RT Journal Article
SR Electronic
T1 Uptake of Encapsulated Ferrous Fumarate Double Fortified Salt in the Public Distribution System in India: A Value Chain Analysis
JF Global Health: Science and Practice
JO GLOB HEALTH SCI PRACT
FD Johns Hopkins University- Global Health. Bloomberg School of Public Health, Center for Communication Programs
SP 832
OP 845
DO 10.9745/GHSP-D-20-00448
VO 9
IS 4
A1 Jadhav, Meena Haribhau
A1 Mannar, Marthi Gurunath Venkatesh
YR 2021
UL http://www.ghspjournal.org/content/9/4/832.abstract
AB Key FindingsDouble fortified salt (DFS) interventions using encapsulated ferrous fumarate premix passed rigorous efficacy evaluations but faced challenges in showing impact at scale. Several technological, market-related, and policy barriers contributed to the reduced coverage and impact of the public-sector-led DFS interventions in India.Value chain analysis can be a useful method to identify and address demand and supply-side barriers to scaling up DFS in settings where the scale-up criteria are met.Key ImplicationsInitiating and sustaining large-scale encapsulated ferrous fumarate DFS interventions in the public distribution system in India involve several challenges that can be minimized through strengthening DFS value chains. Critical interventions for addressing barriers in India's DFS value chain include— building an enabling institutional environment, demand creation through consumer awareness, strengthening institutional markets through public financing, managing cost and risks through public-private partnerships, and assuring quality during commercial scale-up.Considering the high price of DFS when introduced through private markets and the preference of a significant population to low-cost salt options, routing DFS through the public distribution system targeting low-income populations (that enables cost reduction through bulk purchase and subsidizes the product's retail price) is essential.Food fortification is a powerful strategy to reach large populations with multiple micronutrients added to a single food vehicle. The impact depends on the sustained provision and utilization of adequately fortified food by a large population (mainly in low-income and food-insecure settings). We apply a value chain (VC) analysis framework to diagnose and address the barriers to the uptake of encapsulated ferrous fumarate double fortified salt (DFS) distributed through public-sector-led DFS interventions in India.We adapt the VC requirements framework proposed by Henson and Humphrey to identify and categorize barriers along the DFS VC as technological, market-related, and policy-related. We conducted a desk review of published and unpublished literature on DFS and information available in the public domain, semi-structured interviews with VC stakeholders from the private sector, program data from implementing organizations, and participation in multistakeholder consultations on DFS.Major supply-side barriers were under-developed private markets, inconsistent demand from public markets, unpredictable returns-on-investments, and inadequate business incentives to invest in DFS. The product's weak consumer orientation, uncreated consumer demand, low awareness of fortified foods, inadequate nutrition signaling were significant demand-side barriers. Technological barriers related to the requirement of high-grade salt for DFS production and residual organoleptic property of mild discoloration of food. Policy barriers related to inadequate and irregular financing for distributing subsidized DFS through the public distribution system; insufficient policy support for risk-sharing and managing costs associated with fortification; and a weak institutional environment for sustaining DFS interventions.Building an enabling institutional environment, demand creation through consumer awareness, strengthening institutional markets through public financing, managing cost and risks through public-private partnerships, and assuring quality during commercial scale-up are critical interventions necessary to ensure impact at scale.