Menu ENN Search

The distribution systems and channels of RUTF, F100 and F75 for wasted children in Zimbabwe: A rural and urban perspective

A health centre in ZimbabweVakai Makanganise Wisdom G. Dube

Vakai is the National Nutrition Logistics Officer in the Ministry of Health and Child Care (MoHCC).

Wisdom is a Nutrition Consultant supporting the MoHCC with the management of supplies and logistics for nutrition.

Introduction

Malnutrition remains a challenge in Zimbabwe. Levels of stunting (low height for age) are 32% (State of the World’s Children Report, 2015) and wasting (low weight for height) is 3%, 1% of which is severe (Global Nutrition Report, 2014). In 2008, the Ministry of Health and Child Care (MoHCC), in collaboration with UNICEF, introduced the Community Management of Acute Malnutrition (CMAM) approach to reduce mortality and morbidity associated with acute malnutrition. The CMAM approach aims to empower communities to mobilize, identify and treat uncomplicated cases of severe acute malnutrition (SAM) in the home with Ready to Use Therapeutic Food (RUTF) while complicated SAM cases are referred to inpatient facilities for treatment with therapeutic milk (F75 and F100). Children with moderate acute malnutrition are referred to a supplementary feeding programme and other available programmes to improve household food security. The MoHCC with support from UNICEF is responsible for providing nutrition products and training health staff in providing both inpatient and outpatient services.

In 2014, the MoHCC revised its CMAM programme to integrate the management of acute malnutrition with other services such as the Integrated Management of Childhood Illnesses (IMCI); this wider programme is now termed the Integrated Management of Acute Malnutrition (IMAM). To further integrate the programme into the existing health system, at the end of 2014, nutritional products (F75, F100 and RUTF) were included on the national drug supply list and are being delivered as part of the routine delivery of health supplies.

The IMAM programme, largely funded by UNICEF, has been operating in several districts since 2008. By 2012 the programme had reached a geographical coverage of 76% and treatment coverage of 38.2% (State of Global SAM Management Coverage, 2012). The performance of the programme has not been quantified as there is limited monitoring and evaluation in place due to a lack of capacity. However, there are plans to address this in 2015/2016. Repeated informal reports suggest that disruption in the supply of nutritional products is a significant challenge and is likely to effect programme effectiveness. A study was undertaken in response to these reports to identify ways to improve product supply and distribution and is outlined below. 

Methods

The study was conducted in Harare and Marondera Districts representing examples of urban and rural IMAM programming areas. The survey area included ten clinics and two referral hospitals in Harare City Health (Municipality) and 19 clinics and one Provincial hospital in Marondera District.

A cross-sectional survey was conducted at randomly selected sites in both areas and included six health clinics in Harare and six health clinics in Marondera. Three questionnaires were designed for the following groups: 1) nurses, nutritionists and health personnel; 2) hospital store and logistics staff and 3) mothers of children admitted to the IMAM programme. Respondents were asked to rate different aspects of the current supply and distribution system of RUTF, F100 and F75 using a Likert scale (1=Very poor, 2=Poor, 3=Good, 4=Very good) and also included open-ended questions to obtain user perceptions of the current system and their suggestions for improvements.  Questionnaires were tested for reliability and validity before being administered. Participants from each group were randomly selected and each gave informed consent to participate in the survey. Personal, unstructured interviews were also conducted with head office officials with experience of the supply and distribution system in UNICEF, WFP and the MoHCC.  In total 120 interviews were administered across all sites (including questionnaire based interviews and unstructured interviews). Secondary data analysis was also conducted on documents from the MoHCC, UNICEF and WFP including records of stocks, complaints, RUTF consumption and lead times. Qualitative data was analysed manually and quantitative data was analysed using SPSS.

Results

Results showed that, whilst all health workers questioned in Harare (n = 11) were satisfied that transparency (integrity and honesty in the system) exists, some health workers in Marondera (2/5) felt that there was “no transparency”.  Interviews with MoHCC staff revealed that they felt the supply and distribution of nutritional products to be inefficient within the ministry structure. Of the health workers and logistics and supply staff questioned in Harare clinics, none 0/11 declared losses and spoilage in the receiving, stocking and distribution of nutrition products, compared to 4/22 (22%) in Marondera clinics, which may imply that rural institutions are more susceptible to losses and spoilage compared to urban institutions.

Regarding shortages of RUTF, only 2/40 (5%) respondents in Harare declared that their clinic had supply shortages compared to 26/37 (70%) of staff in Marondera clinics. In Harare, 4.5% of mothers/ caregivers declared that they did not receive the necessary supply of RUTF due to shortages compared to 68.4% in Marondera. This reveals that shortages of nutritional products are more common in rural areas.  All staff (nurses, nutritionists and dieticians) in both Harare and Marondera stated that RUTF, F100 and F75 are being given according to the new WHO guidelines. This was supported by interviews with staff of MOHCC and UN agencies. Staff at health clinics rated the effectiveness of distribution of nutritional supplements by the MoHCC and UN agencies more highly in Harare compared to Marondera (in Harare 8/11 rated distribution as “very good” and 3/11 as “good”; in Marondera all respondents, n=22, rated distribution as “good”). Results suggest that there is room for improvement in the distribution system in Marondera, and perhaps in rural areas more generally. 

