Nutrition

Childhood malnutrition is a major public health problem throughout the developing world. Recent estimates indicate that malnutrition is an underlying factor in over 50% of the 10 million deaths from preventable causes in children under the age of five each year. Additionally, the treatment of HIV-positive children is frequently complicated by high rates of acute malnutrition.

The Clinton Health Access Initiative (CHAI) is working to address this problem by increasing access to treatment for severe acute malnutrition(SAM), which affects 19 million children under five, resulting in at least 1-2 million deaths annually.

A Solution: Ready-to-use Therapeutic Food

Until recently, treatment of acute malnutrition has been limited to in-patient settings, leading to high costs and low coverage. This model changed dramatically in 2007, when the World Health Organization adopted a new and significantly more effective community-based treatment model for SAM using energy-dense ready-to-use therapeutic food (RUTF). RUTF requires no mixing, diluting or cooking; can be eaten from the package, stored and administered at home with little risk of contamination; and lasts for up to 24 months. The use of RUTF in a community-based treatment model, and has not only significantly increased coverage rates for malnutrition treatment, but has also made it possible to identify more HIV-positive children through community outreach.

CHAI’s Approach

Using CHAI’s model for changing the economies of scale in the market for drugs and diagnostics, CHAI’s nutrition team works on both the supply and demand side of the RUTF marketplace to establish an efficient and sustainable market and increase access to the product. This has required working to increase demand, increasing the supplier base, and directly lowering the cost of RUTF. This approach has already shown significant results in increasing access to RUTF and availability is expected to grow further, allowing more children to receive the malnutrition treatment they desperately need.

Increase demand

CHAI is facilitating increased demand for RUTF by working with national governments to develop treatment guidelines and budgets for the use of RUTF, and connecting these governments with available funding. In addition, CHAI is partnering with governments and international organizations such as UNICEF to implement pilots for large-scale community-based management of acute malnutrition (CMAM) treatment programs.

CHAI has also secured UNITAID funding to procure and donate RUTF to national programs in 33 countries through 2010, with the end goal of stimulating long-term demand. So far, 17 countries have ordered RUTF. In the past two years, CHAI, with UNITAID funding, has become the third largest procurer of RUTF globally, after UNICEF and Médecins Sans Frontières.

Reduce barriers to entry and lower cost of RUTF

Currently, the RUTF market is limited to only a handful of suppliers that meet the quality standards required to sell to major purchasers. CHAI sees market competition as a key enabler for effective price control and is working to accelerate the number of new suppliers in the market by assisting RUTF producers to overcome key barriers to market entry. These barriers include understanding how to meet international quality standards, navigating intellectual property issues, and securing access to start-up capital. CHAI also provides business consulting advice to both new and existing suppliers to ensure that they produce at the lowest possible cost.

To reduce cost, CHAI is working on a number of immediate interventions, including negotiating with governments to remove import taxes and duties on RUTF and its raw ingredients, catalyzing research to develop the most cost-effective formulations of RUTF, and investing the most streamlined approach towards commodity sourcing.