Industry compliance in national micronutrient food fortification programmes: A systematic review with lessons for Uganda

Abstract

Large-scale food fortification remains a critical strategy for reducing micronutrient deficiencies, but its effectiveness depends on whether industries consistently fortify foods to standard. This review synthesizes global evidence on industry compliance across major food vehicles, including salt, wheat flour, maize flour, edible oil, sugar, and condiments, and applies the findings to Uganda’s programme improvement agenda. A systematic review was conducted using peer-reviewed articles, programme evaluations, policy analyses, survey reports, and Uganda-specific regulatory documents retrieved from academic databases and institutional sources. The synthesis incorporated evidence from Africa, Asia, and Latin America, including Uganda and comparator settings such as Senegal, Tanzania, Kenya, Nigeria, Malawi, Mozambique, Bangladesh, India, Indonesia, Chile, and Costa Rica. The evidence shows that compliance is shaped by regulatory clarity, market structure, premix and equipment costs, quality assurance, external monitoring, political commitment, and credible enforcement. Compliance tends to be stronger in centralized industries such as wheat flour and edible oil, but weaker in fragmented maize markets and among smaller millers. Across countries, a persistent fortification quality gap remains between foods that are legally covered or reportedly fortified and foods that are adequately fortified at production, market, and household levels. Uganda reflects this broader pattern: although the legal and policy framework is established, compliance remains uneven across food vehicles, with stronger adherence among salt, wheat flour, and edible oil producers than among maize millers. Therefore, Uganda should strengthen production-based verification, improve inter-agency coordination, adopt differentiated compliance strategies by processor scale and vehicle, and invest in practical monitoring and enforcement systems that make sustained compliance feasible.