The History of Cooking Oil Fortification in Indonesia: Government Support for the Program and Challenges

The History of Cooking Oil Fortification in Indonesia: Government Support for the Program and Challenges by Idrus Jus’at, Senior Lecturer, Esa Unggul University, Indonesia. Presented at the ReSAKSS-Asia - MIID conference "Evolving Agrifood Systems in Asia: Achieving food and nutrition security by 2030" on Oct 30-31, 2019 in Yangon, Myanmar.

1. THE HISTORY OF COOKING OIL
FORTIFICATION IN INDONESIA:
GOVERNMENT SUPPORT FOR THE
PROGRAM, AND CHALLENGES
Idrus Jus’at
1,2
Soekirman
1
1.Indonesian Coalition for Fortification, (KFI), Jakarta
2.Dept. of Nutrition, EsaUnggulUniversity, Jakarta, Indonesia

2. Nutrition ProblemsPrevalence (%)Source
Stunting 30.8
1)
MOH, 2018
Vitamin A Deficiency 12.2
2)
Sanjaya et al, 2015
Nutritional Anemia 48.9
3)
MOH, 2018
Endemic Goiter 11.1
4)
MOH, 2004
Overweight 35.4
5)
MOH, 2018
1)Children under 5 years of age
2)Children 6-59 m, school, children, female adolescent, women at reproductive (15-29 y)
3)Pregnant mothers
4)School entry pupils,
5)15+ y
Nutrition problems in Indonesia (latest data)

3. Vitamin A deficiency in Indonesia
VAD, defined as a serum retinol < 20 μg/dLor 0.7μ mol/L,
persisted as a public health problem,
affecting 5%-50% of different population sub-groups
[Wieringaet al 2003; Herman et al 2006].

4. The main cause is insufficient dietary intake of vitamin A.
The predominant diet in Indonesia is rice- and vegetable-
based, and provitamin A has low bioavailability.
[De Pee et al 1995; Campbell 2009].

5. Strategies to reduce Vitamin A Deficiency
A semi-annual vitamin A capsule (VAC) distribution program
to children 6- 59 months has been implemented in Indonesia
since 1978.
Approximately 30% of eligible children are not reached
[MOH 2008 and 2010]

6. Strategies to improve vitamin A status of infants below 6
months of age are even more challenging
[Ayah et al 2007].
Other age groups at risk for VAD are not targeted by VAC:
school age children and women of reproductive age.

7. Fortification of cooking oil with vitamin A is considered
a cost-effective, simple-to-implement strategy to cover
all segment of population
[Allen et al 2006; West & Darnton Hill 2008; Martianto
et al. 2005; Martiantoet al. 2007].
The discussion on fortification of cooking oil with
vitamin A started in late 2005.

8. Retinylpalmitateis common in vitamin A fortification,
and has been used successfully in fortifying sugar,
monosodium glutamate and wheat flour
[ArroyaveG et al 1981; Solon et al 2000]

9. Cooking oil use in Indonesia
The portion for domestic consumption is marketed using two
approaches: +30% is sold in larger quantities of branded oil in
supermarkets ( presently, much of which is voluntarily fortified
with 45 IU/g vitamin A = 13.5 mg RE/kg).
About 70% of the oil is sold as unbranded and unpackaged oil
in small neighbourhood shops/stalls (warung). Consumers
bring their own bottle to be filled from a bulk container or buy
small plastic sachets of oil
[Soekirmanet al 2012].

10. Branded cooking oilUnbranded cooking oil
Unbranded cooking oil

11. Fortified Cooking oil with vitamin A
A small demonstration project undertaken in Makassar,
South Sulawesi showed that cooking oil fortification with
vitamin A improved serum retinol concentrations of
school children and was acceptable to poor consumers.
[Martiantoet al 2009]

12. Questions asked by oil companies:
•Why should I involve in the fortification program;
•What are the benefits and risks for my business;
•Would it detriment my product: color, taste, flavor, texture;
•Who will pay the cost if it gives a negative effect to consumers;
•How much should I pay for first investment and for operational cost
(Martianto, 2009)

13. Discussion on developing of SNI
(Indonesia National Standard) on cooking
oil was on the table in 2008-2012.

14. As a prerequisite for mandatory fortification of
cooking oil with vitamin A (Ministry of Industry=MOI),
an effectiveness study was conducted in West Java
province in 2011- 12.

15. The most rewarding result of the cooking oil fortification
project is the impact on the vitamin A status of children
and women.
The VAD prevalence (serum retinol <20 mg/dl) was
reduced more than 60% for all ages, with the highest
reduction seen among school children and women of
reproductive age
(Sandjajaet al., 2015).

