Nutrition governance in Uganda’s food fortification programme: A systematic review of regulatory frameworks, institutional capacity, financing mechanisms and programme evaluation

Abstract

Uganda’s food fortification programme presents a paradox of strong legislative intent but weak implementation, with significant implications for public health and nutrition governance. Despite mandatory regulations enacted in 2005 and amended in 2011, compliance remains uneven only 30% of maize flour and 50% of cooking oil meet national fortification standards, compared to 95% for salt. This review synthesizes findings from over 220 documents spanning policy and institutional performance to assess Uganda’s fortification landscape. Key challenges include fragmented institutional mandates among UNBS, NDA, and MoH, and limited enforcement capacity with weak penalties and infrequent inspections. Comparative analysis with countries like South Africa, Bangladesh, and Vietnam reveals that clear mandates, fiscal incentives, and robust monitoring systems are critical to success. Uganda’s placement in the lower-left quadrant of the global Fortification Performance Matrix characterized by low compliance and immature policy systems underscores the need for integrated reforms. These include revising legislation, expanding fiscal incentives, strengthening institutional capacity, and aligning food vehicles with consumption data. The review concludes that without strategic investment in governance and enforcement, Uganda risks missing the full potential of food fortification to combat micronutrient malnutrition and achieve its national nutrition targets.