Micronutrient deficiencies, particularly iron and vitamin A deficiencies, are considered a major public health problem in the Dominican Republic. In 2003, to respond to this problem and to take advantage of the opportunity to receive financial support from a global funding donor, the Dominican Republic developed a proposal to implement a national wheat flour and sugar fortification program to improve the micronutrient status of its population. This case study explores the country’s experience in developing the national food fortification program, offering an analysis of policy issues, stakeholders, and policy options. Food fortification has led to rapid improvements in the micronutrient status of large proportions of a population at very low cost and is generally considered highly cost-effective compared with other public health interventions. The decision to implement a food fortification program is complex, however, involving critical analysis of the evidence of need; of the types and amounts of the micronutrients to be delivered within the constraints of safety, technology, and cost; of the quality and adequacy of the fortified foods; and of trade-offs with other intervention strategies. A food fortification program as a public health intervention requires continuous multisectoral collaboration. Specifically, it calls for collaboration by three key sectors: the public sector or government, the private sector or food producers, and the civil society or consumers. Within the collaborative process, there is some natural tension between the public sector emphasis on consumer rights, equity, and health context and the private sector focus on consumer demand, commercial viability, and revenue. A balancing of public and private perspectives is thus necessary. A food fortification program must also be developed in the country-specific context, with clear designation of roles and responsibilities at the various levels of the program. Food fortification is just one of many possible public health measures, and the relative importance of other strategies must be weighed under local conditions and the specific mix of local needs. Your assignment is to consider any possible unintended consequences of the proposed national food fortification program, recommend alternative( s) to mandatory mass fortification, and identify the pros and cons of such alternative(s).