16. 6
5.4
0.4
1.2
2.1
0.6
18.2
15.2
9.9
10.9
10
5.3
02468101214161820
Infant 6-11 m
Children 12-23 m
Children 24-59 m
Children 5-9 y
Lactating mothers
Non Lactating women 15-29 y
Prevalence of Vitamin A deficiency (serum retinol
<20μg/dL) at baseline and endline
Base-lineEnd-line
Source: Sanjaya et al, 2015

17. Figure 1. Vitamin A content of cooking oil at different distribution levels
Source: Sanjaya et al, 2015

18. National Figure, 2018
Cooking oil consumption +9.6 kg/p/y ~ 26 g/p/d
2.4
13.5
22.3
24.8
31.5
29.1
0 5 10 15 20 25 30 35
Infant 6-11 m
Children 12-23 m
Children 24-59 m
Children 5-9 y
Lactating mothers
Non Lactating women 15-29 y
Cooking Oil Consumption g/p/d
Sanjaya et al, 2015

19. In 2012 it was agreed that all cooking oil should
contain 45 IU vitamin A/g.
SNI 7709:2012

20. August 13, 2012
A letter from MOH to MOI
Full support for mandatory fortification of cooking
oil with vitamin A to be implemented in April, 2015

21. Actually, the SNI should be imposed by the GOI in
April 1, 2015,
Political situation changed, a new government
policies also changed, new government officers came
in.
Postponed to 2016, and again postponed to 2018

22. The cooking oil industries lobbied to postpone the implementation
with the following reasons:
•Vitamin A should be imported, technology is not available;
•No guarantee vitamin A content still 45 IU at consumers’ kitchen since
the turn over of cooking oil was relatively slow;
•If the police or Indonesian FDA found the level of vitamin A in cooking
oil at consumers below 45 IU, the CEO will go to jail;
•
Should conduct a study to put back βcarotene to cooking oil;
•At the other side, this group exported fortified oil to other countries,
financial profit.
Actually those reasons were unclear and not acceptable

23. THE HOT DEBATE CONTINUED
SCIENTISTS Some OIL
COMPANIES
+ VS +
Most OIL
COMPANIES
SCIENTISTS
CONSPIRACY WITH GOVERNMENT OFFICERS

24. End of 2017
Meeting at MOI (new Minister)
The implementation of SNI 2012 postponed again

25. FEBRUARY 24, 2018
A MEETING AMONG IDI, KFI, IAKMI, PERSAGI, PDGMI 
A PRESS RELEASE OF
INDONESIAN MEDICAL ASSOCIATION
AUGUST 8, 2018
A LETTER FROM MOH TO MOI
‘FORTIFICATION OF COOKING OIL WITH VITAMIN A IS A
COST EFFECTIVE PROGRAM’

26. AUGUST 2018 –APRIL 2019
PRESIDENTIAL CAMPAIGNED INCLUDED ‘STUNTING’ ISSUES
GOVERNMENT DEVELOPMENT POLICY ON SUSTAINABLE
DEVELOPMENT GOALS (SDG’S) WHICH EXPLICITLY INCLUDES
‘FOOD FORTIFICATION’ GIVE A PRESSURE TO THE COOKING
OIL COMPANIES TO COMPLY

27. AUGUST 23, 2019
A MEETING AT THE OFFICE OF VICE PRESIDENT,
ALL PARTIES AGREED UPON IN JANUARY 2020:
* ALL COOKING OIL SHOULD BE SOLD IN A PACKAGE
* BE FORTIFIED WITH VITAMIN A or β-CAROTENE

28. SEPTEMBER 18,
A MEETING AT MINISTRY OF TRADE
•All oil distributed to consumer must be in various size of
packages (250 gr, 500 gr, 1L and 2L) (non- branded
cooking oil will not be available at the market anymore)
•
Oil fortification with vitamin A or βCarotene will be
mandated in January 1, 2020.
•Level of vitamin A 45 IU/g only at the factory not at
consumers

29. SOFT LAUNCHING
‘PACKAGE –FORTIFIED COOKING OIL WITH VITAMIN A’
WAS EXECUTED ON OCTOBER 6, 2019
IN CAR FREE DAY AREAS, JAKARTA
(MOT- MOI-MOH)

30. BUT
WITH A NEW CABINET
WE JUST CROSS OUR FINGER

31. 2007-2012
*Feasibility
*Effectiveness
* SNI
2012-2018
* IMPLEMENTATION
POSTPONED
* HOT DEBATE
* INDUSTRY OPPOSED
* STUNTING -
FORTIFICATION IN SDG’S
PROGRAMS
2019
* AUG 23. MEETING AT
VP’S OFFICE –
-SEPT 18, MEETING AT
MOT
JAN 1, 2020
*BE IN A PACKAGE
*BE FORTIFIED
2020
HOPING
THIS OPTIMISTIC
WILL BE
MATERIALIZED
THE ROAD TO A SUCCESFUL OF FORTICATION
OF VITAMIN A IN COOKING OIL, INDONESIA

32. Source: Lawrence, 2014

33. Priorities among nutritional deficiency conditions (present)
Condition Extent Social
Significance
Feasibility of
Control
EnergyProtein
Malnutrition
VitaminA
Deficiency
Nutritional
Anemias
Endemic Goiter
Obesity