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

Efforts to address Micronutrient deficiencies (MNDs) in lower-and middle-income countries (LMICs) have been gaining pace in recent years. Commodities such as staple foods (e.g., cereals, roots, and tubers) and condiments (e.g., salt) have been targeted as 'vehicles' for fortification and biofortification through numerous projects and initiatives. To date, there have been mixed experiences with delivery and coverage with very little documented on the range of business models applied in different geographies, business conditions and polities and this makes classification and measurement of success and failure difficult. This research aims to address this gap in knowledge through proposing a typology that clarifies similarities (internal heterogeneity) and differences (external heterogeneity) between models and that can allow all types to be defined by the combination of attributes. Building on a comprehensive literature review; NVivo was used to code initiatives from 34 key references (955 cases in total) which have been grouped into 17 categories. Using non-metric multidimensional scaling (NMDS) we find evidence of four business model groupings that typify fortification initiatives: (1) Large-scale private, unregulated, (2) Mixed-Scale, private, unregulated (3) Large-scale, public-private, regulated; and (4) Large-scale, private, regulated. We characterise these four groups with country examples and suggest that this typology can help the discourse around viability of food fortification initiatives.

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

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.

Which Choice of Delivery Model(s) Works Best to Deliver Fortified Foods?

Micronutrient deficiencies (MNDs) occur as a result of insufficient intake of minerals and vitamins that are critical for body growth, physical/mental development, and activity. These deficiencies are particularly prevalent in lower-and middle-income countries (LMICs), falling disproportionately on the poorest and most vulnerable segments of the society. Dietary diversity is considered the most effective method in reducing this deficiency but is often a major constraint as most foods rich in micronutrients are also expensive and thereby inaccessible to poorer members of society. In recent years, affordable commodities such as staple foods (e.g., cereals, roots, and tubers) and condiments (e.g., salt and oil) have been targeted as "vehicles" for fortification and biofortification. Despite efforts by many countries to support such initiatives, there have been mixed experiences with delivery and coverage. An important but little understood driver of success and failure for food fortification has been the range of business models and approaches adopted to promote uptake. This review examines the different models used in the delivery of fortified food including complementary foods and biofortified crops. Using a keyword search and pearl growing techniques, the review located 11,897 texts of which 106 were considered relevant. Evidence was found of a range of business forms and models that attempt to optimise uptake, use, and impact of food fortification which are specific to the 'food vehicle' and environment. We characterise the current business models and business parameters that drive successful food fortification and we propose an initial structure for understanding different fortification business cases that will offer assistance to future designers and implementors of food fortification programmes.