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Strategic opportunities to scale ready-to-use therapeutic foods

How short-term changes to the RUTF market highlight strategic opportunities in the long-term

[Editor’s Note: This is the second post in a blog series on sustainable strategies to improve access to wasting treatment. The series was spurred by the historic half a billion dollars pledged by donors this year to improve child nutrition, with an aim to review strategic ways to use this funding. Insights highlighted are based on a resource guide developed by R4D and UNICEF that offers an easy-to-follow process for governments to identify integration actions that can help achieve program goals for the early detection and treatment of child wasting within routine primary health care systems. In this post, the authors explore the question: How do we ensure a sustained, predictable, and continuous supply of RUTF to meet growing demand?]

Wasting is one of the largest mortality drivers for children under five, contributing to up to two million deaths annually. In 2020, 13.6 million children were severely wasted at any one time, with further increases expected due to the pandemic, and only 1 in 3 of these children receive treatment. Luckily, the world has the tools to prevent many of these deaths: ready-to-use therapeutic foods (RUTF), named “the best invention that no one has heard of” by Saul Guerrero Oteyza, UNICEF’s Senior Adviser, Financing for Child Nutrition and Development. RUTFs are a highly effective and cost-effective treatment with decades of proven success in curing acute malnutrition. However, funding for RUTFs only manages to cover roughly a third of the potential need.

In July and September this year, several donors announced historic investments totaling $577 million to child nutrition. Earlier this month, Devex asked: “Can half a billion dollars address the malnutrition crisis?”

Without a doubt, the funding commitments made in 2022 mean more children who need access to treatment will receive RUTF. But time-bound commitments will not address the underlying challenges in the wasting financing landscape: low and slow domestic contributions, reliance on humanitarian aid that is short-term and unpredictable, reliance on a small pool of donors, and inefficient fragmentation of funding sources.

R4D’s recent RUTF market analysis identified four key actions to scale up the treatment of wasting. The top priority: sustained commitment to long-term funding [see box for four priority actions]. While the commitments made in 2022 are expected to make significant impact, not knowing if this level of funding will be maintained is quite the challenge. This massive influx of funding changed the RUTF market overnight and, suddenly, suppliers faced several challenges to meet the short-term demand, including limited working capital to purchase ingredients upfront and pay for short-term operations. This is explored more in the Devex article.

Four key priority actions to scale up treatment of wasting:

  1. Prioritize sustained commitment to long-term funding from donors, governments or co-financing mechanisms.
  2. Funders and procurers should continue to build supplier capacity, and procure from suppliers with the best combination of price, performance and supply security, especially when considering local producers.
  3. Progressively strengthen country capacity, so the integrated systems can allow for government ownership and management of RUTF.
  4. In addition, invest in the needed evidence generation for alternative formulations and reduced dosages, to eventually help reduce costs of RUTFs and increase local acceptability.


Opportunities and areas to be strengthened

In order to implement the four key actions noted above, here are some opportunities to be considered.

Increased domestic contributions and more efficient use of funds. Country governments need to be in the driver’s seat in deciding how funds for wasting treatment is used in their countries. UNICEF’s Child Nutrition Fund is an opportunity to improve efficiencies by pooling funding and includes an innovative matching instrument that helps catalyze domestic investment for RUTFs. As of November 2022, it has successfully mobilized domestic funding from governments of Nigeria, Uganda, Mauritania and Senegal, in the amount of ~$3.4 million, with many other countries in the pipeline. As more countries buy into this mechanism, donors will need to maintain their commitments while actionable transition plans are developed.

Stronger supply base. Recently, at COP 27, BMGF announced a supplier scale-up facility of $50 million developed with UNICEF to provide suppliers with working capital to expand production, which will mitigate the prepayment challenges and delays to the start of production. This innovative solution, co-developed across partners, can help streamline production while also saving costs to suppliers.

Simplified approaches that maximize access to treatment under constrained resources. More research is being done on ways to optimize treatment protocols through smarter use of ready-to-use foods, including 1) single treatment product for both moderately and severely wasted children (as currently two different products are used); and 2) optimized/reduced dosage of RUTF throughout the course of recovery. Evidence shows that these simplified approaches are effective and allow for more children to be treated, which is crucial when financial resources are limited and unpredictable.

Stronger national supply chains and last mile delivery. To ensure that the funding for RUTF reaches the children in high burden areas, more work needs to be done to address additional RUTF deployment issues in-country. As we suggested in our earlier RUTF analysis, strengthening country capacity and integrated systems should also include plans to integrate RUTF into national supply chain systems and track RUTF in-country effectively. The resource guide that UNICEF and R4D developed has identified integration actions to strengthen country level RUTF management for governments to consider.

2023 presents a unique opportunity to deliver even greater impact per dollar and to move towards more predictable and sustainable long term funding — IF governments, UN agencies and donors are willing to fully commit to new ways of delivering and financing wasting treatment. This is a critical time to think about how to make better use of this years’ funding opportunities and consider what sustainability means for the RUTF market.

Related resources

https://www.unicef.org/press-releases/over-half-billion-dollars-pledged-tackle-severe-wasting-july-unprecedented

https://www.unicef.org/supply/media/13831/file/LNS%20-RUTF-Industry-Consultation-Aug2022.pdf

2022 May, UNICEF presentation in the SQ-LNS Convening

https://www.simplifiedapproaches.org/_files/ugd/2bbe40_4d267de66e5d4af3a43cb799fc2b466d.pdf

Catch up on the series

Comments 1 Response

  1. Takele Tehome December 24, 2022 @ 3:44 am

    Malnutrition resulting in stunting and wasting of children and malnutrition in pregnant and lactating women is critical. My NGO implemented a multisectoral approach for promoting nutrition-sensitive agriculture through funding support from FAO/EU and was very successful. But it could not scale up mainly because of a funding problem. Please help grassroots interventions through national NGO and community based organizations.

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