Why do we work in Maharashtra and West Bengal?

Fortify Health identified Maharashtra and West Bengal as its focus states after completing rigorous analyses of all of India's states. These analyses allowed us to identify the regions where our programme would have the highest impact. We looked specifically at: a) the severity of the problem (i.e. anaemia and NTDs) in the state and; b) the potential to scale our intervention across the state. Important indicators that factored into our analyses include:
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1. Severity of anaemia in the state;
2. Population of the state;
3. Proportion of state’s atta produced in industrialised chakki mills, i.e. in centralised mills vs. small or local chakki mills;
4. Quantity of state’s atta produced centrally;
5. Atta production volume to per capita flour consumption in the state (this data is valuable because it can indicate that 1) there is a strong production base in the state and with that the presence of centralised mills, ideal for industrial fortification, and; 2) in case of mainstreaming fortification in SNPs and government programmes, we can use the existing production capacities in the state and need not rely on neighbouring states, thus saving upon the logistics);
6. Potential for positive update of fortification at state government level.​

State-level indicators​
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Maharashtra
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Severity of the problem
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1. High anaemia prevalence in Maharashtra (MH): Anaemia affects 48% of women aged between 15 and 49 years, 54% of children who are less than six years old and 18% of men aged between 15 and 49 years (Source: NFHS 4)
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2. High rates of neural tube defects:  These are not well documented, but India-wide estimates are a staggering four per thousand births

Potential to scale up​

1. Large population: 110 million (Census 2011)
   
   
2. Relatively high proportion of atta centrally produced: 29% of atta is centrally produced (Source: FFI)
   
   
3. Quantity of centrally produced atta: 765,000 MT/year (Source: FFI)
   
   
4. Relatively high atta production volume to per capita consumption: Centralised mills produce 16,500,000 times the per capita flour consumption (Source: FFI)
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5. High daily per capita flour consumption: ~127g is above WHO threshold for effective fortification programme, which is 60g (Source: FFI)
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6. Some potential for working on fortification of wheat flour with the government in the state: There are not many other actors in this space working specifically on wheat flour fortification, and our cost-neutral approach may appeal to government programmes

West Bengal
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Severity of the problem
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1. High anaemia prevalence in West Bengal (WB): Anaemia affects 63%  of women aged between 15 and 49 years, 54% of children who are less than six years old and 17% of men  aged between 15 and 49 years (Source: NFHS 4)
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2. High rates of neural tube defects:  These are not well documented, but India-wide estimates are a staggering four per thousand births

Potential to scale up

1. Large population: 90 million (Census 2011)
   
   
2. Very high proportion of atta centrally produced: 79% of atta is centrally produced (Source: FFI)
   
   
3. Quantity of centrally produced atta: 549,900 MT/year (Source: FFI)
   
   
4. High atta production volume to per capita consumption: Centralised mills produce 30,500,000 times the per capita flour consumption (Source: FFI)
   
   
5. Adequate to relatively high daily per capita flour consumption in urban areas: ~49g is near WHO threshold for an effective fortification programme, which is 60g (Source: FFI). In urban areas of WB, it is 84g
   
   
6. High potential for government interest: Positive policy space available since WB's state government is distributing fortified atta through the public distribution system (PDS) 
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7. High existing capacity of mills means low hanging fruit: Mills producing fortified atta for the government (PDS) distribution may already be equipped and prepared to fortify open market atta once the cost barrier is removed