Menu ENN Search

Local and centralised therapeutic food production

Smaller scale production of RUTF in Malawi

Summary of editorial1

An editorial in 'Maternal Health and Nutrition' explores some of the issues around local versus centralised control of food production for treatment of severe acute malnutrition. The discussion draws parallels with debates that raged over 20 years ago about home (local) production of oral rehydration salts (ORS) versus the supply of pre-produced (centralised) ORS packages.

The editorial starts with the premise that with community-based management of acute malnutrition (CMAM) scaling up nationally and internationally, the demand for Ready to use Therapeutic Food (RUTF) is rising and the challenges for local production are changing. While small-scale RUTF production can easily supply local feeding programmes, considerable changes are necessary to provide for a country's or a region's needs. Factors such as quality control become increasingly important. Not only must the final product be quality monitored, but also some international manufacturing standards must be provided for, e.g. being able to trace each batch of raw ingredient to the original supplier. Such standards are, of course, expensive and require a level of capital and logistics that are not always straight forward in the countries where severe acute malnutrition (SAM) is prevalent. Thus, while delivery is decentralising over time, there is increasing pressure to centralise and control production.

The editorial raises a number of questions:

Smaller scale production of RUTF in Malawi

A search of the literature found no published study comparing in detail the costs and benefits of smaller-scale local versus larger scale foreign production. Certainly, no study available has attempted to value the broader social impact of local versus international production. The editors also ask what lessons can be learnt from the ORS experience. According to the 2003 Lancet Child Survival series, population coverage of ORS therapy was only 20%, yet universal coverage could have prevented 1,477,000 child deaths per year (15% of the total of child deaths). Clearly, the centralised mode of ORS production and distribution did not achieve the necessary coverage -perhaps there may have been a different outcome with greater emphasis on local home-made ORS.

It is asserted that if the argument for RUTF production were to be made on economic merits alone, even in the absence of 'hard evidence', it is probable that local production would be the preferred option. Centralised production affords economies of scale that place downward pressure on prices. However, if production takes place mostly in high-income countries, much of that benefit risks being eroded by transporting the finished product to low and middle income countries and the higher cost of production inputs (land, labour, capital and entrepreneurship). Furthermore, a simple 'price based' argument neglects the broader economic benefits of producing some quantity in low income countries, i.e. increased employment levels bring a greater opportunity to gain skills and earn a cash wage.

The editorial concludes that public health strategies are not, and should not be, based on economic principles alone, even principles with a possible developmental bias. Quality standards and the need for a ready and substantial supply of RUTF at short notice are just two reasons why this debate cannot be entirely polarised. Current realities must be recognised. The optimal solution is likely to lie in a balance that evolves with time, with the nexus of production shifting gradually south. This will require both support and vision by the international community, local governments and participating organisations in SAM-affected countries.

Show footnotes

1Skordis-Worrall. J and Kerac. M (2009). Localised or centralised control of food production for treating severe acute malnutrition: echoes of a past child survival revolution? Maternal and Child Health (2009), vol 5, pp 195-198

More like this

FEX: Local versus offshore costs of RUTF and LNS

Summary of Research1 Segrè J, Liu G and Komrska J. (2016) Local versus offshore production of ready-to-use therapeutic foods and small quantity lipid-based nutrient...

FEX: Value chain approach to increase production of RUTF/CSB

By Yuki Isogai Yuki Isogai is Operations Officer for the Ethiopia Nutrition Project/Private Sector Development Specialist with the World Bank. She has a wide range of...

FEX: Trials and tribulations of local RUTF producer in Haiti

By Steve Taviner Steve is Development Director of Meds & Food for Kids (MFK) based in St Louis, USA. Before taking on this role, he spent the last 15 months overseeing MFK...

FEX: Letter on commercial production of RUTF, by Michel Lescanne

Dear Editor The widespread application of CTC (Community-based Therapeutic Care) in emergencies and stable situations raises the question of the availability of Ready to Use...

