Menu ENN Search

ACF application to add RUTF to EML sparks lively discussion on en-net

By Tamsin Walters, en-net moderator

Contributions on en-net from Sameh Al-Awlaqi, Dr. Charulatha Banerjee, Paul Binns, Bindi Borg, Jessica Bourdaire, Chris, Suzanne Fuhrman, Michael B. Krawinkel, Paul Mabany, Emily Mates, Kalufenye Ngengele, Sonja Read, Yara Sfeir.

ACF announced on en-net (http://www.en-net.org/question/2799.aspx) their application to the WHO Expert Committee on the Selection and Use of Essential Medicines for RUTF to be accepted to the EML and requested the en-net community to get involved through writing letters in support by 24 February 2017. This announcement created a vibrant discussion on en-net (http://www.en-net.org/question/2799.aspx). Whilst many people support the initiative, several important concerns were raised. These include:

Whether the RUTF composition proposed in the submission would be binding and what might this mean for local production of RUTF and the use of different recipes; sensitivities were raised around the ‘commercialisation of malnutrition’ aspects. If the standards for manufacture change as a result of the listing, consequences such as increased difficulty and cost of production could potentially create a barrier to access rather than the intended removal of a barrier. Neither the report nor the submission document adequately addresses this issue.

Why the advocacy initiative is restricted to RUTF and does not include F75 and F100 as well? What are the potential knock-on effects for similar formulations such as Ready to Use Supplementary Foods (RUSF), other Lipid Nutrient Supplements (LNS) products, and formula milk powders?

One contributors queried whether there is sufficient evidence of the sustained success of RUTF-administration when it comes to re-introduce family foods

Whether the “essential medicines” list is the right place or should it rather be on the “essential supplies” list. A previous investigation in Ethiopia found that if the product is considered a medicine, it must be produced under pharmaceutical conditions. This would considerably increase the price of any locally produced product. It would also have to be approved for usage by the relevant country authority; a process which can take several years. There is no analysis in the submission regarding the potential cost increases and pipeline issues that may result from being listed as a medicine.

Concerns regarding the technical information contained in the submission, such as the "strength" and "therapeutic dose regimen and length of treatment" sections. Protocols are not consistent in application of these aspects and some recent studies have achieved good results with varying doses of RUTF during treatment. 

ACF responded that global action could influence countries to integrate the product into national EMLs, ultimately leading to increased prioritisation of SAM treatment with RUTF, increased budget allocation and improved inclusion within the health system and supply chain. These are critical factors to increase the availability and access to SAM treatment. The document submitted does not necessitate restricting the 'dosage' to that recommended in the submission and the composition as listed in the application is not binding. The submission proposes to add RUTF to the list as a ‘miscellaneous item’, not as a medicine.

While all contributors agree that this is an important debate, the final post called for an enhanced process of engagement on this proposal that enables the considered opinion of a wider group of stakeholders to be heard at the most senior levels. As the outcome is intended to have a global effect, it is important to understand the implications fully, across different countries, and for the conclusions to be supported by more than one organisation. 

More like this

en-net: Getting RUTF on the WHO list of Essential medicines - Call to sign a letter of support - repost

Dear all,

As you may be aware, Action Contre la Faim (ACF) has recently conducted a study on whether RUTF should be added on the Essential Medicines list (EML) of WHO...

en-net: Getting RUTF on the WHO list of Essential medicines - Call to sign a letter of support

Dear all,

As you may be aware, Action Contre la Faim (ACF) has recently conducted a study on whether RUTF should be added on the Essential Medicines list (EML) of WHO...

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: en-net update

By Tamsin Walters, en-net moderator Over the past three months (Nov 2016 to Jan 2017), 47 questions have been posted on en-net, generating 81 responses. The forum areas for...

en-net: We are Working Against "Default Definition, Aren't we?

With some health workers we may notice high number of defaulters in the CMAM program. Without consultation and follow up, this issue continues for months and years and may...

FEX: en-net update

By Tamsin Walters, en-net moderator Over the past three months, 37 questions have been posted on en-net, generating 59 responses. The forum areas for Prevention and management...

en-net: ACF is looking A CONSULTANT FOR A STUDY ON RUTF

We are looking for: A CONSULTANT FOR A STUDY ON RUTF Country: Flying (two African countries) and Paris (ACF-France HQ) Length of contract: 23 working days, starting as soon...

en-net: RUTF - SAM treatment

Standard acute malnutrition treatment protocols base RUTF dosage (no. of 92g sachets) for SAM treatment on weight of the child.
What evidence is this dosage based on,...

FEX: Using MUAC to predict and avoid negative outcomes in CMAM programmes: Work inspired by en-net

By Odei Obeng Amoako Adobea Gloria, Franck Alé, Paul Binns, Kevin Phelan, Jose Luis Álvarez Moran, Casie Tesfai and Mark Myatt. Odei Obeng Amoako Adobea Gloria...

en-net: RUTF ration at the time of discharge

Hi, I am looking for a document stating the protocol on the ration of RUTF to be given to the child at the time of discharge.

Usually, 7 sachets of RUTF is given to...

en-net: Your input into strategic review of child health programming needed urgently

Dear en-net users,

I want to alert you all to a strategic review that is being conducted by the Department of Maternal, Newborn, Child and Adolescent Health of the...

FEX: En-net update

By Tamsin Walters, en-net moderator Over the past four months1, 32 questions have been posted on en-net, generating 69 responses. Two upcoming trainings have been advertised...

en-net: Do you think your child is malnourished?

I read with great interest the latest “Access for All” about barriers of access to CMAM (Puett, C., Hauenstein Swan, S. & Guerrero, S. (2013). Access for All, Volume 2: What...

en-net: FTLC EN FASE DE ESTABILIZACION / RUTF use in stabilisation phase

Buenos días. Sabido es que el abordaje nutricional inicial en la desnutrición aguda con comorbilidad , incluye la fórmula F75 y excluye la FTLc...

en-net: RUSF and RUTF - malnourished PLW

Can plumpysup and plumpynut be used to treat acutely malnourished pregnant and lactating women?

RUSF can also be used in management of Moderate Acute Malnutrition....

FEX: En-net update

By Tamsin Walters, en-net moderator Seventeen questions were posted on en-net between May and July, eliciting 48 replies. Seven were posted in the Assessment area, four in...

en-net: Provision of monthly RUTF in hard to reach areas

I would like to seek guidance from the experts whether is it possible to provide a monthly ration of RUTF in hard to reach areas. I work in Northeast Nigeria where we screen...

FEX: WHO emergency nutrition response in South Sudan

By Marina Adrianopoli and Allan Mpairwe Marina Adrianopoli has been supporting WHO in South Sudan as Emergency Nutrition Focal Point since 2014. She has over 10 years'...

en-net: Manuscript reviewers

I am in the process of submitting my manuscript on "Caregivers' knowledge on severe acute malnutrition treatment objectives and perception of quality of care at...

FEX: Integrating nutrition products into health system supply chains: making the case

By Thomas Sorensen, Patrick Codjia, Patricia Hoorelbeke, Ed Vreeke and Ingeborg Jille-Traas Thomas Sorensen is Chief of Supply with UNICEF's Regional Office in Nairobi. He has...

Close

Reference this page

Tamsin Walters (2017). ACF application to add RUTF to EML sparks lively discussion on en-net. Field Exchange 54, February 2017. p89. www.ennonline.net/fex/54/acfrtufemldiscussion

(ENN_5523)

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.