Why ship-in nutrition-rich foods from abroad to treat malnourished children when they can be made locally, at a fraction of the cost?
Nutrition expert Steve Collins believes it is not only a waste of money for aid agencies to import ready-to-use therapeutic foods (RUTF) manufactured in Europe or the USA, but also a lost opportunity to develop an added-value local manufacturing capacity.
Collins points out that developing countries such as Botswana and India have developed their own RUTF but many aid agencies, including the UN, prefer to buy branded RUTF manufactured abroad such as Plumpy'nut - a lipid paste made from peanuts and milk powder and fortified with vitamins and minerals proven to be effective in treating severe acute malnutrition.
Part of the reason for this was that similar peanut pastes produced in poor countries do not meet the stringent UN requirements on aflatoxin content, which it has set at a maximum of five parts per billion (ppb).
“You can sit in the US and eat food with aflatoxin content of 20 ppb, but if a peanut paste made in Malawi has an aflatoxin content of even 10 ppb it will not be approved by the UN agencies [for use in an intervention programme run by them],” said Collins, addressing a panel discussion at the World Conference on Humanitarian Studies at Tufts University, Medford, USA, on the opportunities in scaling up nutrient-rich food aid.
As a result the cost of product manufacture goes up. Ingredients such as milk powder also add to the costs.
Aflatoxin is produced by a species of fungus which contaminates the peanuts after they are harvested and can affect the liver and even cause cancer. Moderate levels of aflatoxin can moderate a child’s growth. International food standards allow for a maximum of 10-20 ppb of aflatoxin.
NGOs are experimenting with other locally available protein sources such as chickpea to bring the costs of RUTF down.
Jean Herve Bradol, the former president of Médecins Sans Frontières, suggested during the discussion that perhaps a headline-grabbing campaign, similar to those which led to the eradication of small-pox and the manufacture and use of generic antiretrovirals to treat HIV, was needed to create a momentum to tackle malnutrition.
These efforts would help to find a way towards cheaper and more sustainable alternatives.
Maria Kasparian, who heads Edesia, an NGO set up in the USA by Nutriset, the manufacturers of Plumpy’nut, said they were collaborating with partners in developing countries to produce RUTF locally.
Effective distribution networks
Mark Moore, a manufacturer of RUTF in the USA who was trying to set up a plant in Rwanda, said local manufacturers would not be able to handle the distribution networks required to scale-up operations.
He suggested partnerships with private sector multinationals, which have good distribution networks even in remote corners of Africa, such as soft drinks manufacturers.
Bradol pointed out that multinationals are not altruistic and the product would still be unaffordable for the poor. “Price will always be a factor,” he said.
In a commentary in the February 2011 edition of the journal of the World Public Health Nutrition Association, Michael Latham of Cornell University’s nutritional sciences division, and Urban Jonsson, the former chief of nutrition at the UN Children’s Fund (UNICEF), and others caution that the debate around commercial RUTF as a “miracle” cure could distract attention from “rational and sustainable policies and programmes” such as the promotion of breastfeeding.
“As things now are, 'scaled-up' delivery of commercial or foreign 'packages' of nutrition interventions is being aggressively promoted, inside the UN, and outside by major governments, their agencies, foundations, and other big NGOs. Branded, commercial RUTF is now part of these packages," the authors noted.
“In contrast, the promotion of community-based and local government-supported empowerment of people living in poverty to claim their human rights to good nutrition, which is the rational way forward, is neglected.”
Even severe acute malnutrition can be treated with local foods. The authors noted India’s refusal to allow UNICEF to import commercial RUTFs in 2009. About 49 percent of the world’s malnourished children live in India. The authors said: “For decades good Indian hospitals have successfully treated severe acute malnutrition with local foods, comparable to the sugar, casein, oil and milk commonly used in Africa.”
This article was produced by IRIN News while it was part of the United Nations Office for the Coordination of Humanitarian Affairs. Please send queries on copyright or liability to the UN. For more information: https://shop.un.org/rights-permissions
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