Policy to fortify foods transforms Ethiopia’s health, GDP

Ethiopia’s Government spending of $3.8 million over the next 10 years could save tens of thousands of lives, reduce healthcare costs, and raise the country’s productivity, stemming losses of $520 million a year that are being caused by vitamin deficiencies, a new report says.

This is indicated by the analysis published today by the Global Alliance for Improved Nutrition (GAIN) on the costs and benefits of introducing mandatory food fortification in Ethiopia. Decades of records with the United Nations’ Food and Agricultural Organisation show that carbohydrate makes up more than 70 percent of Ethiopia’s national diet, delivering energy.



But very few of the vitamins and minerals that humans need to be healthy². Faced with similar problems, more than 80 countries worldwide have added nutrients to staple foods to reach a wide population without the need to change national eating habits, according to the report.

The new cost benefit analysis found that every $1 spent by government, industry and consumers on
fortifying flour with critical nutrients would bring back $13 of economic benefits to Ethiopia in saved
illness and healthcare costs, and improved productivity: as the country seeks to resolve severe
deficiencies in folic acid and Vitamin A.

Folic acid plays a critical role in preventing stillbirths and deaths in early childhood due to malformed spines and brains. Ethiopians’ average consumption of folic acid runs at less than 200 micrograms per day, compared with the 400 micrograms a day that humans need to be healthy.

As a result, an analysis of Ethiopia’s most recent micronutrient survey found that 84 per cent of Ethiopian women from 15-49 years old are at risk of giving birth to babies with NTDs. Indeed, in Ethiopia, more than 11 times more babies are born with these Neural Tube Defects (NTDs) than in Africa as a whole.



To counter such challenges, countries such as Kenya, Nigeria, Rwanda, Tanzania, Uganda, and Zimbabwe have fortified common staple foods like flour with folic acid, reducing the number of NTD pregnancies by an average 41 per cent.

The health and economic gains of such mandatory fortification in Ethiopia would be considerable, state
the cost-benefit analysis authors, who also estimate that every dollar spent on the fortification of edible oil – 98 per cent of which is currently imported into Ethiopia – will deliver $2.75 in economic gains for the country.

This follows from Ethiopia’s significant progress in tackling malnutrition, with the proportion of children whose growth is limited by poor nutrition, in an impact known as ‘stunting’, having been reduced from from 58 percent in 2000 to 37 percent by 2019.

However, the new cost-benefit report also highlights the ongoing costs of the country’s challenges as a
result of Vitamin A deficiencies, which cause night blindness and a loss of immunity to infections. Recent studies found around 80 per cent of all Ethiopian children – from 92 per cent in Amhara to 55 percent in Gambella – getting insufficient Vitamin A, as well as 82 per cent of Ethiopian women of reproductive age.



“Extremely deficient diets are continuing to deliver ill health to almost every Ethiopian and need urgently addressing,” said Mr Ton Thomas Haverkort, GAIN’s Ethiopia Country Director. “Food fortification is simply a universal solution, which for less than half-a-million dollars a year of government spending can transform Ethiopia’s public health and productivity.”

Ethiopia has taken significant steps towards scaling up fortification programmes, such as preparing
standards for fortification (published in 2017 and 2018), but has not yet mandated the fortification of
flour and edible oil.

The Global Alliance for Improved Nutrition is a Swiss-based foundation launched at the UN in
2002 to tackle the human suffering caused by malnutrition. Working with both governments and
businesses, it aims to transform food systems so that they deliver more nutritious food for all people,
especially the most vulnerable.