Our vision. In the past year, MI reached more than 500 million people in over 70 countries. Financial Supporters. is a world free of hidden hunger.

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2 The Micronutrient Initiative (MI) is the leading organization working exclusively to eliminate vitamin and mineral deficiencies in the world s most vulnerable populations. Our vision is a world free of hidden hunger. Our purpose is to ensure that the world s most vulnerable especially women and children in developing countries get the vitamins and minerals they need to survive and thrive. Our mission is to develop, implement and monitor innovative, cost-effective and sustainable solutions for hidden hunger, in partnership with others. In the past year, MI reached more than 500 million people in over 70 countries. Financial Supporters MI is grateful to the following financial supporters for their contribution to alleviating vitamin and mineral deficiencies. Together, we will end hidden hunger. Canadian International Development Agency (CIDA) Government of Bolivia Government of Indonesia, Ministry of Health Government of Pakistan, Ministry of Health The Izumi Foundation Helen Keller International UNICEF World Bank World Food Programme 1 MICRONUTRIENT INITIATIVE ANNUAL REPORT

3 MESSAGE FROM The President and Chairperson The Micronutrient Initiative and Canada: Leading the Way in the Fight against Hidden Hunger Dear Friends, In 2008, eight top economists, including five Nobel Laureates, came together in Copenhagen, Denmark, to consider economic solutions to ten of the world s biggest challenges as part of the Copenhagen Consensus Conference. They were tasked with determining what investment would have the greatest global impact in terms of cost-benefit ratio. The panel concluded that combatting malnutrition in undernourished children, specifically providing vitamin A and zinc, provides the most beneficial return on investment. Every dollar spent on vitamin A and zinc supplementation programs creates benefits worth more than $17. The third most beneficial investment was the fortification of foods such as iodizing salt and adding iron and folic acid to flour. Health Economist Dr. Sue Horton of Wilfrid Laurier University, in Waterloo, Canada, presented the compelling case at the Copenhagen Consensus about the enormous benefit of micronutrients to global health and development. She examined programs that exist today because of the commitment and funding of the Government of Canada for micronutrient nutrition programs. This sustained support has permitted MI and its partners to achieve significant results that are saving and improving lives around the world, giving Dr. Horton the evidence she needed to demonstrate the incredible impact of micronutrient interventions. Since it was established in 1992, MI has become the leading organization focused exclusively on the elimination of vitamin and mineral deficiencies in the world s most vulnerable populations. Our work earned us recognition from nutrition peers worldwide who ranked MI second after UNICEF of organizations serving the field of nutrition in a 2007 survey undertaken by the UN s Standing Committee on Nutrition. This past year, working in collaboration with a multitude of partners local, national and international, government, industrial, non-governmental and charitable we have made a significant and direct impact on those who are at risk of vitamin and mineral deficiencies. In 2007, through our vitamin A supplementation program, we helped avert an estimated 490,000 child deaths. Our salt iodization efforts enabled 283 million people to consume iodized salt. As a result of MI s direct intervention, 6 million people in Afghanistan, India, Nepal and Pakistan had access to fortified cereal flours. These are only a few examples of the results MI achieved in Through the commitment of more than 75 full time staff, numerous contractors, volunteers and partners and the guidance provided by our international Board of Directors, this past year MI programs reached more than 500 million people worldwide. In the following pages you will read more about MI s work in its areas of strategic priority child survival, child development and women s health to strengthen health, nutrition and global development programs. MI, thanks to Canadian support and strong partnerships with organizations, such as UNICEF, the World Bank and the World Food Programme, has laid the foundation for success in micronutrient programming and continues to build on this success. In the coming year, MI will continue its work to secure commitments from more funders and look to more countries and the philanthropic community to extend the reach of our programs. Thank you for your support. Kul C. Gautam Chairperson, Micronutrient Initiative Former Deputy Executive Director, UNICEF M.G. Venkatesh Mannar President, Micronutrient Initiative

