MONEV

FORTIFIKASI
GIZI
HIYA ALFI RAHMAH, S.Gz., M.P.H

Disampaikan pada MK FortifikasiGizi

Pertemuan 13-14

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CONTENT

01 02 03 04 05

CRITICAL MONITORING REGULATORY HOUSEHOLD IMPACT

CHALLENGES & MONITORING MONEV. EVALUATION
INFORTIF. EVALUATION
PROGRAMME
 1.
CRITICAL CHALLENGES IN
FORTIFICATION
PROGRAMME
Industry Level, Government Level, Consumer & RetailLevel,
Humanitarian Level

(Luthringer et al., 2015)

 01 GOVERNMENT
INDUSTRY LEVEL LEVEL

02
04 👪
HUMANITARIAN
LEVEL 03 CONSUMER &
RETAIL LEVEL

CRITICAL CHALLENGES IN FORTIFICATION

INDUSTRY LEVEL 01
 Poor quality or unsafeinputs
 Poor processing procedures andexpertise
 Improper packaging and handling
 Purposeful underfortification

CRITICAL CHALLENGES IN FORTIFICATION

 GOVERNMENT
LEVEL
02
 Rendahnya prioritas dan kapasitas penegakkanhukum
 Standar yang minimal
 Limited funding
 Terbatasnya personel untuk penegakkanhokum
 Korupsi di antara personelinspeksi
 Kapasitas buruh/ pekerja yang rendah

CRITICAL CHALLENGES IN FORTIFICATION

  Produk kadaluarsa
 Terbatasnya tes untuk menentukan kualitasproduk
 Ketidaksesuaian label produk makanan dengan kontennya
 Rendahnya permintaan konsumen akan produkfortifikasi

03 CONSUMER &
RETAIL LEVEL

CRITICAL CHALLENGES IN FORTIFICATION

  Bervariasinya standar untuk produk dan supplier
 Terbatasnya kapasitas pengembangan produk lokal
 Permintaan produk fortifikasi yang tidakterduga

04 👪
HUMANITARIAN
LEVEL

CRITICAL CHALLENGES IN FORTIFICATION

 2. MONITORING &
EVALUATION
Regulatory Monitoring, Household/ Individual
Monitoring Evaluation

(Allen et al.,2006)
2. MONITORING EVALUASI FORTIFIKASI GIZI
Tujuan utama  Mengkaji:

 kualitas
▪ derajat ▪ Decision making:
keberhasilan 1.Continue
implemen
tasi
fortifikasi gizi ▪ nutrition 2.Expand
pada targeted goals 3.Replicate
fortifikasi
household dan
gizi 4. End
individu

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MONITORING
 continuous collection, review and use ofinformation on
programme implementation activities,
for the purpose of identifying problems, such as noncompliance,
and informing corrective actions so as to fulfil statedobjectives

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EVALUATION
 the assessment of the effectiveness and the impact of a programme
on the targetpopulation.

In the case of food fortification, evaluations are undertaken with the

aim of providing evidence that the programme is indeed reaching
its nutritional goals,
o this an increase in the intake of a fortified food or of specific
nutrients, or
o an improvement in the nutritional status, health or functional
outcomes of the target population

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 3. REGULATORY
MONITORING
Internal Monitoring, External Monitoring,
Commercial Monitoring

(Allen et al.,2006)
 REGULATORY MONITORING
Aim:
to ensure that the fortified food meet the nutrient, quality and safety standards set
prior to programmeimplementation

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1. REGULATORY MONITORING (internal monitoring)
Aim:
to monitor the quality control and quality assurance (QC/QA) practices
conducted by producers, importers andpackers
QC :kontrolmutu/kualitas
QA :jaminan mutu/kualitas HACCP

QACCP.
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 QA QualityAssurance
Kegiatan yang terencana dan
sistematik yang dibutuhkan
untuk memastikan produk/
pelayanan memenuhi standar
kualitas
(FAO, 1996)
QC Quality Control
Implementasi teknis pelaksanaan
bagaimana yang diisyaratkan QA bisa
terpenuhi dengan melakukan berbagai
penilaian, observasi dsb..
QC bagian dari QA
(FAO, 1996) 18
 1. R A W MATERIAL CONTROL
standard specifications must
be adopted for all ingredients
which must then be inspected to
ensure conformity

2. PROCESS CONTROL
all chemical, physical and
microbiological hazards
as well as quality factors
must be identified,critical
control points (CCP)
must be established,
monitored and a record
made ofany action taken;
3. FINISHED PRODUCT
CONTROL
this requires that the finished
product be unadulterated
(tidak dipalsukan) , properly
labelled and that theintegrity
of the finished be protected
from the environment.

