Sanku: from 7 million to ~70 million people in three years — what we’ve learned and what it would take to scale much further

TL;DR

• Food fortification is a well-established, highly cost-effective way to address micronutrient deficiencies, but in many countries the main constraint is implementation. Standards may already exist, while weak enforcement, fragmented milling sectors, unreliable premix supply, limited technology and quality systems, and difficult commercial incentives prevent fortification from working consistently at scale. Sanku works across these implementation barriers to make fortification more reliable and scalable.

• Sanku has grown from helping millers fortify flour consumed by around 7 million people in 2023 to around 70 million today. Over the same period, net donor cost per person has fallen from $0.55 to around $0.10 per year^[1], driven by economies of scale and a growing commercial revenue base.

• We recently commissioned Rethink Priorities (RP) to conduct a cost-effectiveness analysis of our work. The results vary substantially across countries and highlight important uncertainties, but they also identify practical opportunities to improve impact. We are already acting on the findings by improving baseline data, strengthening our evidence and M&E, and sharpening how cost-effectiveness informs expansion decisions.
• Our goal is for the ongoing cost of fortification to become fully market-funded. Commercial revenue covered around one-third of operating costs in FY26, and our current financial model projects that share to rise substantially as we scale, with Sanku reaching operating break-even around FY34. Philanthropy funds expansion, infrastructure and the other investments needed to build the system to much greater scale.
• Over the next 10 years, we plan to scale from around 70 million people reached today to around one billion people reached each year, while achieving commercial break-even. We estimate that this will require just over $100 million in additional philanthropic capital over the next eight years. Earlier commitments could bring forward country expansion, manufacturing, evidence and organisational investments, allowing us to get micronutrients to more people who need them sooner.
• The EA community has been important to Sanku’s growth, and we hope it can help shape and support the next phase. We are sharing this update partly to report back on what that support has helped build, and partly because we would value funding, advice, collaboration, introductions and interest from people who may want to work with Sanku.
• Connect at EAG. Felix will be at EAG NYC (16–18 Oct), with a side trip to the Bay Area afterwards, as well as EAGxAustralasia in Melbourne and EAG SF 2027.

TED Talk: For a short introduction to micronutrient deficiency, the case for food fortification, and Sanku’s approach, watch Sanku Co-Founder and CEO Felix Brooks-church’s TED Talk, recorded at the annual TED Conference in Vancouver in April this year.

Introduction

Sanku has grown roughly tenfold in three years while reducing the amount of philanthropy required per person reached. In 2023, we were helping millers fortify flour consumed by around 7 million people. Today, we estimate that around 70 million people consume flour fortified through Sanku-supported mills across Tanzania, Kenya and Ethiopia. Sanku is also now beginning work in Uganda, our fourth country, where operations are just getting underway. Net donor cost per person has fallen over the same period from $0.55 to around $0.10 per year.

Sanku has also changed considerably since many people in the EA community may have last encountered it. Our early Sanku model focused primarily on reaching small and medium mills that conventional large-scale fortification systems often missed. The Dosifier we invented to address that problem remains core to our work, but Sanku now works with mills of all sizes and has built local nutrient manufacturing, supply chains, field operations, quality systems, commercial revenue streams and government partnerships around the technology.

The EA community and people influenced by its ideas helped Sanku reach this stage. Sanku began as an initiative within Project Healthy Children (PHC), which was recognised by GiveWell as a Standout Charity from 2016 to 2021, when GiveWell retired the category. Sanku remains recommended by The Life You Can Save. We wanted to share what that support has helped build, what we have learned from scaling across Tanzania, Kenya and Ethiopia, and where we think the next opportunities and uncertainties lie.

The timing also feels relevant to two current discussions in global health and EA: food fortification and absorptive capacity. GiveWell is actively exploring large-scale food fortification opportunities in Africa and has described the intervention as the most promising category within its current anaemia-control search.^[2] At the same time, recent discussion in global health and in EA has focused on whether organisations with promising interventions also have the leadership, systems, recruitment capacity and concrete plans required to deploy substantially more funding well.^[3] Both questions are directly relevant to where Sanku is now.

