006-2007, MI continued to host the secretariat
Vitamin A deficiency compromises immune systems, lowering of the Iodine Network to promote and sustain universal salt
resistance to disease and infection and leading to the death of iodization (USI) efforts. MI works closely with UNICEF and
approximately one million children each year. MI programs to ICCIDD on USI programs. Our own work in this area also
avert child deaths by controlling vitamin A deficiency in 2006- includes a major new partnership with WFP to build on the
2007 included arranging for supplies of enough vitamin A progress and foundation established by the USI movement and
capsules and syrup to meet the needs of 347 million to advance the next and hardest phase – reaching the hardest
children in over 70 countries. In addition, MI provided field to reach and achieving coverage for the last 30% of the global
level support in 12 countries to improve current and future population. MI activities over the past year have included iodine
coverage with vitamin A supplements. MI also worked on the programs to enable the increased production of effectively
production and distribution of foods rich in vitamin A, such as iodized salt in 7 countries in Africa, 6 states in India, 6 other
fortified edible oil, and in 2006 MI began hosting the secretariat countries in Asia, and 1 country in the Americas. These
of the newly formed GAVA. programs led to the production of enough additional
iodized salt to reach 267 million people. That equates to
approximately 5% of global salt consumption.
6 The Micronutrient Initiative Annual Report 2006-2007
Children in Bihar, India receive lozenges fortified
with multiple micronutrients to help prevent anemia
and promote healthy development.
Iron deficiency anemia impairs the mental development of over Poverty and Hunger
40% of the developing world’s infants. Zinc deficiency impedes
MDG#1: Eradicate extreme poverty and hunger
child growth and development and folic acid deficiency in
pregnant women leads to serious neural tube birth defects. In MI works to help reduce poverty and hidden hunger and,
2006-2007, MI programs to reduce iron, zinc, folic acid and in turn, to increase productivity and economic growth
other deficiencies reached 13 million people in 10 through reduced vitamin and mineral deficiency among
countries. Programs included the supply, distribution and the most vulnerable and the weakest economic sections
monitoring of multi-nutrient lozenges in India and zinc of the population.
supplements and sachets of micronutrient powders for
institutional and home use in Asia and the Americas as well as a MI’s work to include micronutrients in feeding programs in
micronutrient powder for use in community feeding programs for emergency situations reaches some of the world’s poorest and
refugees in Darfur. most vulnerable people at times when they are particularly
susceptible to illness and disease and therefore have both the
greatest need and least access to high quality, nutritious foods.
Women’s Health and Empowerment
MDG#3: Promote gender equality and empower women Much of MI’s work in this area is policy related. An important
MDG#5: Improve maternal health example is MI’s service as a member of the Nutrition Cluster
of the UN Interagency Steering Committee (IASC) for
MI works to improve the survival, health and productivity of coordination of humanitarian assistance. Participation and
women by increasing iron, folic acid and iodine intake and, membership in this group allows MI to influence and advise
in turn reducing the consequences of iron deficiency key decision makers (international organizations, NGOs and
anemia and of poor pregnancy outcomes. UN agencies) on the importance of and most appropriate use
of micronutrients in emergencies.
The impact of iron deficiency on women tends to be greater
than that on men, reducing women’s potential to participate in One interesting example of MI’s practical, field-level work to
social and economic activity and to escape poverty. Women are improve the micronutrient quality of food provided during
more susceptible to anemia throughout their years of child- emergencies is the South-South transfer of technology that
bearing age and particularly during pregnancy itself. A occurred when MI adapted a vitamin and mineral mix developed in
combination of approaches including supplements and foods India for testing and use in emergency feeding programs in Darfur.
rich in or fortified with iron and folic acid, are typically the best See the Highlights from Africa section on page 11 for more details.