REQUIRED COMPONENTS OF A Q A (FAO, 1996)

The Following Steps In The Implementation Of A Quality Assurance
Programme In The Production Of A Fortified Food (Wilson ,1991)

Determinat ion
Product
of critical and
1 safety 3 5 7 Documentat ion
quality control
assessment of QA system
points QA audit
Recall Feedback
Product Product
system mechanism
specificat ions analysis
2 4 6 8

(FAO, 1996)
The Following Steps…

01 Product Specifications
All specifications for fortificants, food vehicle and
any other ingredients must be documented as
well as acceptable deviations of these. These
include specification of particle size, colour,
potency, level of fortification as well as any
other requirement which might be deemed
necessary

1 3 5 7

2 4 6 8
The Following Steps…

02 Product Safety Assessment

This involves an assessment of
microbiological, chemical and
physical hazards for allingredients
and the finishedproduct

1 3 5 7

2 4 6 8
The Following Steps…

03 Product Analysis
Sampling and testing proceduresfor
all ingredients and the finished
product must be explicitlystated

1 3 5 7

2 4 6 8
The Following Steps…

Determination of critical and

04 quality control points
Kontrol yang tidak memadai dapat menyebabkan risiko
kesehatan yang tidak dapat diterima atau berdampak
buruk thd kualitas produk. Sistem control dan kegiatan
untuk mengkontrol kualitas harus selalu
didokumentasikan.

1 3 5 7

2 4 6 8
The Following Steps…

05 Recall System
A mechanism must be put in place
whereby product can be recalled if such
action becomesnecessary

1 3 5 7

2 4 6 8
The Following Steps…

QA Audit
06
Periodic checks are necessary to verify
that the QA system is effective and
product quality is maintained up to the
ultimate consumer

1 3 5 7

2 4 6 8
The Following Steps…

07 Feedback mechanism
Response toconsumers and other
relevant groups to correct any
deficiencies discovered.

1 3 5 7

2 4 6 8
The Following Steps…

Documentation of QAsystem
08 Details of the QA programme used in
the production of the fortified food
must be readily available to relevant
individuals andorganizations

1 3 5 7

2 4 6 8
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 2. REGULATORY MONITORING (external monitoring)
Aim:
to inspect and audit activities carried out at production centres (factories and
packers) and importation custom sites
Conducted by: Memastikan kepatuhan pelaksanaan fortifikasi
Governmental authorities sesuai dengan standar dan peraturan yangtelah
ditetapkan.
Activities:
 checking the performance and the records of the producers’ quality assurance procedures
(technical auditing);
 confirming that the technical specifications for the product are being met at factories,
packaging sites and points of entry into the country (inspection).
2. REGULATORY MONITORING (external monitoring)

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2. REGULATORY MONITORING (external monitoring)

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external monitoring
Industrialized Country
External monitoring dilakukan
1x setahun melalui food labels
(mengetahui kandungan
micronutrient dalam bahan
makanan) dilakukan di tingkat
market
Developing Country
External monitoring dilakukan di
tingkat industri karena sulitnya
untuk melacak dan menarik kembali
produk yang sudah beredar di
pasaran
2. REGULATORY MONITORING (commercialmonitoring)
 similar to external monitoring in that it is generally the responsibility of the
government and its purpose is to verify that the fortified products comply with
standards, but is conducted at the level of retail stores
 4. HOUSEHOLD MONEV
Assessment of provision, utilization and coverageof
fortification programme

(Allen et al.,2006)
 4. HOUSEHOLD MONITORING

Aim:
to assess whether or not a programme is providing appropriately fortified products
in sufficient amounts and at affordable prices to the targeted population.

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 1.PROVISION(ketentuan)
Untuk memastikan individu/ rumah tangga target memiliki
akses thd makanan terfortifikasi dan memastikan bahwa
makanan terfortifikasi memenuhi standar kualitas

2. UTILIZATION 3. COVERAGE (cakupan)

(pemanfaatan) Untuk memastikan individu/
Untuk memastikan individu/ rumah tangga target
rumah tangga target membeli mengkonsumsi makanan
dan mengkonsumsi makanan terfortifikasi dalam jumlah dan
terfortifikasi frekuensi yang tepat
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5. IMPACT EVALUATION
Assessment of adequacy, plausability, probabilityof
fortification programme

(Allen et al.,2006)
 5. IMPACT EVALUATION
Aim:
 The main purpose of evaluating any intervention is to determine whether or
not it is reaching its overall goals.
 In the case of food fortification programmes, the primary objective is to improve
the nutritional status of the target population.
Activities:
 Research
Conducted by:
 Independent research group or internationalagencies

Impartially Funding
(ketidakberpihakan) (Pembiayaan)

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IMPACT EVALUATION T Y P E
Depends on:
 Specific purpose of theevaluation
 Availability of resources
PROBABILITY
Untuk menilai apakahprogram
fortifikasi bertanggung jawab thd
pengurangan prevalensi defisiensi zat
gizi tertentudengan tingkat
keparcayaan yang tinggi
ADEQUACY
untuk menilai apakah prevalensi
defisiensi mikronutrien tertentuberada
pada atau di bawah tingkat yang
ditentukan sebelumnya
PLAUSABILITY
Untuk menilai bahwafortifikasi
makanan yang dilakukan
masuk akal untuk mengubah
status gizi
Adequacy Evaluation

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Plausability Evaluation

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Probability Evaluation

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 REFERENCE…

Allen, L. et al. (2006) ‘Guidelines On Food Fortification with Micronutrients’. France: WHO & FAO,
p. 376.
FAO (1996) Food Fortification: Technology and Quality Control. Rome. Available at:
http://www.fao.org/docrep/W2840E/w2840e00.htm#Contents.
Luthringer, C. L. et al. (2015)‘Regulatory Monitoring of Fortified Foods: Identifying Barriers and
Good Practices’, Global Health: Science and Practice, 3(3), pp. 446–461. doi: 10.9745/GHSP-D-15-
00171.

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Aim Higher
Thank you!

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