Saving lives with RUTF (ready-to-use therapeutic food)
UNICEF has been procuring almost 80 per cent of the world’s RUTF, a life-saving essential supply that treats severe wasting in children under 5 years old.
RUTF is the abbreviation for “ready-to-use therapeutic food”, a life-saving essential supply item that treats severe wasting in children under 5 years old. Wasting is defined as low weight-for-height and happens when someone has not had enough food or food of adequate quality. If not appropriately treated, wasting in children is associated with a higher risk of death.
RUTF paste was invented by a French research scientist, André Briend, 25 years ago and became commercially available in the early 2000s. It is made from powdered milk, peanuts, butter, vegetable oil, sugar, and a mix of vitamins and minerals. One RUTF sachet combines 500 calories and micronutrients that have:
- High nutritional value allowing malnourished children to gain weight quickly.
- Two-year shelf life, making it convenient to pre-position in a warehouse.
- Appealing taste and easy digestibility.
- No need for preparation – children eat it directly from the packet.
Gilbert Dachi, Manager of UNICEF’s Nutrition Programme in South Sudan responsible for the care and treatment of children with acute malnutrition, explains. “In South Sudan, UNICEF and partners treat close to a quarter of a million children every year with RUTF – averting potential deaths. Nutrition programmes for children with severe wasting in South Sudan achieve a treatment recovery rate of 95 per cent.”
Malnutrition is a leading contributor to South Sudan’s high mortality rate of 96.2 deaths for every 1,000 live births among children under five years old. Compare this devastating number with Denmark, Japan, Switzerland, and the UK, where the under-five mortality is between two to four deaths per 1,000 births. Each year South Sudan distributes about 2,600 metric tons (MT) or 190,000 cartons -185 truckloads of RUTF, procured by UNICEF or donated as contributions-in-kind.
In addition to funding, the availability of RUTF depends on where RUTF is sourced. Global suppliers of RUTF are based in Europe, Asia, Africa, and the Americas. Initially, the level of RUTF production was not sufficient to keep up with the increasing demand for RUTF. One way to help make RUTF more readily available is by supporting production in or close to countries that experience a high burden of malnutrition by local food manufacturers.
To create healthy markets and in line with its sustainable procurement strategy, UNICEF has partnered with other expert agencies to expand the supplier base with a focus on local production of RUTF. For example, in 2005, Niger began producing RUTF under a franchise agreement with the global supplier in France. Five years later, Niger no longer needed to import RUTF and, in addition, became a supplier for neighbouring countries.
By 2021, UNICEF’s supplier base of RUTF grew to 21 – out of which 18 are based in countries where RUTF is used locally. UNICEF suppliers in Burkina Faso, Haiti, Kenya, Madagascar, Niger, Pakistan, and Sudan also provide RUTF for international procurement.
At the moment, all UNICEF-procured RUTF is peanut-based. However, UNICEF, nutrition partners, and industry are exploring the possibility of manufacturing RUTF using other nutrition-rich sources such as soy, chickpea, and oats. It will be essential to ensure that new formulations meet the high nutritional value, taste, and quality parameters that define success.
For the last four years, UNICEF has been procuring an estimated 75 to 80 per cent of the world’s RUTF – equivalent to 49,000 metric tons (MT). Between 2017 and 2021, UNICEF procured some two million cartons for South Sudan.
Delivering RUTF to communities where children live is a complex exercise requiring foresight and fortitude. Supplies leaving the UNICEF warehouse in Juba are transported to warehouses in ten field offices across the country. Once commodities reach these field locations, UNICEF partners take supplies across the last mile – to community health programmes. Supply planning ensures that three-month buffer stocks are available in nearby warehouses in case there is a surge in demand or a delay in replenishment.
Meticulous planning is critical in countries where poor infrastructure directly impacts children’s access to RUTF.
Window of opportunity
“The rainy season is dreaded in terms of logistics because road access is significantly constrained from May to the end of October,” says Gilbert. “We need to map out our last-mile distribution points, and if we manage to pre-position RUTF in remote locations during the dry months, we can save significantly on transportation costs.”
If this window of opportunity is missed, Gilbert and colleagues have only one alternative: delivery by air – a service managed by the humanitarian-based Logistics Cluster, operating on a first-come, first-serve basis.
“Unless you are prioritised, arranging shipments by air will cause a further delay,” notes Gilbert. “Air delivery is five times more expensive than by road. However, for parts of the country where conflict and insecurity make it too dangerous to travel by truck, delivering RUTF by air is a permanent feature.”
A violation of children’s rights
Malnutrition is a violation of children’s right to nutrition. Gilbert and other UNICEF colleagues are deeply moved by the relief and appreciation that mothers express when their children are saved by RUTF treatment. RUTF’s irrefutable success in saving millions of children from dying has had the power to shock donors and partners to do whatever it takes to ensure RUTF is adequately pre-positioned wherever children are vulnerable to hunger crises.
Integrating nutrition supply chains into national supply systems to improve care for vulnerable children and support for the cost-effective and sustainable production of RUTF is a significant contribution of the supply function towards saving lives. However, UNICEF’s Nutrition Programmes are based on evidence-informed protocols for the early detection and treatment of children with severe wasting. A holistic, preventive approach is at the heart of UNICEF’s nutrition strategy (see below).
UNICEF’s Nutrition Strategy 2020-2030
To achieve the Sustainable Development Goal (SDG) of ending child malnutrition, UNICEF’s Nutrition Strategy 2020-2030 calls for multisector programmes to strengthen the capacity and accountability of food, health, water and sanitation, education and social protection systems to deliver nutritious diets, essential nutrition services and positive nutrition practices for children, adolescents and women.
National governments have primary responsibility for upholding children’s right to nutrition. But the path to nutritious diets, essential nutrition services and positive nutrition practices for all children, adolescents and women demands a shared purpose, with commitments and investments required from a range of government, societal, public, and private partners.