way to help prevent anemia. Flour fortification is one area in
which MI has invested significant effort. A post project review in
2006 indicated that the MI model of flour fortification with iron Infectious Diseases
and folic acid has been particularly successful in the Middle East MDG# 6 Combat HIV/AIDS, malaria and other diseases
and has resulted in well-functioning national programs reaching
approximately 80 million consumers there. MI and other FFI MI has recently established the interaction between
partners continue to mobilize key actors to accelerate the further micronutrient nutrition and infectious diseases, including
scaling-up of such efforts in the Middle East and other regions. malaria, TB, and HIV/AIDS, as a new area of focus in the work
of the organization. MI will work towards improving our
Beyond flour fortification, MI supported an important study on understanding of how these interactions affect human health.
the efficacy of iron fortified rice. This represents a promising new MI will advocate, and mobilize resources, for action to
approach to addressing anemia on a very large scale because strengthen the scientific and operational evidence base linking
of the wide-spread use of rice as a staple food. The study was micronutrients with infectious diseases, and will translate that
published in the American Journal of Clinical Nutrition. In evidence into policy and intervention where relevant.
Nicaragua, MI has been assisting the Programa de Atención
Integral a la Niñez Nicaraguense (PAININ) in a project to MI’s newly begun work in this area has included commissioning a
replace iron syrup supplements with sachets of multiple review of evidence in the research literature relating to
micronutrient powder to help address anemia among children interactions between micronutrients and HIV. The review is in
and expecting mothers. progress and MI expects to publish the findings during the 2007-
2008 fiscal year. MI is working with WHO, UNICEF, and key
international partners to address iron deficiency safely in malaria-
endemic areas through a two-pronged approach. This includes
systematic communication of information based on the most
recent studies as well as proactive support for research to
address identified knowledge gaps. MI is also analyzing recent
evidence that may show a positive link between micronutrient
supplementation and cost-effectiveness of tuberculosis treatment.
Full audited financial statements available at www.micronutrient.org.
Summarized Statement of Net Assets
As at March 31, 2007
(expressed in U.S. dollars)
Cash 1,096,542 676,679
Short-term investments 9,200,630 5,352,584
Amounts receivable and other current assets 3,108,289 7,244,020
Capital assets 665,994 291,382
Future income tax asset 11,337 12,365
Accounts payable and accrued liabilities 578,257 505,345
Deferred project contracts 7,920,784 8,601,473
Lease inducement – net of amortization 240,289 –
Net assets 5,343,462 4,470,212
Total Expenses ($28.2 million) Program Expenses by Region ($25.8 million)
Vitamin A Procurement and Interventions 15.2 million Africa 5.1 million
Iron Interventions 2.8 million Asia 8.6 million
Iodine Interventions 6.6 million Americas 1.0 million
Other Vitamin & Mineral Interventions 1.2 million Global Programs 11.1 million
Management and Administration 2.4 million
8 The Micronutrient Initiative Annual Report 2006-2007
Summarized Statement of Activities and Changes in Net Assets
For the year ended March 31, 2007
(expressed in U.S. dollars)
Contracts 28,199,198 30,695,399
Interest and other 834,561 171,317
Program activities 25,782,887 27,695,669
Management and administration 2,422,415 2,995,889
Total expenses 28,205,302 30,691,558
Net revenue for the year 828,457 175,158
Net assets – Beginning of year 4,470,212 4,140,352
Translation adjustment 44,793 154,702
Net assets – End of year 5,343,462 4,470,212
Summarized Statement of Cash Flows
For the year ended March 31, 2007
(expressed in U.S. dollars)
Cash flows from (used in)
Net revenue for the year 828,457 175,158
Items not affecting cash 147,707 123,724
Net change in non-cash working capital items 3,527,954 (142,827)
Investing activities (4,058,933) 207,484
Effect of translation (25,322) (48,238)
Net change in cash for the year 419,863 315,301
Cash – Beginning of year 676,679 361,378
Cash – End of year 1,096,542 676,679
Non cash activity 250,739 –
SOLUTIONS FOR SOLUTIONS FOR HIDDEN
HIDDEN HUNGER IN AFRICA HUNGER IN AFRICA
A refugee in South Darfur displays a container of “Rahma” –
a powder containing vitamin A, iron, and folic acid that is
added to food to reduce anemia. In trials at two camps in
Darfur the powder was effective in reducing anemia among
children 6 months to 5 years old. The powder was adapted
from a product developed and used in India.