4 CHILD SURVIVAL Vitamin A and zinc lower global child mortality In 2007, MI supported the delivery of more than 530 million doses of vitamin A to 233 million children through health services and systems. Through this intervention alone, MI helped avert an estimated 490,000 child deaths. Zinc in Guatemala: Achieving 50 Per Cent Coverage in a High Disease Burden Province Sets the Stage for National Scale Up With funding from the Izumi Foundation, MI implemented a zinc supplementation project in three districts of Alta Verapaz, a high disease burden province of Guatemala. MI distributed 20mg zinc tablets and provided funding for training, monitoring and supervision by project staff. Local staff were trained by the Ministry of Health on how to teach caregivers on the proper use of zinc supplements during treatment for diarrhea in children. Coverage of 50% was achieved, with better adherence to the required course by less well-educated and poorer mothers, increasing the chances of survival of their children suffering from diarrhea and increasing the time period between episodes. We are optimistic that the Government of Guatemala will now scale up zinc supplementation and become one of the first few countries with a national zinc program. In September 2007, new data was released that showed that, for the first time in recent history, there were fewer than 10 million annual child deaths. There are many factors that have led to this reduction, including improved water and sanitation facilities, massive vaccination campaigns and integrated health approaches. Vitamin A supplementation, the core of MI s work, is also a fundamental tool in this reduction in global child mortality. It is recognized as one of the most cost-effective interventions that improves children s resistance to disease and infection. In 2007, MI provided over 530 million doses of vitamin A enabling 233 million children to be reached through health services and systems. Through this intervention alone, MI helped avert an estimated 490,000 child deaths. And just as new evidence in the 1980s led to the discovery of the immune-system-boosting properties of vitamin A, the use of zinc supplementation to reduce child mortality is also becoming increasingly evident; through trials we continue to see that zinc supplementation in children during bouts of diarrhea can not only lessen the effects, it can also postpone the next episode for two to three months. In late 2006, the Government of India announced a policy change to include zinc in the treatment of diarrhea. MI is working closely with other stakeholders to ensure that policy changes are implemented at scale. We are collaborating with partners to develop step-by-step state-level scale-up guidelines and are developing proposals for an increase in zinc interventions in two Indian states. Support from the Izumi Foundation has been integral to MI s zinc programming in Guatemala. MI s support for child survival extends beyond simply the delivery of vitamin A and zinc. The importance of incorporating vitamin A and zinc supplementation programming into core health services cannot be underestimated it is a simple and cost-effective way to improve the chances of survival for millions of children. But funding for these programs is only usually available for the short term and from only a limited number of donors. As part of its five-year strategic plan, MI recognizes the importance of working with governments to ensure supplementation is part of their own health programming. Over five years, MI aims to work with 60 countries to advocate and improve capacity for institutionalizing the provision of vitamin A and/or zinc supplements to children under the age of five. In 2007 alone, MI, with the support of the MI-World Bank Senior Nutrition Specialist, worked with governments and partners in several countries to identify, mobilize and efficiently use domestic and supplementary resources to achieve their vitamin A program objectives. According to UNICEF, 10 countries now have proposals in their national budgets for vitamin A supplement procurement. 3 MICRONUTRIENT INITIATIVE ANNUAL REPORT

5 Reaching the Hard-to-Reach: Vitamin A Supplementation in Bangladesh Vitamin A supplementation programs have made incredible progress. Between 1999 and 2005, coverage with two doses of vitamin A per year in children aged 6 to 59 months increased more than fourfold and approaches 80% in the least developed countries. But often it is the most vulnerable and hardest to reach children, those arguably most in need, who are missing out on the benefits of vitamin A supplementation. A successful MI program in Bangladesh undertaken in 2007 and 2008 provides a good model for the rest of Asia, and the world, on how to reach the unreached. MI estimated that around 600,000 children in Bangladesh were not being reached with vitamin A supplementation, primarily from socio-economically vulnerable households. In August 2007, MI built on an already successful twodistrict pilot project to reach hard-to-reach children. Partnering with two NGOs, Health, Education and Economic Development (HEED) and BRAC, MI trained and deployed Vitamin A Extenders into 12 more districts, who, in turn, coordinated with government health staff and trained special volunteers. The volunteers collected data, conducted house-tohouse visits, made follow-up visits and monitored distribution. Through this outreach, not only did 360,000 formerly unreached children receive vitamin A, essential information was collected about the needs of those children so they can receive additional health and social services. Key to this success was the use of active involvement of community groups and special volunteers, including women, active in the community in monitoring, collecting data and mobilizing families with previously unreached children. Knowing Where Vitamin A Deficiency Exists is Essential for Program Delivery For countries to assess whether and to what extent vitamin A deficiency (VAD) is a public health problem in its populations, they need user-friendly and affordable means of assessing VAD prevalence. Gold standard methods such as High Pressure Liquid Chromatography (HPLC) are not always feasible in areas where tools, equipment and capacity are not available locally. Logistics for sending and cost for analyzing samples out of country are also prohibitive. MI arranged for the field testing of a rugged, portable and inexpensive fluorometer that can quantify vitamin A in serum or plasma at a tenth of the cost of HPLC. In previous years, field tests were conducted in Ethiopia and Kenya in collaboration with Oklahoma State University and the University of Washington. This year, MI supported a third trial by Helen Keller International and the Université de Ouagadougou in Burkina Faso. As the testing continues and adjustments are made to the instrument, MI hopes to determine whether the fluorometer can be used as a local, low-cost and accurate method of tracking VAD prevalence in populations at risk of vitamin A deficiency. In addition in 2007, MI continued to support work by the World Health Organization on reviewing and publishing country level data on vitamin A deficiency prevalence.

