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Man processing wheat in Uganda
Photo Credit: SPRING

Close to a third of diets worldwide don’t have the right mix of vitamins and minerals, or micronutrients, because of limited availability and access to diverse, nutritious foods. Large-scale food fortification (LSFF) involves adding vitamins and minerals to commonly consumed staple foods and condiments during industrial processing.  However, only half of centrally processed maize flour is fortified, a third of centrally processed wheat flour, and one percent of centrally processed rice. While there’s strong evidence suggesting LSFF is a safe and effective intervention to address inadequate micronutrient intake, it has not yet effectively addressed this issue in low- and middle-income countries (LMIC). Despite mandatory fortification programs in over 135 countries, LSFF is not reaching its full potential in terms of LMICs adopting LSFF and effective implementation, monitoring, and evaluation of LSFF programs.

USAID has renewed its commitment to support food fortification as a key approach to address dietary adequacy through food systems programming. As a part of its efforts, USAID has developed an LSFF results framework and a programming guide that reflects commitments made at the 2021 UN Food Systems and Nutrition for Growth Summits. The guide, centered on a results framework, is meant to serve as a tool for Bureaus, Missions and development partners across government, the private sector and civil society to assess their specific needs and strategic opportunities, to design, implement, monitor and evaluate, and adjust large-scale food fortification programming for countries based on their local context.

To help USAID design LSFF programming, USAID Advancing Nutrition has developed a methodology to assess diets, markets, and the cost and affordability of an adequate diet using dietary and market data.

Clear and practical assessment methods and reliable data for decision-making will help USAID and partners generate and assess the evidence needed to inform LSFF programming and promote healthy and nutritious diets among target populations. The methods are used to— 

  • assess fortifiable food consumption and dietary micronutrient inadequacies
  • identify probable fortification vehicles
  • assess the market availability of potential fortifiable food vehicles and existing centrally processed fortified food vehicles
  • model the potential contributions of centrally processed fortified foods to addressing micronutrient inadequacies 
  • model the potential contribution of centrally processed fortified foods on the cost and affordability of an adequate diet.

LSFF has the potential to address inadequate dietary micronutrient intake, one of the primary causes of micronutrient malnutrition—a serious problem in LMIC. Improving LSFF programming is essential to unleashing this potential and ultimately to improve diets by reducing micronutrient inadequacies and deficiencies. 


From 2021-2023, USAID Advancing Nutrition supported the Government of Uganda in advancing the country’s food fortification program.