Why fortification can be highly cost-effective

Food fortification is widely regarded as one of the most cost-effective nutrition interventions available. WHO describes it as such such, and the broader evidence base supports fortification as an effective way to address several important micronutrient deficiencies when the right food vehicle reaches the target population and fortification is delivered consistently.^[4]

Part of the advantage is that fortification can build on staple-food production and distribution channels that already reach very large populations. Micronutrients can be added during normal food processing and then consumed repeatedly through foods people already buy and eat, generally requiring little behaviour change from consumers. The nutrient inputs themselves are relatively inexpensive, and production, quality-assurance and monitoring costs can be spread across large volumes. Importantly, however, this does not mean the infrastructure required for fortification already exists or works well everywhere.

By adding essential vitamins and minerals during food processing, fortification can reduce anaemia, neural tube defects and other health consequences of micronutrient deficiency. Sanku formulates its premix to meet national fortification standards, so the nutrient mix varies by country and can include iron, zinc, vitamin A, folic acid and other B vitamins. Ethiopia’s national standard notably excludes iron, so Sanku’s Ethiopian premix does too.

Where fortification falls short in practice

Fortification policy often runs ahead of effective implementation. Many countries have mandatory standards, but that does not mean all flour is fortified, or fortified consistently to the required standard. Small and medium mills may lack dosing equipment, affordable and reliable premix, packaging, training and technical support. Larger mills generally have more capacity, but can still face problems with premix quality, testing, supply reliability, monitoring, enforcement and compliance.

The implementation gap is also economic. Fortification adds costs for millers, while consumers often have limited willingness or ability to pay more for fortified flour than for an otherwise similar unfortified product. A model that depends only on requiring mills to absorb those costs can therefore be difficult to sustain, particularly in competitive and fragmented markets. Effective fortification needs to address the commercial incentives alongside the technical and regulatory constraints.

From a small-mill technology to a broader fortification system

Sanku was created to address a persistent gap in existing fortification systems: reaching the small and medium mills that many families rely on for their staple flour. Conventional fortification programmes have generally been better suited to large industrial producers, leaving many smaller mills without the equipment, affordable premix, training and support needed to fortify consistently. Sanku’s early work focused on making fortification practical in those mills.

Sanku invented the Dosifier to make fortification practical in these smaller mills. The Dosifier is a patented, IoT-enabled machine fitted directly to milling equipment, with nearly 1,800 units now deployed. It automatically adds a precise amount of nutrient premix as flour is produced and can transmit operating data through a cellular connection, allowing Sanku to monitor use remotely and identify when a mill needs maintenance, restocking or support.

One of our earliest scaling lessons was that the technology was only one part of making fortification work reliably. Working directly with millers made clear that consistent fortification also depended on reliable premix supply, training, maintenance, quality assurance, field support and an enabling regulatory environment. Sanku gradually built these capabilities around the Dosifier, including supply chains, field teams, monitoring systems, commercial operations and government partnerships.

Building local nutrient premix production was one of the most important additions to Sanku’s model. Sanku built and operates Eastern Africa’s first dedicated nutrient premix factory in Tanzania, which opened in 2024. Before this, millers depended heavily on imported premix, with high costs, long lead times and greater supply risk. Local production has significantly reduced costs and lead times while giving Sanku greater control over quality and supply. A second factory in Addis Ababa has now been completed and premix production will officially start in November this year.

Sanku now works across the milling sector, from last-mile village mills to large producers. The small and medium mills Sanku was created to reach remain central to the model, but larger producers can reach millions of people and use the same nutrient-production, supply-chain and quality assurance (QA) infrastructure. Working across the sector has contributed substantially to Sanku’s recent growth and commercial revenue.

Working with larger mills also makes additionality harder to estimate. At many small mills, RP assumes fortification without Sanku is negligible. Large mills are more likely to fortify to some degree anyway, and the available evidence on what would happen without Sanku is limited. Our reach figure therefore measures the number of people estimated to consume flour fortified through Sanku-supported systems; it is not itself a measure of counterfactual impact. We return to this below because improving the evidence on this question is now one of our priorities.