6 CHILD DEVELOPMENT Providing Micronutrients Now Earns Great Benefits in the Future In 2007, MI s contribution to Universal Salt Iodization (USI) reached more than 280 million people, protecting an estimated 4.7 million newborns from the risk of mental impairment. MI and USI in Pakistan: Expanding Iodization by Working with Small-scale Processors The Pakistan Salt Industry is predominantly made up of around 1,100 small-scale Chakki operators who use small crushers and grinders. Implementing and monitoring iodization programs with all these operators is a major logistical and regulatory challenge. As a result, up until recently, only 14% of Pakistani households consumed iodized salt. But MI developed an approach that has rapidly increased iodized salt consumption to more than 60% of households by making compliance more attractive and easier for the Chakki operators. MI s strategy is based on building strong cooperation between all partners and building government capacity in the areas of implementation and monitoring. MI formed District Coordination Committees with industry and government representatives, as well as other stakeholders. Official Focal Points were trained in monitoring and reporting techniques and awareness-raising. MI has trained more than 980 salt processors in 65 districts on iodization techniques and helped form or strengthen Salt Processors Associations. A viable and affordable potassium iodate premix supply chain is ensuring adequate supply and MI-appointed Salt Extenders throughout the country, individuals who work with smaller processors on quality control, monitoring and data collection, have become key to iodization program sustainability. While no national legislation is currently in place, municipal and territorial laws have been passed in certain areas to enforce iodization. MI s multipronged approach over several years has helped to increase iodized salt production in the country to as high as 70% in some areas. More than 38 million newborns are at risk of iodine deficiency disorders (IDD) and IDD remains a significant public health problem in more than 50 countries. Hunger, under-nutrition and infections continue to make iron deficiency anemia a critical risk factor for cognitive development in early childhood. Iron deficiency in children aged 6 to 24 months impairs the mental development of approximately 40 to 60% of the developing world s children. Hundreds of millions of children aged 6-24 months are iron deficient, as their diets fail to meet the complex demands of their growing minds and bodies. The impacts of IDD and iron deficiency anemia on the cognitive development of affected newborns and young children can put at risk the successful completion of primary schooling for millions of children. Iodizing salt has been the primary way to reach those at risk of iodine deficiency disorders and the global attempt for Universal Salt Iodization (USI) has made tremendous progress, reaching 70% of the world s households. But there are still significant gaps; in 36 countries, fewer than half of households consume iodized salt. MI is making a concerted effort to reach those still not consuming iodized salt, usually because they can t afford or access salt that is sold in formal markets. MI is working primarily with the smaller scale salt processors, such as those in Senegal and Ghana who are harvesting salt from seasonally dried lagoons and sea water, and those in Pakistan who crush rock salt, to find effective ways to iodize their salt. Working directly with producers provides the required iodine to those people who buy or barter salt in informal markets. In 2007, MI s contribution to Universal Salt Iodization (USI) reached more than 280 million people, protecting an estimated 4.7 million newborns from the risk of mental impairment. MI also makes an additional contribution to USI through its support of the Iodine Network, which focuses on advocacy at all levels to tackle the remaining gap to achieve USI. In December 2007, the Iodine Network held a side event to the UN General Assembly Special Session on Children to review the progress made in USI, renew commitments and discuss challenges. Unlike vitamin A supplementation and salt iodization, there is no single intervention that is optimal for increasing the iron intake for young children once they reach the age of six months. MI continues to explore options and mixes of approaches to decrease iron deficiency anemia and produce the greatest possible health benefits for the largest possible number of children. 5 MICRONUTRIENT INITIATIVE ANNUAL REPORT

7 Globally MI works to fortify flour with iron and other nutrients, provide multi-micronutrient powders to add to complementary foods for young children, create the right conditions for the production of double fortified salt and iron-fortified rice, as well as distribute multiple micronutrient candies in targeted areas for preschool children over three years of age. MI continues to expand its reach to deliver programs that give children the vitamins and minerals they need to develop into healthy and productive adults. COMBINING THE RIGHT TECHNOLOGY AND REVOLVING FUNDS: Building and Sustaining Salt Iodization in Senegal Senegal is an important salt producing country and exports salt throughout West Africa. Iodizing salt has been law since 1995 but less than half of what the country produces is being adequately iodized. For several years, MI has partnered with government departments, industry and producers organizations on monitoring, testing and improving iodization methods. In 2005, MI shifted its focus to work primarily with small processors where efforts to adequately iodize had been failing. The biggest obstacles were access to an adequate and quality supply of potassium iodate and an effective way to mix it into the salt. Most of these small processors belong to groupements d intérêt économique or GIE, small salt cooperatives. MI introduced a model where mobile salt iodization machines and potassium iodate were provided to the GIEs, along with training on how to use them both. GIEs use them to provide salt iodization services to salt harvesters and traders and collect fees through a cost-recovery scheme. The money is then used by the GIEs to buy more potassium iodate and maintenance for the salt iodization machines. A steady demand for the potassium iodate ensures a consistent and quality supply. MI s participative strategy development with GIE members established a sustainable and affordable procurement system. Three central purchasing units are set up for this purpose. In 2007, 19 GIEs were provided with 28 mobile salt iodization machines and 7MT of potassium iodate which contributed to the production of 89,000 MT of iodized salt in one year by small salt processors. VITA SHAKTI: Multiple Micronutrient Powders a Key Part of West Bengal s Integrated Child Development Scheme In the South 24 Parganas district of West Bengal, India Anganwadi centres, village-based childcare centres, provide children aged six months to six years and pregnant and lactating mothers with a variety of health and development activities. These centres, part of the Integrated Child Development Scheme (ICDS), provide a daily meal of Khichdi, cooked rice, lentils and oil. Although the Khichdi may be sufficient to satisfy a child s hunger, it does not provide enough nutrients to satisfy a growing child s needs. In more than 5,000 Anganwadi centres in 31 project areas, MI worked with its key government partners to fortify Khichdi with a multiple micronutrient powder called Vita Shakti, which contains vitamin A, folic acid and nearly 50% of a child s recommended daily allowance of iron. The powder is available in 500 gram packets and each packet can cater to 2000 beneficiaries. In 2007, this fortification program reached more than 1 million children. The program is now scaled up to the entire State of West Bengal and the government is now paying for the program using its own budget a good example of sustainability. A study to evaluate the feasibility of national scale-up demonstrated the efficacy of the meal in improving iron status and reducing the prevalence of iron deficiency and IDA in children aged 3-6 years. Proven effectiveness and low cost, along with high program adherence by Anganwadi cooks, make an excellent case for national scale-up.

