Introduction
UNICEF’s Africa Regional Workshop on Universal Salt Iodization (USI) and Food Fortification was held in Accra, Ghana, from October 28-30, 2024. The event brought together government officials, development partners, international organizations, and public health experts to discuss critical issues related to large-scale food fortification (LSFF) and iodine nutrition in Africa. Participants included representatives from ECOWAS, WAHO, ECHA, USAID, the Bill & Melinda Gates Foundation, the CDC, AFFORD, and TechnoServe.
This three-day workshop sought to reaffirm the importance of salt iodization, integrate USI into food fortification frameworks, and explore innovative, sustainable strategies to improve nutrition security in Africa.
Picture of workshop participants
Day 1: Understanding the Global Landscape of Food Fortification and Salt Iodization
The first day of the workshop provided an overview of the global and regional context of LSFF and USI, highlighting lessons learned, challenges, and successes. Key topics discussed included:
- Food Fortification as a Key Food Systems Intervention: Experts underscored fortification as a vital public health strategy to combat micronutrient deficiencies, particularly iodine deficiency disorders (IDDs). The impact of fortifying staple foods like flour, salt, and oil was discussed, showcasing evidence of reductions in anemia, goiter, and neural tube defects.
- The Evolution and Future of Universal Salt Iodization (USI): Speakers highlighted that while 128 countries have salt iodization programs, many African nations are struggling to maintain consistent quality and enforcement of iodization regulations.
- Challenges in Achieving Full Coverage: While global iodine deficiency rates have declined, access to adequately iodized salt remains inconsistent, particularly in low-resource settings. Countries were urged to strengthen governance structures, integrate fortification into food safety policies, and increase private sector engagement.
The day ended with interactive working groups, where participants discussed regional bottlenecks and possible strategies for strengthening food fortification programs.
Day 2: Emerging Trends and Strategies for Strengthening Food Fortification
On the second day, discussions focused on emerging threats to food fortification programs, governance issues, and the role of the private sector. Key takeaways included:
- Sentinel Site Methodology for Monitoring Iodine Status: Experts proposed simplified, cost-effective approaches for tracking iodine deficiency trends, allowing for better real-time adjustments in fortification programs.
- Private Sector Engagement in Salt Iodization: Discussions centered on the role of the food industry in fortification compliance. Participants emphasized that LSFF programs must engage manufacturers, ensuring that industry leaders see food fortification as a priority rather than a regulatory burden.
- Regulatory Challenges and Policy Gaps: Many countries lack effective monitoring frameworks for iodized salt and fortified foods. The workshop emphasized enhancing data-driven decision-making to improve oversight and accountability.
In the afternoon, country representatives shared case studies on national fortification programs, outlining both successes and obstacles in maintaining high iodization coverage.
Day 3: Country Reports, Lessons Learned, and the Way Forward
The final day was dedicated to regional and country-level reflections, including:
- Challenges Facing USI Programs: Countries such as Nigeria, Ghana, and Tanzania highlighted key barriers to effective salt iodization, including poor consumer awareness, inadequate funding, and weak enforcement mechanisms.
- Improving Coordination Across Sectors: Experts recommended merging national fortification alliances with food safety bodies to ensure better regulatory enforcement and sustainability.
- Data-Driven Approaches for Food Fortification: Participants stressed the need for regular iodine status monitoring and the use of innovative tools for tracking fortification compliance.
- The Future of Salt Iodization and LSFF: The workshop concluded with a call to action to integrate USI and food fortification into broader nutrition policies, ensuring sustained political and financial commitment.
Key Discussions and Highlights
Strengthening Food Fortification within Food Systems
Food fortification remains a critical public health intervention in Africa, ensuring access to essential micronutrients. A central message from the workshop emphasized the need for strong regulatory frameworks and policies to ensure food safety, nutrition, and affordability. Countries were encouraged to integrate fortification into national food security strategies, ensuring food fortification aligns with broader food safety and quality measures.
The Urgency of Sustaining Universal Salt Iodization (USI)
Although USI programs have been largely successful, they face several vulnerabilities. Many countries lack updated data on median urinary iodine concentration (MUIC), leading to outdated assumptions. Over 60% of African countries have insufficient or outdated iodine status data, making it difficult to monitor progress effectively.
Utilizing Sentinel Methods to Improve Iodine Status Tracking
Given the challenges of conducting nationally representative iodine surveys, sentinel surveillance methods were proposed as a more cost-effective and timely alternative. These methods focus on:
- Identifying geographical areas with low household iodized salt (HHIS) coverage.
- Using small-scale but frequent sample collection to track iodine levels.
- Comparing subpopulations at higher risk of iodine deficiency with those adequately covered.
A significant insight from the workshop was that household iodized salt usage does not always correlate with iodine status. This discrepancy highlights the need for improved monitoring of iodine consumption from processed foods.
Challenges in Large-Scale Food Fortification (LSFF)
Despite its potential, LSFF faces several barriers:
- Regulatory Weaknesses – Enforcement of food fortification policies remains weak in many countries.
- Resource Limitations – Many national quality control laboratories lack the capacity to monitor fortified food compliance.
- Inconsistent Standards – Many countries still use food intake data from the 1990s, making some fortification targets outdated.
- Coordination Gaps – Weak collaboration between public and private sector actors hinders effective implementation.
Lessons from Regional Programs
Several successful regional initiatives were highlighted during the workshop:
- ECOWAS and WAHO’s Harmonization Efforts – Strengthening food fortification regulations and regional trade policies.
- Nigeria’s Salt Iodization Model – Demonstrating the importance of a multi-sectoral task force that involves both government agencies and private sector stakeholders.
- Ghana’s Renewed USI Strategy – Prioritizing industry training, consumer education, and stricter regulatory enforcement.
Future Directions and Commitments
The workshop concluded with key commitments from stakeholders:
- Strengthening regulatory enforcement for LSFF and USI.
- Ensuring sustainable financing to reduce donor dependency.
- Enhancing regional collaboration to address cross-border trade and supply chain issues.
- Improving data collection using cost-effective monitoring methods such as sentinel surveys.
The Africa Regional Workshop underscored the importance of sustaining USI programs, strengthening food fortification policies, and improving data-driven decision-making. With renewed focus and stronger collaboration between governments, private sector actors, and development partners, Africa can make significant strides in addressing micronutrient deficiencies and improving public health outcomes.