Three lessons from scaling across Tanzania, Kenya and Ethiopia

Scaling across Tanzania, Kenya and Ethiopia has given us a clearer view of what it takes to grow effectively. Three lessons in particular are shaping our next phase.

1. Build with millers, and adapt to the market

Working directly with millers has shaped both our technology and our wider operating model. More than 500 millers were involved in the R&D and field testing of the Dosifier, providing feedback based on real operating conditions. In Tanzania, millers told us that reducing what they spent on flour bags would make it easier to absorb the cost of fortification. Sanku now produces and sells millions of bags each month, with the commercial margin helping offset the cost of premix.

Local market conditions also shape which parts of the model work in each country. We initially expected the bag model to work in Kenya too, but it did not prove viable there. It is currently used only in Tanzania, although we think it may be well suited to Uganda. Our approach is therefore to take the underlying capabilities — technology, nutrient production, QA, monitoring, supply chains and field operations — into new countries while adapting how they are deployed locally.

2. Establish stronger baselines before entering new markets

Stronger baseline data should improve both how we design new-country work and how credibly we estimate its additional impact. In Kenya and Ethiopia, we did not establish as strong a baseline before scaling as we would now want, which makes it harder to estimate retrospectively what would have happened without Sanku. This is particularly important when working with larger mills, where some fortification may already be happening. Before entering new markets, we now want a clearer picture of existing fortification and compliance, the structure of the milling sector and the main implementation gaps. The RP work discussed below reinforced the importance of doing this earlier.

3. Recruitment and People Ops can become a constraint on scale

Our experience aligns with two recent arguments about absorptive capacity: Jack Lewars’s Donors should push animal welfare and global health charities to have more robust scaling plans and Berke Çelik and Tony Senanayake’s People Operations Gap in Global Health. Both argue, in different ways, that scaling effectively requires investing in management, recruitment and people systems before they become bottlenecks.

As Sanku expanded from one country to three, recruitment and People Ops sometimes constrained how quickly we could build the teams we needed. Limited funding certainty has also sometimes made it harder to recruit continuously and move quickly when particularly strong candidates became available. For the next phase, we want to invest more now in recruitment and People Ops, alongside leadership and other enabling functions, so that we can hire, develop and retain the people needed to scale effectively.

What we learned from the Rethink Priorities analysis — and how we’re acting on it

Alongside what we had learned from scaling, we wanted an independent cost-effectiveness analysis to identify where our current work could improve, understand the most important evidence gaps and uncertainties, and better inform future country expansion. We therefore commissioned and funded Rethink Priorities (RP) to analyse our work in Tanzania, Kenya and Ethiopia. RP is responsible for the report and its conclusions. The full report is available here.

RP estimates substantial differences in impact and cost-effectiveness across the three countries covered by the analysis. It reports its cost-per-DALY estimates both gross of revenue and net of revenue; in the net figures, revenue from Sanku’s commercial sales is used to offset programme costs.

RP’s multiple of GiveWell’s benchmark combines its modelled health and economic benefits. See the full report for the methodology and assumptions.

The difference between the gross and net figures also shows the role of Sanku’s commercial model: revenue from miller sales reduces the philanthropic cost of generating a given level of modelled impact. All else equal, as commercial revenue covers a larger share of operating costs over time, the net-of-revenue cost per DALY should fall further.

Part of the difference across countries reflects the maturity and scale of Sanku’s operations. RP says Tanzania’s stronger result reflects “both the maturity and scale of the Tanzanian operation” as well as its relatively low-compliance environment. Tanzania is our oldest and largest operation, while Kenya and Ethiopia are newer markets that have not yet reached the same scale. RP’s cost analysis also finds that fixed country-presence costs are particularly important at low operating scale. These factors are only part of the explanation, however; country context and counterfactual assumptions also have a major effect on the results.