8 FINANCIALS Summarized Statement of Net Assets As at March 31, 2008 (expressed in U.S. dollars) $ $ Assets Current assets Cash 906,144 1,096,542 Short-term investments 14,577,115 9,228,945 Amounts receivable and other current assets 772,341 3,079,974 16,255,600 13,405,461 Capital assets 680, ,994 Future income tax asset 11,118 11,337 16,947,017 14,082,792 Liabilities Current liabilities Accounts payable and accrued liabilities 980, ,257 Deferred project contracts 8,836,999 7,920,784 9,817,044 8,499,041 Lease inducement 241, ,289 10,058,431 8,739,330 Net assets 6,888,586 5,343,462 TOTAL EXPENSES ($29.3 Million) Program Expenses by Region ($27.7 million) Vitamin A Procurement and Interventions Iron Interventions Iodine Interventions Other Vitamin & Mineral Interventions 17.3 million 2.3 million 6.3 million 0.9 million Management and Administration 2.5 million Africa 6.1 million Asia 8.7 million Americas 0.3 million Global Programs 12.0 million 7 MICRONUTRIENT INITIATIVE ANNUAL REPORT

9 Summarized Statement of Activities and changes in Net Assets As at March 31, 2008 (expressed in U.S. dollars) $ $ Revenues Contracts 29,298,583 28,199,198 Other income 890, ,561 30,189,485 29,033,759 Expenses Program activities 26,837,021 25,782,887 Management and administration 2,460,843 2,422,415 Total expenses 29,297,864 28,205,302 Net revenue for the year 891, ,457 Net assets Beginning of year 5,343,462 4,470,212 6,235,083 5,298,669 Translation adjustment 653,503 44,793 Net assets End of year 6,888,586 5,343,462 Summarized Statement of Cash Flows As at March 31, 2008 (expressed in U.S. dollars) $ $ Cash flows from (used in) Operating activities Net revenue for the year 891, ,457 Items not affecting cash 149, ,707 Net change in non-cash working capital items 3,625,636 3,542,548 4,667,161 4,518,712 Investing activities (4,343,263) (4,073,527) Effect of foreign exchange on cash (514,296) (25,322) Net change in cash for the year (190,398) 419,863 Cash Beginning of year 1,096, ,679 Cash End of year 906,144 1,096,542 Non cash activity 250,736