MI programs in Africa in 2006 reached an
estimated 98 million people.
MI published a
A major focus for MI’s work in Africa has been the expansion of detailed toolkit to help
vitamin A supplementation and integration with programs to district level managers
improve child survival. The efforts include regional and throughout Africa
country-level advocacy to secure sustainable funding for plan, implement, and
vitamin A supplementation and ensure delivery of vitamin A as monitor vitamin A
part of a package of child survival services. MI has published a supplementation in
detailed toolkit for planning, implementing and monitoring Child Health Weeks.
Vitamin A programming
vitamin A supplementation in Child Health Weeks. It is aimed at
aims to improve
district level managers to support their work to develop vitamin
immune function and
A supplementation programs.
reduce child mortality.
MI has also worked to increase the proportion of salt that
is fully iodized from major African salt producing
countries such as Sudan, Senegal, Ethiopia, Ghana,
Mozambique, Tanzania and Angola. This work has included
tailoring salt iodization equipment to fit the needs of different
sized salt production plants, tools for monitoring at the
production level and developing a training video and an
operation manual for salt iodization equipment. Our work
complements the policy and demand creation thrust by
governments and other international agencies to enable a
coordinated push towards USI in the region.
Efforts to prevent iron deficiency anemia
and other forms of hidden hunger
included working closely with the new
Partnership for Africa’s Development
(NEPAD) and the African Union (AU) as
well as WFP, the UN High Commission
for Refugees (UNHCR), USAID, and
GAIN to secure high-level
endorsement of nutrition security
within food security programs. Work
to bring together African grain, oil, sugar
and salt producers to fortify their
products with essential vitamins and
minerals continued with the launch of
the FortAf website and email newsletter.
MI launched the FortAf website and
email newsletter to bring together
African grain, oil, sugar and salt
producers to fortify their products
with essential vitamins and minerals.
See the website at www.fortaf.org.
10 The Micronutrient Initiative Annual Report 2006-2007
G F B
HIGHLIGHTS FROM AFRICA
Supported UNICEF in training over 1,300 health workers from D
720 health posts in nine provinces on the importance of
vitamin A supplementation and deworming.
Partnered with the Government of Ethiopia, the World Bank, A
the USAID-funded A2Z project and UNICEF to complete an
important costing study needed to secure long term,
sustainable funding for Vitamin A supplementation in Ethiopia. E
Continued to provide support through UNICEF for extending H
the number of small producers iodizing their salt. Partnered
with WFP and initiated support to additional small producers,
procuring equipment to enable iodization.
please see the Innovations section on page 5.
In 2006, MI partnered with the Rapid Results Institute, the Developed advocacy materials to promote iron
Government of Kenya, and the Kenyan oil industry to supplementation through school nutrition projects to the
complete the first ever food fortification rapid results initiative Ministry of Education.
(RRI) in Africa. The Initiative greatly sped the process of
introducing fortified oil products and one of the early South Africa
implementers, the private company Bidco, had three certified H Supported the Medical Research Council to improve
products on store shelves in 130 days. The initiative triggered standardization of iodine monitoring methods.
a process of industry change and other industry members
have indicated that 9 more brands will soon be applying for Continued, together with GAIN, and UNICEF, to support the
certification of fortified products. MI plans to build on this South African government and the large South African flour
success and use the RRI model to stimulate flour fortification millers through strengthening the monitoring and
in Kenya in the 2007-2008 fiscal year. communication aspects of the ongoing commercial fortification
of maize and wheat flour with vitamin A, iron and folate
Nearly 2 million children received vitamin A supplements with Collaborated on a project to support small and medium scale
MI funding support in 2006 – approximately 200,000 more maize millers in South Africa to meet the flour fortification
children than were reached in 2005. regulations. The project included developing a training manual
and workshops for small millers and developing a series of
articles for publication in commonly read agricultural and farming
F Nigeria magazines. Program challenges included the need to build trust
Placed hidden hunger, and vitamin A supplementation for with reluctant millers within a highly competitive market.