Tanzania has the strongest results. RP estimates Tanzania at ~4.6× GiveWell’s benchmark today, which it describes as “commendably close” to GiveWell’s current 6× funding bar. It estimates ~8.2× if all Sanku-supported flour in Tanzania switched to using the iron compound NaFeEDTA, which would put Tanzania above that bar. We plan to make the switch only for our small maize mills, and subject to securing the necessary funding, so the full 8.2× should be read as an upper bound rather than an estimate of the planned transition.

Kenya and Ethiopia score lower for different reasons. In Kenya, much of Sanku’s work is with industrial-scale mills, which RP assumes would already fortify to some degree without Sanku. That assumed counterfactual fortification comes with substantial uncertainty, and RP says cost-effectiveness would be significantly higher under plausible alternative values. RP also models a higher-counterfactual scenario in which these estimates fall substantially. In Ethiopia, the national fortification standard excludes iron. Iron accounts for more than 90% of the DALYs RP estimates Sanku averts in Tanzania and Kenya, and all of RP’s modelled economic-benefit channels are linked to iron. Ethiopia therefore has no modelled wage gains. At the same time, commercial revenue reduces Ethiopia’s estimated cost per DALY from $1,918 gross to $617 net of revenue, and RP notes that its revenue model may be particularly sustainable.

There is substantial uncertainty around the estimates, and RP notes that its assumptions may “either upwardly or downwardly bias our headline results”. It identifies three particularly important uncertainties: counterfactual fortification, the estimated effects of fortification on relative risks for key health outcomes, and the assumption of a linear dose-response relationship between nutrient intake and health impacts.

For example, one potential upward bias is the assumption that any additional malaria risk from increased iron intake is negligible. RP notes that the evidence is mixed and cites a 2026 Cochrane review finding little to no effect of iron supplementation on clinical malaria overall. Given the relatively low malaria prevalence in the three countries analysed, RP does not model this effect, but notes that this may slightly overstate estimated health benefits. In the other direction, the report excludes possible indirect effects from Sanku’s work on fortification among non-partner mills, which may bias its estimate of total benefits downwards.

How we’re acting on the findings

• Switching Tanzania’s small maize mills back to NaFeEDTA, subject to funding. The iron compound we use today fully meets Tanzania’s national fortification standard and continues to deliver meaningful health benefits. But RP’s analysis finds that switching to the more bioavailable NaFeEDTA could increase those benefits substantially and improve cost-effectiveness. We used NaFeEDTA previously and stepped back from it following stockouts, logistical challenges and cost pressures. We are targeting small maize mills because maize’s higher phytate content makes the benefit of the more bioavailable iron compound particularly important there, and because the switch is operationally feasible for these mills; large wheat mills are not currently a practical target. Subject to securing funding for the additional cost, we plan to make the switch.
• Improving baseline data before entering new markets. As discussed above, we want a clearer picture of existing fortification and compliance before scaling, particularly where larger mills may already be fortifying to some degree but the quality and consistency of that fortification are uncertain. This should help us design around the actual implementation gaps and estimate our counterfactual impact more credibly, while also giving us a better basis for assessing any indirect impact on fortification beyond Sanku partner mills.
• Sharpening how cost-effectiveness informs expansion decisions. Cost-effectiveness is already an important input into how we assess opportunities to scale. The RP analysis gives us a stronger basis for using it alongside evidence, operational feasibility and country context when deciding where and how to expand.

Why scale further, and what it will take

Micronutrient deficiencies remain a major global health burden, while many countries still lack the infrastructure and systems needed to fortify staple foods reliably at scale. Uganda is now Sanku’s fourth country, with operations just getting underway. Over roughly the next decade, we aim to grow to around ten countries and reach approximately one billion people annually.

What it will take

1. Just over $100 million in additional philanthropic capital over roughly the next eight years, with earlier commitments enabling faster scaling. We estimate that getting from here to around one billion people reached annually and commercial break-even will require just over $100 million in additional philanthropic capital. This would fund country expansion, manufacturing capacity, R&D, evidence generation and the organisational investments needed to support that growth. Earlier commitments could allow us to enter countries in parallel, build manufacturing capacity sooner, strengthen evidence and research, and recruit key teams earlier — ultimately getting micronutrients to more people who need them sooner.

