TABLE 1.

Description of framework components for assessing food fortification programs¹

Framework component	Description
Assessment	Characterizing need for the intervention in a particular setting including the availability of reliable data that measure the burden of micronutrient deficiency in the population and the potential effectiveness of various interventions to reduce both inadequacies and deficiencies. Because fortification is one of the many micronutrient delivery interventions available, program managers should have data on the appropriate suite of interventions and understand how the introduction of one will affect the delivery and impact of another.
Analysis	Two elements were reviewed: technical feasibility and economic viability. Within technical feasibility, it is important to ensure characteristics of the fortification vehicle meet criteria to succeed programmatically including whether the food vehicle has wide coverage and consistent consumption; is centrally processed (contains the technology and capacity to meet standards); is compatible with the added nutrients (the addition of micronutrients does not change the appearance, color, taste, smell, and texture of the food and there is minimal micronutrient loss); and is safe to consume. It is also important to assess the comparative economics of fortification programs, especially if different vehicles and distribution mechanisms are being considered for implementation. The respective cost for fortification borne by both the public and private sectors should be explicitly stated.
Action	Focuses on national legislation, regulations, and standards as they relate to DFS formulation and end product quality, packaging, and nutritional claims. Enforcement of standards depends on the existence of external inspections, auditing, and the monitoring regime of the government as well as internal quality control and assurance by the fortifying industries. Programs must provide clear and unambiguous interpretation of the standards and legislation to all stakeholders, transparent testing, and open communication with the private sector (3).
Monitoring and evaluation	Aims to assess the compliance and performance of a fortification program and evaluate its impact on the population in terms of change in biological markers and the risk of excesses. For the purposes of this article, only monitoring is included because, at the time of writing, results of the first DFS program impact evaluation were not available. The evaluation will assess the impact of DFS in the Public Distribution System program in India's Uttar Pradesh state on the reduction of anemia and iron deficiency in women of reproductive age.

¹DFS, double-fortified salt.