children, on the agenda at the Presidential Stakeholder Forum
on Child Nutrition, the World Health Day Media Forum, and Sudan
the consultative forum Nutrition in Under Fives: A Review of I
the National Response. Put agreements in place to ensure implementation of the
Sudan National Plan for Universal Salt Iodization, and
Participated in the Iodine Network assessment mission to procured equipment and potassium iodate for 14 large salt
certify that Nigeria had achieved universal salt iodization. producers in the Port Sudan area.
Completed successful South-South transfer of technology by
G Senegal adapting a multiple micronutrient powder used in India to
Supported Senegal to develop a Strategic Plan for fortify meals for internally displaced persons in two refugee
Fortification by providing technical assistance. Secured multi- camps in South Darfur. The powder, which contains vitamin A,
sectoral endorsement of a universal salt iodization monitoring iron, and folic acid, proved effective in reducing anemia
plan to be led by the Premier’s Office. among children 6-59 months of age in the camp. By providing
strong options for improving the micronutrient quality of foods
Concluded an innovative program to map all the small-scale provided in refugee camps, MI expects to significantly
salt producers in Senegal using a Global Positioning System increase the ability of humanitarian organizations to protect
(GPS) platform. This mapping exercise allowed MI to identify some of the most vulnerable segments of the global
those producers to receive support and in some cases population from hidden hunger.
custom-built equipment in the first phase of a joint-
Government of Senegal-MI-WFP project. For more details,
HIDDEN HUNGER IN ASIA
A boy gets vitamin A syrup at a rural site in Jharkhand, India.
MI undertook successful collaborative advocacy to increase the
upper age limit for vitamin A supplementation programs in India to
the international standard of 5 years. This dramatically increases
the number of children that will be reached and protected.
MI programs in Asia in 2006 reached an HIGHLIGHTS FROM ASIA
estimated 340 million people.
Vitamin A supplementation has continued to be a major focus Completed a scoping mission in December 2006 and
for MI throughout Asia. Notable efforts in this area during subsequent strategy development to scale-up MI’s work to
2006-2007 included successful collaborative advocacy to address hidden hunger in Afghanistan with funding support
increase the upper age limit for vitamin A supplementation from CIDA.
programs in India to the international standard of 5 years.
This change dramatically increases the number of children Began work on salt iodization and flour fortification to address
who will be reached and protected. In addition to supporting iodine deficiency and anemia. Partnered with WFP in
the supply of vitamin A syrup, MI also supported vitamin A Afghanistan and flour millers in Pakistan. Through this
delivery in 6 Indian states with emphasis on strategies for partnership, MI is supporting the fortification of flour in
reaching the hard to reach. Other areas of focus included Pakistan for distribution in Afghanistan, where it is expected
salt iodization, with significant progress in Pakistan and Sri to reach some 2.5 million people over an 18 month period
Lanka, and work with a variety of multiple micronutrient beginning in July 2007.
products such as Anuka and Nutri-Candies.
MI’s ongoing work to provide vitamin A supplements through
MI continued to work throughout Asia to stimulate and UNICEF now reaches approximately 5.3 million children in
support the development of strong national nutrition Afghanistan each year.
policies and micronutrient programs. For example, MI
provided technical support for the development of the Nutrtion B Bangladesh
PC-1 plan in Pakistan and launched the India Micronutrient Successfully piloted a model for getting vitamin A supplements
National Investment Plan. The Investment Plan seeks to to hard to reach children.
protect 206 million people per year from hidden hunger
over a five year period. It was developed in consultation with Continued upgrading salt iodization plants, leading to
government departments, academic institutions, significant improvements in the quality of salt iodization.
nongovernmental organizations, the private sector and other
international organizations and it has been influential in the Groundwork by MI on oil fortification led to nation-wide scale-
development of the Government of India’s 2007-2011plan. up by GAIN.