We have already seen how large, flexible capital can change Sanku’s growth trajectory. In 2021, MacKenzie Scott gave Sanku an unrestricted $8 million grant, at a time when our annual budget was around $2 million. We used it to expand into Kenya and Ethiopia, strengthen leadership and operations, and build Eastern Africa’s first dedicated nutrient premix factory in Tanzania.

2. Organisational capacity to support expansion into more countries. Expanding into several more countries will require another step-change in Sanku’s organisational capacity.  Priorities include recruitment and People Ops, country and regional leadership, finance and information systems, manufacturing management, and research and M&E. We are already investing in these areas so that our teams and systems can keep pace with expansion.

How you can help Sanku scale

Advice and collaboration. We would value input from people with experience scaling high-impact organisations, particularly on country expansion and prioritisation, evidence and M&E, organisational design, recruitment and People Ops, manufacturing and supply chains. Introductions to people or organisations with relevant expertise would also be very helpful.

Funding: Our near-term funding picture has two parts:

• Around $7 million to close the FY27 funding gap. Our approved FY27 plan assumes around $13 million in philanthropic funding, of which approximately $6 million has been secured.
• Roughly $8 million in additional room for more funding. Beyond the approved FY27 plan, we have identified projects and workstreams that could begin in FY27 if further funding were available, including the planned switch to NaFeEDTA for small maize mills in Tanzania, accelerated country expansion, manufacturing, evidence generation, and building the team, recruitment and People Ops capacity needed to scale effectively.
• You can donate to Sanku via Every.org. Tax-effective giving options are also available through The Life You Can Save in Australia and the UK, Rethink Charity in Canada and High Impact Athletes in New Zealand. For more information about ways to give, visit sanku.com/donate

People. We expect to recruit significantly as Sanku grows, including across country and regional leadership, research and M&E, manufacturing and other enabling functions. If you might be interested in working with Sanku in future, or know people we should speak to, we would be glad to hear from you.

See the work first-hand. We welcome people interested in visiting Sanku’s work in East Africa, including partner mills and our premix factories in Tanzania and Ethiopia.

Contact: Felix Brooks-church, Co-Founder & CEO ([email protected]), or Rickard Vikström, Senior Advisor to CEO ([email protected]).

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Conflict of interest disclosure: This post was drafted by Rickard Vikström, Senior Advisor to the CEO, and Felix Brooks-church, CEO of Sanku. Rickard also serves on the board of The Life You Can Save Australia, which recommends Sanku. He is not involved in decisions about which organisations The Life You Can Save recommends.

AI disclosure: LLMs were used to support drafting, editing, research and fact-checking.

1. ^{^}

    Net donor cost per person measures the annual philanthropic subsidy required to sustain Sanku’s current fortification operations, after commercial revenue, divided by the number of people reached. It includes direct implementation, field operations and supply-chain costs, but excludes costs primarily associated with future growth or broader organisational investment. Based on our current projections, this measure falls from about $0.06 in FY27 to $0.02 in FY30. Commercial revenue, which covered around one-third of operating costs in FY26, is one reason the donor subsidy falls as Sanku scales. We also track an all-in donor cost per person, which includes all Sanku expenditure, net of revenue, including expansion, manufacturing, R&D, research and other organisation-wide investments. This falls from about $0.17 to $0.08 over the same period. The donor-cost figures cited in this post are based on Sanku’s internal financial data and projections; RP did not audit them and they are not results from the RP report.

2. ^{^}

    GiveWell, “GiveWell Launches RFIs for Targeted Vaccination Outreach in Three Countries and Anemia Control Programs in Africa,” 2 March 2026.

3. ^{^}

    See, for example, Jack Lewars, “Donors should push animal welfare and global health charities to have more robust scaling plans,” EA Forum, August 2026; and Berke Çelik and Tony Senanayake, “People Operations Gap in Global Health,” EA Forum, September 2026.

^{^}

World Health Organization, “Food fortification,” 14 February 2022.
https://www.who.int/news-room/questions-and-answers/item/food-fortification

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