10 WOMEN S HEALTH Healthy Women are the Foundation of Families, Communities and Countries In Afghanistan, MI provided 13,000 pregnant women in nine districts at high risk of iodine deficiency with iodized oil capsules to protect their newborns from iodine deficiency disorders. Accelerating and Expanding Food Fortification in Kenya Food fortification in industrialized countries has been credited with a reduction in deficiencies such as vitamins A and D, iodine and iron. Replicating this success in less developed countries has met with challenges including access and affordability. In 2006, MI and the Rapid Results Institute worked with the Kenya National Food Fortification Alliance, a private-public partnership, to make oil and edible fats fortified with vitamin A widely available to consumers. On March 1, 2007, the Ministry of Health announced the launch of cooking oil with a new fortification logo. Fortification of these products really took hold in 2007, giving a boost to vitamin A consumption in Kenya, with an estimated 10% of the population reached by one brand alone. Following the success of the oil rapid results process, MI, through KNFFA, brought together key actors from flour manufacturers and government with an aim to produce five multiple micronutrient fortified flour products. MI will continue to motivate other edible oil manufacturers to fortify oil with vitamin A, strengthen the Kenya Bureau of Standards product sampling and analysis and work with stakeholders to strengthen the flour fortification program. MI believes that everyone has a right to the vitamins and minerals that will provide for their full economic and social participation in society. We promote the use and benefits of micronutrients, especially for women. The benefits of having a healthy female population go beyond the individual woman; healthy women have healthy daughters and sons. MI s main area of focus in women s health, iron deficiency, is a key risk factor in the deaths of more than 100,000 mothers annually. The impact of iron deficiency on women tends to be greater than that on men, reducing women s potential to participate in social and economic activity and to escape poverty. Supplements and foods rich in or fortified with iron and folic acid can help prevent iron deficiency anemia. This past year, MI s work in women s health included food fortification and supplementation programs. Also important to women s health is the provision of adequate iodine to prevent iodine deficiency disorders. In 2007, MI programs enabled 283 million people to consume adequately iodized salt, including 132 million females, in turn protecting an estimated 4.7 million newborns from the risk of mental impairment. In Afghanistan, MI provided 13,000 pregnant women in nine districts at high risk of iodine deficiency with iodized oil capsules to protect their newborns from iodine deficiency disorders. This year also saw the wider distribution of salt fortified with both iodine and iron, an innovation spearheaded and supported by MI. Although it is currently being used in hot meal programs for school children in India, double fortified salt has the potential to be of significant benefit to women s health as it becomes more widely available. By working to improve women s health, MI is making a contribution to the Millennium Development Goals of gender equality and improving maternal health, as well as to the goals of reducing child mortality and increasing access to education. 9 MICRONUTRIENT INITIATIVE ANNUAL REPORT

11 Iron and Folic Acid Supplements in Nepal: Trained Community Health Workers Ensure High Adherence At 42%, the prevalence of anemia among pregnant women in Nepal is very high. The government s policy to address this is to provide iron and folic acid (IFA) tablets to all pregnant women on a daily basis from the second trimester to 45 days after delivery. In 2001, supplement coverage was only 23%, leading the government to modify its policy by prioritizing IFA supplementation through Female Community Health Volunteers (FCHVs). MI supported this policy shift by helping the Department of Health Services develop and launch an integrated, community-based micronutrient intervention program with the FCHVs. MI was involved in the design, development and implementation of this program which has led to high coverage and compliance of IFA supplementation and a community and government network that works closely together. National coverage of IFA supplementation increased from 23% in 2001 to 59% in 2006 and, by the end of 2007, the program was scaled up in 34 districts, thanks to MI support and in another 9 districts thanks to the support of other partners. More than 600,000 pregnant women per year now consume IFA tablets in Nepal as a result of this initiative. In addition to IFA supplementation, the program also provides postpartum vitamin A supplementation, counselling during antenatal check-ups, deworming of pregnant women, and promotion of iodized salt use, diversification of diet and rest during pregnancy. Commitment to Good Health: Young Bangladeshi Women Continue Taking Iron and Folic Acid Supplements For two years, MI supported a small pilot project with Health Promotion Limited (HPL) for testing social marketing of Iron-Folic Acid tablets in Bangladesh where 43% of adolescent girls are anemic. Through Community Maternity Practitioners, 63,000 young women were enrolled and received one iron-folic acid tablet per week. A year after the pilot project that provided free tablets ended, 23% of participants continued procuring the iron and folate tablets on their own. MI and HPL are working to develop a strategy to secure higher adherence by female adolescents to procuring tablets that aren t given for free. Ten Years of Flour Fortification: Lessons Learned in India In 1998, MI was the sole initiator of wheat flour fortification to reduce anemia among women and children in the Indian state of West Bengal. Ten years later, fortified flour is reaching 6 million beneficiaries in several additional states, including Gujarat, Andhra Pradesh and Chandigarh. In December 2007, MI sat down with key stakeholders to share lessons learned during a decade of flour fortification. Among the key findings: Evidence of impact, expert advice, and public-private collaboration are key for scale-up; champions, such as Gujurat s Chief Minister who launched the program in his state, help promote fortified flour to consumers and producers; and government support and political will play a critical role in the success of a program. MI s efforts have resulted in a significant policy change the Government of India now permits the distribution of wheat flour fortified with vitamins and minerals through the nationwide Targeted Public Distribution System, reaching millions of women and children throughout the country.

