Overcoming RUTF storage challenges in Tigray, northern Ethiopia
Lulseged Tolla, Charlotte Walford and Pankaj Kumar, Concern Worldwide Ethiopia
Lulseged Tolla has been working with Concern Worldwide since 2011 on CMAM and IYCF programmes.
Pankaj Kumar has over four years experience with Concern Worldwide in Ethiopia and has worked in a number of other African countries.
Charlotte Walford has been working with Concern Worldwide Ethiopia since September 2012 supporting their CMAM and IYCF programmes.
The 2011 Ethiopian Demographic and Health Survey showed that nationally, 9.7% of children under five years old were wasted and 44.4% stunted. In Tigray Region specifically, levels of undernutrition in this age group are higher than average: 10.3% wasted and 51.4% stunted. A number of large-scale emergency and development programmes are being implemented by the Government and key stakeholders (NGOs & the United Nations) to support improved health and nutrition.
Since 2007, Concern Worldwide Ethiopia has been providing support to Tigray Region in northern Ethiopia for the treatment of acute malnutrition through an outpatient therapeutic care programme (OTP), which has now been integrated into service delivery at health facilities. In August 2009, with funding from the World Bank, the interventions were scaled-up in five woredas (districts) with high rates of acute malnutrition.
During the past four years of implementing OTP activities, it was observed that most health posts (HPs) had problems with the proper storage of RUTF and other OTP supplies. Concern Worldwide and the local government conducted an assessment of the storage situation to identify the barriers to proper storage and to develop practical and affordable solutions.
A qualitative assessment consisting of 1) key informant interviews with Health Extension Workers (HEWs) and health professionals (health extension programme supervisors and woreda health office nutrition experts) and 2) team observation was undertaken in 72 HPs in five woredas in the region.
Interviews and observation in the HPs identified two main issues with the storage of RUTF:
- Open storage. Most health posts consist of one room, as they were intended to only provide preventive health activities. Although recently constructed, there is often no appropriate storage space for RUTF and other OTP supplies. RUTF was rarely stored in a self-contained locked unit or separate room, as recommended for other medical supplies. RUTF was kept in a storeroom with other medical and non-medical supplies in 42% of HPs. Of the remaining HPs, 37% stored RUTF on the floor or on a bench, 14% in either locked or unlocked cabinets, whilst 7% stored RUTF in the examination room, in bags or at nearby health centres.
- Rodents and insects. Rats were a problem in 50% of HPs and small insects (weevils) in 4%. This was largely due to the presence of openings/holes around the edges of windows, doors or under the roof.
To improve storage at the HPs, a number of changes were put in place:
- An appropriate, lockable metal cabinet to store RUTF and other OTP supplies was designed, manufactured and delivered to 90 HPs. These cabinets were initially installed in 2012 and follow up during monitoring visit revealed 100% utilization. HEWs reported no loss of RUTF due to rodents, insects or theft with the use of the cabinets. The cabinets are projected to have a shelf life of more than 15 years. The cost of one metal cabinet is approximately 450 USD.
- Health Post staff were also trained on how best to store RUTF, medications, equipment and supplies for OTP outreach, based on Ethiopia’s national protocol for the management of SAM.
To improve storage conditions of RUTF more widely in Ethiopia, the following activities are recommended:
- Develop clear policy guidelines regarding RUTF handling and storage in collaboration with government
- Provide awareness for HEWs, supervisors and woreda focal person on the importance of RUTF as a medical supply, rather than a food item, to ensure proper storage status
- HEWs should receive training (pre-service or in-service) on logistics management
- Adequate, locked storage facilities for RUTF should be provided as standard either in the form of a locked cabinet or as an additional, locked room. Including such a cabinet for nutritional supplies is now considered best practice by development partners and the Government of Ethiopia as a part of National Nutrition Programme.
For more information, please contact Pankaj Kumar, email@example.com.
More like this
FEX: Health system strengthening through material support to health posts in Ethiopia
By Charlotte Walford, Lulseged Tolla and Pankaj Kumar Charlotte Walford has been working with Concern Worldwide in Ethiopia since September 2012 supporting their CMAM and IYCF...
NEX: Enlisting donkeys to improve nutrition support in rural Ethiopia
Abduljebar Osman Abdulahi and Selamawit Yilma Abduljebar Osman Abdulahi is the Project Nutrition Coordinator for International Medical Corps in Oromia region East Hararghe...
