Fortify Health began in 2017 as a question: How can we fill a gap to cost effectively improve public health at scale? In searching for the answer to this question, Fortify Health’s founders looked at the burden of anaemia globally and the evidence around programmes that tackle anaemia. We were particularly struck not only by the depth of the anaemia issue in India, but also by the evidence, scalability and cost-effectiveness of one particular solution to address anaemia: wheat flour fortification. Thanks to existing, rigorous evidence on fortification and many conversations with experts in the nutrition field, we decided that wheat flour fortification in India was a clear, important starting point as the answer to our initial question.
In 2018 Fortify Health secured its first Incubation Grant of $300,000 from GiveWell and hired a dedicated team in India. We set up our two flagship programmes to enable wheat flour fortification at-scale, starting in Maharashtra and West Bengal, and received a follow-up grant from GiveWell of ~$1 million in 2019, allowing us to expand our programmes to Madhya Pradesh. Each of our flagship programmes focused, and still focuses, on a different public channel: a) supporting mills to fortify wheat flour for the open market, and b) collaborating with state governments and quasi-governmental organisations to fortify the wheat flour they provide to their beneficiaries. Between 2018 and 2021, in spite of challenges posed by the pandemic, we were able to demonstrate proof of concept of our programmes.
In 2022, Fortify Health received an ~$8.2 million grant from GiveWell to support scaling up of our flagship programmes. This led to the second phase of Fortify Health’s journey, as the team focused on developing the foundations for scale. This involved hiring department leads for each of the programmatic areas (open market, partnerships and M&E) and putting systems and processes in places that would support rapid growth.
At present (late 2023), our team is mobilising for the next phase of Fortify Health’s scale up. We currently have partnerships with more than 50 mills and a team of more than 50 people, working in 6 states: Maharashtra, West Bengal, Madhya Pradesh, Telangana, Karnataka, and Delhi NCR. We've also signed implementation partnerships with Feeding India and Food Fortification Initiative, with the aim of amplifying our impact. We've signed academic partnerships with with the Indian Institute of Technology (IIT) Delhi and CFTRI, to generate evidence about food fortification at scale.
Over the next two years, our strategy is to drive impact through scale. By the end of this period, we aim to be a market maker in the states we operate in by increasing the demand for fortified wheat flour across millers, government partners and eventually beneficiaries. The aim is that over time, we will create a positive feedback loop where other organisations and stakeholders are incentivised to invest their own capital in fortifying wheat flour. This feedback loop will help drive the long-term strategic goal of fostering sustainability of the intervention.
Fortify Health’s founding team received initial funding and mentoring from Charity Science (now Charity Entrepreneurship), with the aim to set up an iron and folic acid fortification initiative that may eventually meet the highest standards of cost-effectiveness, and deliver significant impact with limited resources. Joey Savoie, Co-founder and Director of Strategy at Charity Entrepreneurship, was especially supportive of Fortify Health’s work in these early years.