12 The Micronutrient Initiative: Progress through Partnership MI, with the encouragement of CIDA, is reaching out to other donors to come on board and help us bring these proven health interventions to millions more people around the world. MI and the World Food Programme: An Iodization Partnership MI s mission is to develop, implement and monitor sustainable solutions for hidden hunger, in partnership with others. The World Food Programme (WFP) is the United Nation s front-line agency in the global fight against hunger. It is clear that our two organizations should work closely together in projects that reach those who do not have access to adequate nutrition. MI and WFP, with funding from CIDA, developed the Iodine Initiative and created the position of Technical Expert within the WFP, which provides technical, managerial and programmatic support to iodization projects in five countries: Ghana, India, Pakistan, Senegal and Sudan. In 2007, the Iodine Initiative participated in building the technical, production and business capacity in salt iodization of approximately 10,000 small salt producers, at least 75% of whom were women. In two years, this position within the WFP has helped produce almost 336,000 metric tons of iodized salt, achieving 115% of the production target. In this partnership for salt iodization, MI brings its long-standing technical expertise and wide network, while the WFP offers strong operational presence, procurement and logistics skills and rigorous monitoring standards. Dr. Sue Horton s conclusion that every dollar invested in vitamin A and zinc interventions yields a benefit of $17 further reinforces the cost-effectiveness of MI s programming. This past year, every dollar contributed to MI core programming by our major funder, CIDA, was matched by over $4.50 from other sources. The added value of MI s programming cannot be measured only in terms of dollars MI s research, technical expertise and advocacy has far reaching results. We apply our expertise to find innovative solutions that have a large-scale impact on hidden hunger. We work with governments to design solid plans that will enable countries to attract funding for nutrition programs. We also work with the private sector, from large industry to small processors, at the multinational level as well as in countries, to motivate companies and support them in their work. Our partnerships with NGOs allow us to work with them on raising awareness and extending programs to those who are hardest to reach. In addition to its own work, MI is an integral part of many international networks and initiatives, allowing us to further extend our reach. Our leadership with global and regional bodies such as the Iodine Network, the Flour Fortification Initiative, FORTAF, NEPAD and the Ten-year Strategy for the Reduction of Vitamin and Mineral Deficiencies are an integral part of MI s mission, vision and purpose. Whether implementing a pilot project which can then be scaled-up on a national level or providing policies to governments on micronutrient deficiency control, MI s impact is far-reaching and long lasting and brings the end to hidden hunger just that much closer. The impact we have on the lives of those affected by vitamin and mineral deficiencies is not achieved in isolation. It takes the tireless dedication of our partners, including UNICEF, the World Food Programme, The World Bank, Helen Keller International, Project Healthy Children, Food Basket Foundation International, Child-to-Child Health Development Agency, Institut de Technologie Alimentaire and Association Sénégalaise de Normalisation. It takes the commitment of national, regional and local governments in the countries most affected by hidden hunger. They are our primary counterparts and provide our work with official sanction and recognition. At the field and implementation level, it takes the perseverance of hundreds of contractors and volunteers, including Salt Extenders, door-to-door data collectors and those women involved in maternal health programs. And it takes funding. Our primary funder, the Government of Canada through CIDA, has dedicated millions of dollars to saving and enhancing lives through the Micronutrient Initiative. It continues to support innovative approaches to eliminating hidden hunger. But it cannot do it alone. MI, with the encouragement of CIDA, is reaching out to other donors to come on board and help us bring these proven health interventions to millions more people around the world. MI s work is global in its reach and needs global support to increase our impact. It s one of the wisest investments donors can make. 11 MICRONUTRIENT INITIATIVE ANNUAL REPORT

13 MI and the World Bank: Advancing Micronutrient Nutrition MI works closely with the World Bank in an effort to promote and scale up micronutrient nutrition programs globally. In addition to collaborative efforts with the Bank in South Asia and Latin America, MI supports the position of Senior Nutritionist Specialist within the Bank s Africa Division, assigned to identify and implement micronutrient opportunities within the context of the Bank s projects. The specialist plays an integral role in increasing the awareness and support for nutrition in general and micronutrients in particular at the Bank. The position is one of connector, continuously trying to identify common interests between institutions and individuals in client countries, partner organizations and the Bank s own staff, advising colleagues and broadening contacts and dialogue at the country level. Thanks in part to these efforts, vitamin A supplementation coverage is now used as a performance indicator in relevant World Bank-supported projects. MI-World Bank collaborative efforts have contributed to an additional $10 million for nutrition in Burkina Faso, preparation and approval of funding for the National Nutrition Project in Ethiopia and preparatory studies for the ICDS 4 project in India. MI LEVERAGE AT THE COUNTRY LEVEL: Stories from the Field In in Ethiopia, MI was central to the design and development of the new National Nutrition Strategy and the National Nutrition Program Similar processes were supported by MI in other countries such as India, Pakistan, Nepal and Bangladesh in previous years. During this process, MI delivered strong technical input to a policy framework while advocating for the addition of key micronutrient interventions. This work has demonstrated the MI s ability to act as a lead agency to support the government and other partners on the implementation of these policies. Last year MI earned the World Bank Global Development Marketplace Award for its work with communities using small-scale water mills in Nepal to fortify local maize flour with iron, folic acid and vitamin A. This enabled MI to assist with further expansion to water mills across the Lalitpur district and also attracted the interest of Project Healthy Children (PHC) an American-based NGO focused on supporting small-scale food fortification in the developing world. Together, PHC and MI are combining their resources to improve the design and to develop a business model for the scale-up of the program. PHC has plans to spread the prize winning, locally developed water mill technology to other rural regions of the developing world. Rice fortified with iron is that much closer to being available more widely thanks to a tripartite agreement signed by MI, DSM and Bühler in India in January MI is leading a pilot rice fortification program in one of India s southern states. In order to reach the most vulnerable, the partnership will distribute the rice through public channels. Millions of low-income and malnourished children will be reached. MI s work helped Bolivia to become the first country to have a national program using sachet-based, Sprinkles -type, multiple micronutrient powders known as Chispitas. They are made available to all Bolivian children 6 to 24 months in the health services package supplied through SUMI, the national universal health plan targeting mothers and children, to reduce anemia and other micronutrient deficiencies.