MI’s New Delhi office also continued to support the
development of the MI India Trust, which became fully
operational in 2006-2007. In addition to being MI’s prime 10 million more people are protected from iodine deficiency
implementation partner in India, the Trust has provided disorders as a result of MI supported salt iodization work
efficient procurement services for MI programs in other through UNICEF and in collaboration with the Ministry of Health
countries throughout Asia, Africa, and Latin America. in 7 of China’s Western provinces. While the national
percentage of households using iodized salt has improved
significantly in China, given the high population of 1.2 billion
there is still need to reach and protect more people in the poor
and rural areas through this MI-UNICEF-Ministry of Health
Successfully advocated with UNICEF for the Government of
India to extend vitamin A supplementation programs to include
children aged 37 to 59 months. The cut-off had previously
been at 36 months of age.
Supported the supply of 109 million doses of locally produced
Partner representatives attend the launch of the AJK Wheat
Flour Fortification Project in Pakistan in January 2007. Collaborated with WFP in Rajasthan, using a new model of
Representatives include the MI National Program Manager organizing small-scale salt producers into associations to help
in Pakistan, the Government of Pakistan Senior Minister, increase their capacity to iodize their product.
the Minister of Food, the Minister of Agriculture,
and the CIDA representative
12 The Micronutrient Initiative Annual Report 2006-2007
Worked with ICCIDD on a
targeted advocacy program to further
universal salt iodization.
In collaboration with UNICEF, completed a
study to prove the feasibility of using Anuka
multiple micronutrient sachets in the Integrated
Child Development System in Rajasthan. The test H
has been so successful that the project will be expanded
to the State of Orissa by UNICEF with funding from BASF. E
Engaged with the States of Tamil Nadu, Andhra Pradesh and
Karnataka to develop a pilot rice fortification project that will
initially target government feeding and food distribution
programs that use rice.
Established a partnership with an Indian company in Mumbai to Completed a national survey of iodine
supply the premix for MI double fortified salt programs globally. deficiency disorders and iodized salt coverage
Ensured 3.6 million children in Tamil Nadu consumed more Collaborated with WFP and Population Services International
iron to prevent anemia through a midday meal program that (PSI) to develop a low-cost fortified complementary food for
uses salt fortified with iron and iodine. children. Nepal is now among the first countries to introduce
such a food at a price point that makes it accessible to low-
Launched the India Micronutrient National Investment Plan income families.
(IMNIP) for 2007-2011, developed co-operatively with
government and private sector representatives and civil Supported further intensification of Maternal and Neonatal
society partners, to provide a roadmap for addressing Micronutrient Program (IMNMP) in 12 more districts bringing
micronutrient deficiencies in India. See Focus on Partnership the total districts supported by MI up to 35. Encouraged by
section on page 4 for more details. the success of the program, other development partners have
also replicated the program. It is now in place in 41 of 75
districts in Nepal.
Successfully pilot tested an innovative device to fortify flour
produced at small village watermills without using electricity or
increasing the miller’s workload. The project has since won a
World Bank Development Marketplace award. See the
Innovations section on page 5 for more details.
Supported a pilot test of an innovative approach to vitamin A
supplementation that does not rely on twice-yearly National
Immunization Days, which are due to be phased out in 2009.
Supported the distribution of Sprinkles™ using both a social
marketing approach and free distribution through the Lady
Health Worker Program.
Supported the scaling-up of wheat flour fortification in
Children in Tamil Nadu consume more iron to prevent anemia collaboration with partners such as the Government of
through a midday meal program that uses salt fortified with both Pakistan, WFP, and GAIN.
iron and iodine. The program protects 3.6 million children.
Supported the design of a national iodine deficiency control
program by the Government of Pakistan and worked with small-
E Indonesia scale salt producers in 53 districts to encourage salt iodization.