FEX: CMAM rollout in Ethiopia: the ‘way in’ to scale up nutrition
By Dr Ferew Lemma, Dr Tewoldeberhan Daniel, Dr Habtamu Fekadu and Emily Mates Dr Ferew Lemma is Senior Nutrition Advisor to the State Minister (Programs), Federal Ministry of...
FEX: Integrating Infant and Young Child Feeding and the Productive Safety Net Programme in Ethiopia
By Adèle Fox Adèle Fox is currently based in Concern Worldwide Burundi office as Maternal, Newborn and Child Health Trainee. Adèle completed a Masters in Public Health from...
FEX: Integrating OTP into routine health services CONCERN’s experiences
By Emily Mates Emily Mates is a public health professional with a focus in nutrition. She recently left Concern Worldwide, Ethiopia where she worked for many years in...
FEX: An analysis of Fresh Food Voucher Programme piloted in Ethiopia
By Pankaj Kumar, Anne Marie Mayer and Elizabeth Molloy Pankaj Kumar has been working in Ethiopia with Concern Worldwide since 2010. Previously he has worked in Zambia,...
FEX: The Cost of Selective Feeding (Special Supplement 2)
by Rose Caldwell & Alistair Hallam (Valid International) The aim of this paper is to present the cost per beneficiary of CTC and discuss aspects of these costs, underlying...
FEX: World Vision programme for severe acute malnutrition in SNNPR
By Dr. Sisay Sinamo and Dr. Gedion Tefera Dr Sisay Sinamo is Coordinator for the Health and Nutrition Coordination Unit with World Vision Ethiopia. A medical graduate from...
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: Decentralisation and scale up of outpatient management of SAM in Ethiopia (2008-2010)
By Sylvie Chamois Sylvie Chamois has been a Nutrition specialist with UNICEF Ethiopia and Burundi for the past 9 years. Before joining UNICEF, she spent 6 years working as a...
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...
en-net: Seeking consultant - Final Evaluation of CMAM project, Tigray, Ethiopia (World Bank funded)
1. Project Summary The Piloting Community-Based Management of Acute Malnutrition Project, funded by World Bank-Japanese Social Development Fund and implemented by Concern...
FEX: The roll out of IMAM in Kenya’s urban slums
By Koki Kyalo, Claire Orengo, Regine Kopplow Koki Kyalo is the Urban Nutrition Programme Manager at Concern Worldwide, Kenya. She has worked with Concern Worldwide for five...
FEX: Creating an enabling policy environment for effective CMAM implementation in Malawi
By Mr Sylvester Kathumba Mr Sylvester Kathumba is Principal Nutritionist with the Ministry of Health, Malawi. This article was authored by Mr Sylvester Kathumba with policy...
FEX: Effectiveness of Integrated Outpatient Care of Severe Acute Malnutrition in Ethiopia
By Martin Eklund and Tsinuel Girma Martin Eklund holds an MSc in Clinical Nutrition from the University of Copenhagen. His specialisation is community-based management of...
FEX: Barriers to access for SAM treatment services in Pakistan and Ethiopia: a comparative qualitative analysis
Summary of research1 Location: Ethiopia and Pakistan What we know: Community-based sensitisation can overcome lack of awareness that impedes access to SAM treatment, but is...
FEX: Timely expansion of nutrition development activities in repose to an acute flooding emergency in Malawi
By Natasha Lelijveld, Elizabeth Molloy, Jennifer Weiss, Gwyneth Hogley Cotes Natasha Lelijveld has recently completed a nutrition research project in Blantyre, Malawi and is...
FEX: From the editor
Ethiopia is a diverse country where a significant proportion of the population live on or below the poverty line, where food insecurity is widespread and rates of acute...
FEX: CMAM scale-up: experience from Ethiopia’s El Niño response 2016
By Christoph Andert, Zeine Muzeiyn, Hatty Barthorp and Sinead O'Mahony Lisez cet article en français ici Christoph Andert is a Nutrition Advisor at GOAL's HQ. For the...
NEX: Improving nutrition behaviours through a Care Group Model project in Somalia
Halima Hillowis a nutritionist working in Somalia with World Concern. She has a degree in Food and Nutrition from the Ahfad University of Women in Sudan and is currently...
Reference this page
Lulseged Tolla, Charlotte Walford and Pankaj Kumar (). Overcoming RUTF storage challenges in Tigray, northern Ethiopia. Nutrition Exchange 4, July 2014. p16. www.ennonline.net/nex/4/en/overcoming