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Evaluation of the Food Fortification Programme in Pakistan

Micronutrients deficiency is a major public health problem in Pakistan, particularly among women of reproductive age and children under five. A National Nutrition Survey carried out in 2018, showed that 34% of women of reproductive age and 49% of children under five years were iron-deficient, the prevalence of Vitamin A deficiency was 27% among women of reproductive age and 51.5% among children under five years. Large-scale food fortification or fortification of widely consumed foods is considered a medium- to long-term strategy to increase people’s regular consumption of essential nutrients, thus reducing the risk of specific micronutrient deficiencies in the population.

The Food Fortification Programme (FFP) is a £46 million programme supported by the UK Foreign, Commonwealth and Development Office (FCDO), in which wheat flour is fortified with iron, folic acid, zinc, and Vitamin B12, and edible oil/ghee with Vitamins A and D. The main objective of the programme is to contribute to improved nutrition status in Pakistan, particularly in women of reproductive age and children, through sustainably improved access to and consumption of fortified wheat flour and edible oil/ghee.

This is being done through four key technical components:

  • Technical assistance and support to government;
  • Technical assistance to wheat flour and edible oil/ghee industries;  
  • Public advocacy, media, and communications; and
  • Commissioning targeted studies to guide the implementation of the programme

Our approach

We, in partnership with the Global Alliance for Improved Nutrition (GAIN), are carrying out an independent evaluation of FFP. The primary purpose of the overall evaluation is summative: to inform FCDO and the Government of Pakistan about the programme’s progress and results, using an independent perspective.

The evaluation uses a theory-based methodological design. A theory-based approach draws on the programme’s theory of change to identify key issues the evaluation should address; empirically verifies outcomes and assumptions along three impact pathways (the private sector pathway, the public sector pathway, and the public awareness pathway); and draws conclusions about whether, and how, the programme contributed to the observed results.

The overall evaluation covers the programme period beginning in February 2016 until its end in January 2021. The timing of the evaluation has been organised around key points in the programme’s lifecycle:

  • Mid-term of the programme: a mid-term evaluation of the programme was conducted in 2019 covering the first three years of the programme’s implementation.
  • Annual reviews: an annual summary with a specific focus on value for money (VfM) reporting was completed in April 2020
  • End of the programme: the end-of-programme evaluation is being conducted just as FFP is closing down and will highlight summative findings on FFP’s relevance, effectiveness, efficiency and sustainability.

Objectives
The overall evaluation has five specific objectives:

  1. To assess whether the programme contributed to increased production of adequately fortified wheat flour and oil/ghee and improved public sector management of food fortification in Pakistan;
  2. To understand why, and how, programme interventions do/do not produce intended and unintended changes;
  3. To assess the long-term sustainability of the programme, in particular by examining factors that are likely to affect the continuation of food fortification in Pakistan;
  4. To assess the relevance of programme design and implementation; and
  5. To assess the programme’s value for money.

Outcomes

The evaluation was designed as a utilisation-focused evaluation. Findings and recommendations from the midterm evaluation have been used by FCDO and FFP to adapt programme activities as appropriate and to design new activities and approaches.

The findings of the overall evaluation are intended to provide evidence-informed lessons and suggestions for future food fortification programming and policy in Pakistan and for actions that stakeholders (such as government, development partners and civil society) can undertake to garner great commitment for fortification. The evaluation will also contribute to global evidence and good practice for effective food fortification programming and policy.