TOR to Conduct Gender Sensitive Supply Chain and Market Analysis of Folic Acid Premix Supply for Double Fortification of Salt – Iodine and Folic Acid (DFS–Iofa) –
Consultancy and Training
Background
Micronutrients deficiencies remain the main risk factors for causing infection and chronic disease morbidity and mortality among all ages in Ethiopia. It is a major public health problem, with women and children most at risk. Folate deficiency is one the most common deficiencies among women of reproductive age (WRA) in Ethiopia. The national micronutrient survey conducted in 2016 by Ethiopian Public Health Institute (EPHI) reveals that the prevalence of serum folate and RBC folate deficiency among WRA was 17.3% and 32%, respectively, describing the prevalence of folate insufficiency, which is the main risk factor for Neural Tube Defects (NTD). Recently, a hospital-based study conducted in Tigray region showed a prevalence of NTD of 131 per 10,000 births, and other hospital-based study in Addis Ababa also showed a high incidence of NTDs, at 64 per 10,000 live births. These prevalences are higher than the prevalence found in countries with successful large-scale food fortification programs with folic acid, which consistently show 5-6 per 10,000 live births. This indicates the magnitude of the problem and emphasizes the urgency to implement programs that improve folate status and reach all women of reproductive age. The NTD prevalence significantly decreased in more than 60 countries that effectively mandate food fortification with folic acid[1]. Fortifying flour with folic acid is an effective way to reduce the occurrence of neural tube defects (NTDs) at a national level[2].
During the last three years, Nutrition International (NI) and EPHI together with international partners (UC-Davis, ReachAnother Foundation, and the University of Toronto) have been engaged in the development of iodine-folic acid double-fortified salt (DFS-IoFA). Double fortification of salt with folic acid in addition to iodine is a new initiative using already available technologies and infrastructure, and could be a promising and innovative strategy to prevent NTD on top of the current benefit of preventing iodine deficiency disorders (IDD). Ethiopia is self-sufficient in the production of salt, and the presence of a successful mandatory salt iodization program over the past 10 years, that already reaches over 90% of the population, are very indicative that DFS-IoFA has the potential to be a high-impact, low-cost intervention.
Timely and regular access to affordable and quality Folic Acid (FA) and potassium iodate (KIO3) compounds is critical for the successful implementation of DFS-IoFA project. Supply chain and market analysis will be conducted to map supply (production) and demand (market) for FA to develop cost-effective solutions to ensure folic acid supply for DFS-IoFA. The demand for FA will be established in accordance with the scaling up of the project, i.e., the pilot phase of DFS-IoFA market introduction will help to gauge the rate of adoption of the new product and allow to model the potential scale up and establish the market demand. NI will engage a consultant to support this supply chain analysis and explore integration of folic acid with the current universal salt iodization (USI) supply chain. The market analysis focusses on understanding the dynamics of market buyers/CIFs behavior, assesses the buying patterns, explores if importing FA and preparing a spray solution with KIO3 at the CIF level is feasible and cost-effective, and assesses expected challenges for FA supply and best lessons from the existing KIO3 supply system.
In support of the provision of FA supply for the DFS-IoFA study and to inform decision makers with evidence, NI will hire a consultant to explore FA supply system and outline the capacities and the processes required to establish a national premix supply system that ensures timely and sustainable access to premix to produce DFS-IoFA.
Objectives
The objective of the FA supply chain analysis is to understand and document the different options of availing folic acid premix for the planned production of DFS in Ethiopia and recommend short term and long-term strategies that ensure an uninterrupted supply of quality FA in Ethiopia.
Specific objectives
- Assess the current KIO3 procurement, supply, distribution, monitoring and cost recovery mechanism.
- Describe the role of major actors and stakeholders involved in KIO3 supply chain system,
- Identify the opportunities and challenges of the existing supply chain and the cost recovery mechanism,
- Assess the policy makers’ ideas or perception on integration of folic acid with potassium iodate.
- Explore the availability and test feasibility of private sector model or public-private partnership model to import or locally produce FA premix.
- Explore the opportunities, advantages, and disadvantages of engaging the public, private and mixed model in folic acid-potassium iodate supply chain.
- Provide recommendations and best option for a folic acid and potassium iodate procurement, supply distribution and monitoring system.
- Review the pros and cons of integrating Folic Acid supply with KIO3.
- Address pros/cons of importing folic acid as a separate chemical, to be supplied to the millers so they will mix it with KIO3.
- Assess the supply and logistics of micronutrient premix used for Corn-Soya-Blend which is managed by EIIDE.
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