14 GLOBAL Highlights: MI s work around the world Mozambique: MI supported five Mozambican salt producers with equipment and potassium iodate to help with progress toward USI in the country. Nigeria: Eighty per cent of children aged 6 to 59 months were reached twice-yearly with VAS. MI played a major role in providing technical input on the inclusion of micronutrients into the Integrated Maternal, Newborn and Child Health Strategy and the second phase of the National Economic Empowerment and Development Strategy. MI also worked with local NGOs to expand its reach. FBFI, an NGO financially and technically supported by MI, identified why some children in two states weren t being reached with vitamin A supplements through traditional delivery methods. After identifying the gaps, FBFI then set out to collaborate with other NGOs and state authorities on different strategies to reach these children. IN AFRICA In early 2008, MI relocated its Africa regional office from Johannesburg, South Africa to Dakar, Senegal. Our presence in Senegal allows MI to be at the heart of its micronutrient fortification and supplementation programming in Africa. Ethiopia: MI has worked with the Government of Ethiopia to support VAS and USI through a combination of financial, technical, and policy and program development. Today, Ethiopia is MI s largest program in Africa. For the past two years, twice-yearly coverage of children aged 6 to 59 months with vitamin A supplements has reached more than 90%. The Federal Ministry of Health, UNICEF and MI developed a comprehensive joint plan of action for salt iodization in Afar, where MI will provide a comprehensive package of support to salt processors, enhancing their capacity to adequately iodize salt. Ghana: The salt iodization units commissioned and put into service at four salt units, and the 3.3 MT of KIO3 made available to salt processors have together built local capacity for iodizing more than 35,000 MT of salt. MI supported the launch of a National USI strategy led by the Government of Ghana. Kenya: Double-fortified salt is now being considered for use in refugee camps and, with Ministry of Health approval, WFP will procure DFS for control of IDA in emergency feeding programs. With the help of MI and UNICEF, the Ministry of Health developed draft national micronutrient deficiency control guidelines. The Sahel: Vitamin A coverage was maintained at more than 90% in Burkina Faso, Mali, Niger and Senegal. While continuing to support Mali oil fortification program, MI helped start up fortification of edible oil with vitamin A in Burkina Faso and conducted oil industry assessments in Niger and Benin, the few remaining countries of the regional initiative Tache d huile that had not yet received assistance. MI helped the Government of Senegal set up a Quality Control and Quality Assurance system to ensure adequate iodization of salt produced in the country. Nineteen small salt producers organizations were equipped with mobile salt iodization units, and MI-supported organizations produced 89,000 metric tons of iodized salt over 12 months, enough for more than 20 million people living in Senegal and neighboring countries. MI is working closely with the Cellule de Lutte contre la Malnutrition, the Senegal agency in charge of the control of malnutrition, and other partners to oversee USI activities in the country. MI is one of the Government of Senegal s main partners in establishing and implementing a national food fortification plan and has helped the government to develop norms for the fortification of edible oils with vitamin A and wheat flour with iron and folic acid. Sudan: MI signed a multi-partner USI action plan with the Ministries of Health and Industry, WFP and UNICEF. All salt production sites in Sudan have been identified and mapped with detailed technical assessments for each site. Iodization equipment has been procured by MI and established in all units. 13 MICRONUTRIENT INITIATIVE ANNUAL REPORT

