An Evaluation Study of ADB Interventions on Nutrition and Food Fortification

Date: December 2004
Type: Evaluation Reports
Evaluation; Health; Poverty
Series: Special Evaluation Studies


This study explores the strengths and weaknesses of regional technical assistance (RETA) as a modality in addressing nutrition issues and initiatives. These RETAs were evaluated against their goals and objectives, and against the assessments and ratings of technical assistance completion reports.

Five developing member countries (DMCs) were selected for detailed field assessments: Bangladesh, the People's Republic of China, Indonesia, Kyrgyz Republic, and Viet Nam.

In these five countries, consultations and interviews were conducted with policymakers and stakeholders related to health and nutrition, such as the public and private sector involved in nutrition and food fortification, nongovernment organizations, nutrition institutions, academics, and the United Nations Children's Fund (UNICEF). Desk reviews were carried out for other countries.

Summary of findings

  • The study found that for some DMCs, the regional approach provided by RETA was not enough. Country-specific assistance in integrating nutrition plans into development plans and support for pilot projects are necessary.
  • Technical assistance should include a small investment component to improve effectiveness and sustainability through demonstration, such as piloting.
  • Nutrition interventions should be "owned" by the stakeholders involved by tailoring them to local social conditions through involvement of the civil society, related development partners and private sector representatives.
  • Poverty reduction and strengthening of health care systems alone cannot solve micronutrient deficiency problems. Consumers do not automatically demand micronutrient-rich foods with increased income.
  • Major constraints to implementing nutrition programs are poor access to essential services, such as health and education; declining state of health services; low resource allocations given to these sectors; and lack of poverty and nutrition data.
  • Most poor people in areas with the greatest risk of micronutrient undernutrition usually do not eat foods that can be fortified.
  • Poverty reduction and strengthening of health care systems alone cannot solve micronutrient-deficiency problems. Consumers do not necessarily demand micronutrient-rich foods.

Lessons and future assistance

  • Micronutrient fortification has to be combined with other food security and community nutrition initiatives.
  • Safety-net programs, including refugee feeding, must respond to total nutrition needs, not only calorie needs.
  • Promotional efforts on micronutrient fortification often neglect to emphasize the recurring costs of regulatory and enforcement mechanisms, testing laboratories, and training. These costs, which are not generally part of short-term assistance packages, need to be taken into account by governments to ensure that their efforts are sustainable.
  • Nutrition efforts should be appropriate to the level of nutrition risk and capacity of the countries involved and their development partners. Future nutrition efforts should consider the following points:
    • Geographic and socioeconomic baseline data on malnutrition risks are essential for developing an appropriate mix of nutrition interventions,
    • Periodic assessments of and updates on nutrition status and situation (such as childhood population nutrition, obesity, and micronutrient status) are important.
    • Monitoring and risk management capacities of participating countries need to be improved to allow increased coverage and sharper focus on delivery of fortified foods consumed by the poor.
    • Appropriate technologies need to be transferred to governments, nongovernment organizations, food industries, and consumer groups to ensure successful and sustainable fortification projects.
    • Holistic solutions for poverty reduction are needed to mitigate risks of malnutrition by supporting complementary activities on nutrition improvement and empowerment of women.


  • In designing a food fortification intervention and in calculating the cost effectiveness of the intervention, ADB should take into account costs that are often ignored, for example, costs which are related to supporting quality assurance and standardization.
  • Modified (hybrid) modality RETA/technical Assistance (TA) that allows small investment components, i.e. for piloting, appears to have potential in enhancing effectiveness and ensuring sustainable impact of ADB-financed RETA/TA. ADB should explore the possibility of this modified (hybrid) modality in ADB's ongoing effort to restructure its TA operations.
  • Findings and outputs of the nutrition-related RETAs, and identified lessons from other ADB nutrition-related operations, can provide useful inputs for a nutrition section that should be incorporated into the updated ADB Policy for the Health Sector or the integrated Health, Nutrition and Population Strategy planned for 2006.
  • ADB should continue playing the role of a catalyst in nutrition development efforts in the region.
  • RETAs should build ownership by tailoring nutrition interventions to local social conditions.
  • Holistic solutions in poverty reduction that can address and mitigate underlying risks for poor nutrition should be promoted by supporting complementary activities for improved nutrition and empowerment of women in ADB operations.


  • Basic Technical Assistance Data
  • Executive Summary
  • Map
  • I. Introduction
  • II. Trends and Issues
  • III. Inclusion of Nutrition Issues in ADB Poverty Assessments and Country Strategy and Program Updates
  • IV. ADB Assistance Associated with Nutrition
  • V. Evaluation of Regional Technical Assistance Projects on Nutrition and Food Fortification
  • VI. Strengths and Weaknesses of Regional Technical Assistance in the Area of Nutrition and Food Fortification
  • VII. Conclusion
  • Appendixes