Worked with Government of Indonesia, the Coalition for
Fortification in Indonesia (KFI) and UNICEF to support the H Sri Lanka
national vitamin A supplementation program and with KFI and
Commenced work to upgrade two main salt iodization
UNICEF on support for production of adequately iodized salt.
plants, which have the capacity to produce enough salt to
meet 80% of the country’s needs. The plants were
Provided technical assistance to Asian Development Bank
subsequently inaugurated by the Prime Minister and
nutrition project, helping test home-based fortification and
recognized nationally by the President.
IN THE AMERICAS
MI developed the technical process to fortify cassava
snacks, such as the one this Haitian boy is eating,
with vitamin A, B vitamins, folic acid, iron and zinc.
Reducing vitamin A deficiency to prevent child deaths has been A survey of the fortified oil actually consumed at household level
a high priority in the Americas and MI addressed this through was also commissioned last year and is in progress.
the supply of vitamin A capsules. MI also supported improved
delivery of vitamin A supplements through a child health week in Guatemala
Haiti. And in Bolivia MI helped strengthen local capacity for
Reached 20,000 low-income children with multiple
monitoring and quality assurance of vitamin A fortified oil,
micronutrient sachets and zinc supplements through an
which is now distributed nationally after earlier MI support.
ongoing trial. Worked through Guatemala’s public health system,
with funding from the Izumi Foundation.
MI has been focusing regional salt iodization efforts on Haiti,
where only 2% of households have access to effectively iodized
salt. MI worked with WFP on improving layouts for salt ponds Haiti
and mapping salt production in Haiti. MI also participated in a Developed the technical process for fortifying cassava snacks
multi-agency advocacy mission and the development of an which have been incorporated into school feeding programs.
iodization work plan with local officials.
Iron deficiency anemia is a significant nutritional problem in the
Americas and MI has therefore been promoting the use of Contracted by the Inter-American Development Bank to provide
multiple micronutrient sachets to reduce the prevalence of technical assistance replacing iron syrup with multiple micronutrient
nutritional anemia in children 6 to 24 months old. Efforts have sachets. The sachets will reach 87,000 children under six years of
been focused in Haiti, Guatemala, Bolivia, and Nicaragua. age and 13,000 pregnant and lactating women through the
Programa de Atención Integral a la Niñez Nicaraguense.
HIGHLIGHTS FROM THE AMERICAS Multiple
Bolivia sachets called
Chispitas and zinc
18 million multiple micronutrient sachets called “Chispitas” supplements were
distributed. Chispitas incorporated into new zero malnutrition distributed to
health policy in the first documented instance of a national children in low-
government scaling up the free public distribution of multiple income families
micronutrient sachets to a national level. through the public
Approximately 34 million litres per year of vitamin A fortified oil,
60% of the national supply, is now being produced and marketed 18 million more
commercially in Bolivia as a result of MI’s long-term collaboration Chispitas sachets
with and technical and financial support for the World Food were distributed.
Programme and public and private sectors in Bolivia.
SOLUTIONS FOR HIDDEN HUNGER IN THE MIDDLE EAST
10 Years of Progress through Wheat Flour HIGHLIGHTS FROM THE MIDDLE EAST
MI recently completed a review of its investment over the past Yemen
10 years to fortify wheat flour in the Middle East. The results are Flour fortification was launched on a national scale with MI
encouraging. Five years after the completion of MI’s work, and a support. More than 60% of the country’s flour is now fortified.
total investment of approximately $3 million, the following results
are being achieved on a self-sustaining basis: Conducted a salt situation analysis and made recommendations
on improving the proportion of adequately iodized salt in Yemen.
• 7 million metric tons of fortified flour was milled in 13 countries,
reaching 80 million people
• 10 countries have established standards for fortified flour and 4
more countries are currently developing standards
• 13 ongoing national programs have expansion plans and 3
additional countries have plans to initiate flour fortification
14 The Micronutrient Initiative Annual Report 2006-2007
MI Develops a New Strategy
for Accelerating Global Progress
and Fostering Innovation
As we end the fiscal year and look back to take stock of our
progress, we also look forward to the coming years and the
challenges and opportunities they will hold for MI and the
constituencies we serve. This is especially true for MI at the
close of the 2006-2007 fiscal year as we both celebrate 15
years of progress and look ahead with a renewed 5 year
strategy for the years 2008-2013.