15 IN ASIA Afghanistan: MI opened an office in Kabul, Afghanistan in 2007 and helped to build and strengthen capacity in the Ministry of Health s Nutrition Department. MI worked on program plans for micronutrient initiatives, budget planning and interagency coordination. MI supported the fortification of wheat flour as well as increasing access to iodine through salt iodization and iodized oil capsule distribution. Bangladesh: Advocacy work by MI salt extenders, and equipment upgrading and repairs led to a doubling (from 36% to 70%) in the percentage of adequately iodized salt produced in MI-refurbished salt iodization plants. MI serves on the Nutrition Working Group, a group of donors and implementation agencies that provide technical support to the government, the Nutrition Task Force and the VAS and Salt Iodization Steering Committees under the Ministries of Health and Industries respectively. MI provided financial and technical support for the national Vitamin A supplementation campaigns, with a particular focus on special approaches for reaching the hard to reach. China: MI continued the three-year UNICEF/MI/Ministry of Health collaborative project to increase household use of iodized salt in low-coverage provinces. India: More than 45 million doses of VAS were distributed in the six MI-supported states in MI is supporting a USI Master Plan for mitigating IDD in India by 2010, with a particular focus on enhancing the iodization and quality control capacity, especially of small processors. MI supported programs to control anemia both at a population-wide level (double fortified salt, wheat flour, rice) and targeting the special needs of children (e.g. Vita-shakti, Anuka). The MI India Trust is increasing its operational capacity which will enable it to implement projects supporting VAS, salt iodization, and micronutrient provision through ICDS supplementary nutrition programs in six states. Indonesia: VAS coverage increased from 60% in February 2007 to 80% in August 2007 in low-performing areas in three Indonesian provinces. MI provided ongoing assistance to the Government of Indonesia in its strategy to accelerate USI MI, together with KFI (Indonesian Coalition Fortification) participated in the start-up of the rice fortification project. Nepal: The MI-supported intensification of Maternal and Neonatal Micronutrient Program was expanded to two new districts, now reaching a total of 34 districts. MI provided technical and financial support for the launch of a socially marketed, low-cost fortified blended complementary food targeting children aged 6 to 24 months. MI supported USI through a social marketing campaign and the expanded use of the government-endorsed two-child logo on adequately iodized salt and also launched a national wheat flour fortification program in large mills, which is complemented by the initiative to fortify the grains that are milled by the small water-mills in more remote areas. Pakistan: 29 million Pakistani children aged 6 to 59 months were reached with two doses of vitamin A supplements and more than 180,000 children aged 6 to 24 months were reached with multiple micronutrient powders, adding nutritional value to their complementary food. MI was a key partner in the national wheat flour fortification project and played a lead role in scaling up the national USI program. MI made significant advances in flour fortification implementation and sustainability in the State of Azad Jammu and Kashmir and the earthquake-affected areas of North Western Frontier Province. Sri Lanka: In 2007, MI upgraded the salt factory at Lanka Salts and refurbished the salt factory at Putallam, allowing for the production of an additional 86,000 metric tons of iodized salt per year, reaching 19 million people. in The Americas Bolivia: Coverage of Chispitas in children under 5 is now at 80% with 90% of households adhering to directions on how to use them. MI s advocacy efforts led to micronutrient malnutrition being recognized as a prominent component in the national Desnutricion Cero (Zero Malnutrition) program. MI provided further technical assistance in nutrition policy and programming interventions. Guatemala: The evidence and momentum generated by the zinc and Chispitas supplementation project in Alta Verapaz has encouraged government officials to create a National Action Plan to Control Micronutrient Malnutrition and draft standards of supplementation for Chispitas and zinc supplements. A Chispitas manual in Spanish was developed for distribution and will facilitate wider use of these multiple micronutrient supplements across Central and South America. Haiti: MI provided high-dose vitamin A capsules in sufficient quantities to meet the annual requirement of two doses for Haitian children aged 6 to 59 months. MI continues to work with WFP and local NGOs to make salt iodization feasible in the country and funded the GIS mapping of small salt processors to enable the dissemination of improved harvesting techniques and promote salt iodization.

16 About the Micronutrient Initiative Passionate about developing and implementing solutions for hidden hunger, the Micronutrient Initiative works in partnership with governments, the private sector and civil society organizations to address this serious problem that affects one third of the world s population. Governed by an inter national Board of Directors, MI works in Asia, Africa, Latin America and the Middle East and reaches people in over 70 countries. With headquarters in Ottawa, Canada, MI maintains regional offices in New Delhi, India and Dakar, Senegal that manage our country offices in Asia and Africa. Contact Information Headquarters 180 Elgin St. 10th floor Ottawa, Ontario Canada, K2P 2K3 Tel: Fax: mi@micronutrient.org Africa Regional Office Villa No. 6, Cité Alima Sipres 2 Sud Foire, Face VDN BP Fann Dakar, Senegal Tel: Fax: miafrica@micronutrient.org Asia Regional Office 11 Zamroodpur Community Centre, Kailash Colony Extension, New Delhi , India Tel: Fax: miasia@micronutrient.org Board of Directors (As at March 31, 2008): Kul C. Gautam Chairperson Former Deputy Executive Director UNICEF Francis R. Davidson Health Science Specialist USAID Robert Greenhill President Canadian International Development Agency Richard Ham Senior Vice President Brown Brothers Harriman Robert Moore Past President Kiwanis International Jean-Louis Sarbib Managing Director Wolfensohn & Co. Julian Schweitzer Director, Health, Nutrition and Population World Bank Sheila Sisulu Deputy Executive Director World Food Programme Officers and Senior Staff M.G. Venkatesh Mannar President David Porter Vice-President, Corporate Services France Bégin Senior Manager, Program Evaluation and Development Mark Fryars Director, Program Services Evelyne Guindon Director, Resource Development and Partnerships Luc Laviolette Director, MI Asia John McCullough Director, MI Africa