FEX: Community care: addressing the management of severe malnutrition

Summary of published paper1 Bedessa TFC, Ethiopia (May 2000) The long-held traditional approach to treating severely malnourished individuals in emergencies is challenged in...

FEX: Ready-to-use therapeutic food and the WHO list of essential medicines

By Aurélie du Châtelet, Anne-Dominique Israel, Elise Rodriguez, Wisdom Dube, Laetitia Battisti, Magali Garcia, Coline Morin and Natalie Sessions. Aurélie...

FEX: Technical and Management issues within CTC (Special Supplement 2)

4.1 CTC from Scratch - Tear Fund in South Sudan By Ed Walker (Tearfund) Beneficiaries collecting their general ration in South Sudan. Tearfund has been working in Northern...

FEX: Local Production of RUTF (Special Supplement 2)

By Dr Peter Fellows Introduction The development of RUTF has been an important factor facilitating the development of CTC. However at the moment, most RUTF is made in France,...

FEX: Postscript: Local purchase of ingredients for RUTF in developing countries?

By Steve Collins Steve Collins is a medical doctor with a doctorate in nutrition. He has been working in humanitarianism since 1985 and is the originator of the CTC/CMAM model...

FEX: From the editor

Rabia, seven months, with her mother at an OTP Aim and structure of this special issue This Field Exchange special issue on ‘Lessons for the scale up of Community-based...

FEX: Impact of local RUTF manufacture on farmers’ incomes in Malawi

By Marta Ortiz Nunez Marta Ortiz Nunez is a recent Masters graduate in International Development. In 2006 she co-founded a Spanish non-governmental organization focusing on...

FEX: Increasing Access to Ready-to-use Therapeutic Foods (RUTF)

By Jan Komrska Jan Komrska is a pharmacist working at UNICEF Supply Division leading Nutrition unit and responsible for procurement of products related to nutrition...

FEX: Series of letters on ENN conflict of interest, by Noreen Prenderville, Mark Myatt, Steve Collins and Mark Manary

A word from ENN In Issue 23 of Field Exchange, a letter by Mary Lunga'ho, Lida Lhotska and Rebecca Norton was published highlighting concerns they had regarding potential ENN...

FEX: Valid Nutrition

Name Valid Nutrition Address Cuibín Farm, Derry Duff, Bantry, Co. Cork, Ireland Chief Executive Officer: Derek Staveley Phone +353 86 7809541 Chair of Trustees...

en-net: Setting up RUTF Production Facility in Africa - Questions

I have been doing research on SAM and the role of RUTF since past few months. I spoke with members from Unicef and they mentioned that their focus will be on procuring RUTF...

FEX: Regional CMAM meeting in Ethiopia 2011

In collaboration with the Government of Ethiopia and in consultation with national and international agencies, the Emergency Nutrition Network (ENN) is planning a three day...

FEX: Local Production of Processed complementary food: World Food Programme experience

Summary of published review Blended food is often used in supplementary feeding programmes. Fango, Ethiopia, 2000. Pieternella Pieterse (Concern) Pieter Dijkhuizen has been a...

FEX: Study on hygiene practices and market chain of milk and milk products in Somalia

By Susan Momanyi and Andreas Jenet Susan Momanyi joined Vétérinaires Sans Frontières (VSF) as a nutritionist in 2009 and has been working with fresh food vouchers in South...

FEX: Scaling up ORS and zinc treatment for diarrhoea reduces mortality

Summary of editorial1 With most countries still not on track to achieve millennium development goal 4 - that of reducing child mortality by two thirds from 1990-2015, a recent...

FEX: From the Editor

A key thematic focus of this issue of Field Exchange is Humanitarian Reform. There have been many reviews and evaluations concerning the level of progress made since the reform...

Close

Reference this page

Skordis-Worrall. J and Kerac. M (2009). Local and centralised therapeutic food production. Field Exchange 37, November 2009. p7. www.ennonline.net/fex/37/local

(ENN_3961)

Close

Download to a citation manager

The below files can be imported into your preferred reference management tool, most tools will allow you to manually import the RIS file. Endnote may required a specific filter file to be used.