This new strategy will anchor the work of the MI to the
Millennium Development Goals, focusing our work even more
sharply on maximizing our contribution to child survival, child
development, women’s health and empowerment, and the
reduction of poverty, hunger and infectious diseases. In
particular, MI will prioritize micronutrient programs that improve
child survival. Our second largest area of focus will be
micronutrient programs to promote healthy child development.
The strategy recognizes our commitment to reach the most
vulnerable people as a fundamental operating principle that
will be woven throughout our programming. This includes
special emphasis on ensuring that women and girls, rural
communities, and the poorest segments of society are all
reached by and benefit from our programs.
MI has worked hard to stimulate awareness of micronutrients
and their importance to the achievement of the Millennium
Development Goals. As awareness has grown, so has the
range of micronutrient products available and the variety of
mechanisms to deliver them. Because these products and
delivery mechanisms are all at different stages of evolution, MI
recognizes the need to show leadership in ensuring
evidence-based effectiveness while stimulating innovation.
Therefore a key component of the new strategy is MI’s
commitment to strike an optimal balance between extending the
reach of established solutions and developing, testing and
stimulating the adoption of new ones where needed. The bulk
of MI’s efforts will be devoted to accelerating progress and
protecting more people through well established solutions such
as vitamin A supplementation and universal salt iodization. MI
will also continue to play an important role in stimulating the
broader adoption of well-tested and promising new solutions
such as fortified lozenges, double fortified salt, and multiple
micronutrient powders. Selective forward-looking research and
development projects will round out MI’s efforts.
We will share more details of the new 5 year strategy and
resulting plans as we continue to refine and operationalize with
the invaluable and ongoing input and support of our partners
and financial supporters.
About the Micronutrient Initiative
Passionate about developing and implementing solutions for hidden hunger, the Micronutrient Initiative works in partnership with
governments, the private sector and civil society organizations to address this serious problem that affects one third of the world’s
population. Governed by an international Board of Directors, MI works in Asia, Africa, Latin America and the Middle East and reaches
people in over 70 countries. With headquarters in Ottawa, Canada, MI maintains regional offices in New Delhi, India and Johannesburg,
South Africa that manage our country offices in Asia and Africa.
Board of Directors Officers and Senior Staff Contact Information
Mr. Kul C. Gautam Mr. M. G. Venkatesh Mannar Headquarters
Deputy Executive Director, UNICEF President 180 Elgin St., Suite 1000
Chair Ottawa, Canada, K2P 2K3
Mr. David Porter Tel: +1 613 782 6800
Mr. Robert Moore Vice-President of Corporate Services Fax: +1 613 782 6838
Past-President, Kiwanis International Email: email@example.com
Vice-Chair Mr. Mark Fryars
Director, Program Services Africa Regional Office
Mr. Richard Ham P.O. Box 2927
Managing Director, Ms. Evelyne Guindon Houghton, South Africa, 2041
JPMorgan Investment Bank Director, Resource Development and Tel: +27 11 327 6292 or +27 11 327 7820
Member and Chair of Finance Partnerships Fax: +27 11 327 6286
and Audit Committee Email: firstname.lastname@example.org
Mr. Luc Laviolette
Ms. Frances R. Davidson Director, MI Asia Asia Regional Office
Health Science Specialist, 11, Zamroodpur Community Centre
U. S. Agency for International Development Ms. Carol Marshall Kailash Colony Extension, New Delhi
(USAID) Director, MI Africa 110048, India
Member Tel: +91 11 4100 9801
Fax: +91 11 4100 9808
Mr. Jean-Louis Sarbib Email: email@example.com
Director, Wolfensohn & Co.
Ms. Sheila Sisulu
Deputy Executive Director,
World Food Programme (WFP)
Ms. Diane Vincent
Development Agency (CIDA)