Mothers and children at a health centre in ZimbabweRecommendations

Participants offered various recommendations for the improvement of the current supply-distribution chain of nutrition products, the integration of nutrition products into the national drug list and the IMAM programme in general. These include:

Conclusions

The study suggests that the supply and distribution system in Harare has a high level of transparency with limited stock-outs. However, challenges exist in the supply and distribution of products in Marondera and potentially, in other rural settings.  Recommendations have been made to improve the supply management and delivery of nutritional products in these areas; however, there is a strong need for advocacy to identify partners and raise funds to continue the IMAM programme. It is hoped that the additional monitoring and evaluation capacity in 2015 will help to standardise a system for routine monitoring and document the performance of the programme to facilitate advocacy efforts.

More like this

FEX: Letter on local v imported therapeutic milk, by Rebecca Norton and Jean-Pierre Papart (with responses by Mike Golden, Ann Ashworth, Mary Lung'aho and David Sanders)

Recently, ENN was party to an exchange of questions and discussion between field staff and 'experts' relating to decisions on the use of readymade therapeutic products versus...

FEX: Bottleneck analysis for the integrated management of acute malnutrition services in Somalia

View this article as a pdf Lisez cet article en français ici By John Ntambi, Madina Ali Abdirahman, Dorothy Nabiwemba, Pramila Ghimire, Sayed Ezatullah Majeed,...

FEX: Experiences and challenges of programming in Northern Syria

By Emma Littledike and Claire Beck Emma Littledike has been the Health and Nutrition Manager for World Vision International on the Northern Syria response since September...

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...

FEX: Sally Mugabe Children’s Hospital: A Snapshot

View this article as a pdf This article offers insight into the provision of inpatient treatment of complicated wasting at the Sally Mugabe Children's Hospital,...

FEX: Adaptations to community-based acute malnutrition treatment during the COVID-19 pandemic

View this article as a pdf Lisez cet article en français ici By Maria Wrabel, Sarah King and Heather Stobaugh Maria Wrabel is CMAM Adaptations Project Officer with...

FEX: Use of RapidPro for remote collection of nutrition data during the drought emergency and COVID-19 pandemic in Zimbabwe

This is a summary of a Field Exchange field article that was included in issue 64. The original article was authored by Nakai Munikwa, Pauline Tsikayi, Desire Rwodzi, Mara...

en-net: Quantification and Supply Plan for Management of Acute Malnutrition Products

Do we have any tools for quantification and supply planning of Management of Acute Malnutrition products i.e RUTF, F-100, F-75, RESOMAL etc? I would be glad to check if there...

FEX: Sally Mugabe Children’s Hospital: A snapshot

This is a summary of a Field Exchange field article that was included in issue 67. The original article was authored by Svitlana Austin, Molifia Manyasha-Kuona, Elizabeth...

FEX: A pragmatic approach to treating severe malnutrition in emergencies: is F75 always beneficial?

By Saskia van der Kam Saskia is the headquarters nutritionist in MSF Holland. This article describes MSF's experience of implementing a therapeutic feeding programme for...

FEX: Integrated management of acute malnutrition in Kenya including urban settings

By Valerie Sallie Wambani Valerie Wambani is Programme Manager for Food Security and Emergency Nutrition, Division of Nutrition, Ministry of Public Health and Sanitation. She...

FEX: Community management of acute malnutrition in Mozambique

By Edna Germack Possolo, Yara Lívia Novele Ngovene and Maaike Arts Edna Germack Possolo is Chief of the Nutrition Department of the Ministry of Health, Republic of Mozambique...

en-net: RUTF

Are simplistic charts for calculation of RUTF ration required per day based on weight recommended by WHO? Most of the RUTF sachets are packed in 92 gms can it be done in 100...

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: Treatment of severe malnutrition in Tanzania - a problem with ‘scoops’

By Chloe Angood Chloe Angood has an MSc in Public Health Nutrition and a BA and MA in International Development Studies. She works for the International Malnutrition Task...

FEX: Local versus industrially produced therapeutic milks in managing severe malnutrition

By A Ould Sidi Mohamed, M. Diagana, Federica Riccardi, Abimbola Lagunju, Jean-Pierre Papart and Rebecca Norton. A Ould Sidi Mohamed is a paediatrician and chief of the...

en-net: Treatment of severe acute malnutrition

What are the likely scenario to follow if you face supply rupture in the SC more so F75 and the few boxes you have had just expired. Is it advisable to use the expired milk for...

FEX: Severe acute malnutrition: an unfinished agenda in East Asia and the Pacific

By Cecilia De Bustos, Cécile Basquin and Christiane Rudert Lisez cet article en français ici Cecilia De Bustos is a nutrition and public health specialist 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: ComPAS trial in South Sudan and Kenya: Headline findings and experiences

View this article as a pdf Lisez cet article en français ici By Bethany Marron, Pamela Onyo, Eunice N Musyoki, Susan Were Adongo and Jeanette Bailey Bethany Marron is...

Close

Reference this page

Vakai Makanganise Wisdom G. Dube (). The distribution systems and channels of RUTF, F100 and F75 for wasted children in Zimbabwe: A rural and urban perspective. Nutrition Exchange 5, May 2015. p11. www.ennonline.net/nex/5/distributionsystemsrutfzim

(ENN_5129)

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.