Estimating the Costs of Alternative Large-Scale Food Fortification Programs in Burkina Faso: A MINIMOD Tool for Informing Policy Discussions

Abstract

Objectives Decisions regarding the types and amounts of micronutrients to include in large-scale food fortification (LSFF) programs should consider costs. The Micronutrient Intervention Modeling (MINIMOD) cost tool estimates the costs of alternative LSFF programs, with focus on stakeholders’ cost burdens. Methods An activity-based cost model was developed and adapted to the context of Burkina Faso. Key national characteristics (e.g., population size), and information on existing and hypothetical LSFF programs (e.g., adherence to standards) establish the model's platform. Private- and public-sector costs (as relevant) of designing, implementing, and managing LSFF are included. The model contains a micronutrient premix cost calculator. LSFF-vehicle-specific consumption patterns (e.g., g/day of fortifiable wheat flour consumed, based on household survey data) link costs to program reach. A ten-year planning time horizon is adopted. Results The premix required to fortify wheat flour with iron and folic acid (60 mg/kg of ferrous fumarate, 2.5 mg/kg of folic acid – the current standard) is estimated to cost ∼$2.11 (2020 USD) per MT of fortified flour, with overall 10-year program costs of ∼$2.4m; ∼25% faced by industry (e.g., internal quality control), ∼23% by government (e.g., external monitoring), and 52% by stakeholders who would cover premix costs (generally assumed to be industry, with some pass-through to consumers). Cost per person and cost per person reached are ∼$0.010 and ∼$0.023, respectively. Including zinc in this premix (95 mg/kg of zinc oxide) would increase the cost per MT of fortified flour to ∼$3.02, total 10-year program costs to ∼$3.3m, and cost per person and per person reached to ∼$0.014 and ∼$0.032, respectively. The premix's share of costs increased to ∼54%. Conclusions The levels and compositions of the costs should be considered when designing and managing LSFF, in part because different stakeholder groups, including consumers, will be called upon to pay them. Premix costs are one main cost driver; increasing the number and/or amounts of fortificants will increase overall program costs and shift the burden of costs among stakeholders. Funding Sources Research was supported by a grant to UC Davis from Helen Keller International through their support from the Bill & Melinda Gates Foundation.

Modeled impacts of bouillon fortification with micronutrients on child mortality in Senegal, Burkina Faso, and Nigeria

“…36 The objective of this study is to estimate lives saved among children 6-59 months of age attributable to fortification of bouillon with vitamin A, zinc, and/or folic acid, alone and in combination, at various levels of fortification and considering the effects of existing LSFF programs in three West African countries: Senegal, Burkina Faso, and Nigeria. This analysis builds on previous work that has estimated the impact of bouillon fortification on dietary adequacy, [37][38][39] and complements parallel efforts to estimate the costs and cost-effectiveness of bouil-lon fortification 40 in these three countries. Together, these results can inform ongoing discussions related to bouillon fortification standards.…”

“…In this paper, we present simulated program benefits (i.e., number of lives saved) in Senegal, Burkina Faso, and Nigeria for 2023–2030 as average annual values. An accompanying paper 40 presents estimates of program costs over a 10‐year time horizon (2020–2030); in this scenario, 2021–2022 were considered as start‐up years in which program investments are made but no health impacts are generated, and we further assumed that full program benefits would accrue beginning in 2023, the first year modeled here. Detailed methods for estimating lives saved for each nutrient, including modification of default LiST values to align with MINIMOD‐SD estimates, are described below.…”

Including calcium‐fortified water or flour in modeled diets based on local foods could improve calcium intake for women, adolescent girls, and young children in Bangladesh, Uganda, and Guatemala

“…In addition to the development and procurement of micronutrient premix, the inclusion of calcium in flour fortification programs or standards would require monitoring and enforcement of compliance to ensure that fortified foods are reaching the most vulnerable 63 . Analysis with existing tools, such as those developed under MINIMOD, could be used to model the potential cost implications of adding calcium to wheat flour premix or increasing its calcium content 64 . However, as wheat flour is not widely consumed in all countries, 8,10 prior to recommending this flour fortification as a strategy, analysis using the HECS data from this study or primary data should confirm whether those consuming wheat flour in countries such as Bangladesh are the same population groups with low calcium intakes who could benefit from a fortification strategy, or if a different fortification vehicle should be selected.…”

Firm-Level and Public-Sector Costs Make Small-Scale Maize Flour Fortification Challenging in Uganda

“…Modeling exercises also tend to focus on the proportion of any fortifiable vehicle that is produced (domestically or abroad) by large-scale operations. 17,18 This effectively removes smaller-scale, “infeasible” 7 producers from the calculations of expected nutritional benefits and costs, suggesting that insurmountable technical and cost issues will emerge at any and all scales of production below that of large, industrial producers. Nevertheless, driven by consumption patterns of the population in lower socioeconomic strata, for more than 30 years fortification of foods produced by smaller-scale firms has been considered and in some cases promoted to reach these populations vulnerable to micronutrient deficiencies.…”