Interagency activities to assure Nutrition Product

quality

Background and Progress Update

Timeline : Quality Assurance development of Nutritional Products

2005

Sca

le

up o

f CM

AM

2011

Inte

rag

ency

Gro

up

Est

ablis

hed

WF

P, U

NIC

EF,

MS

F

2012

Sys

tem

stre

ngth

enin

g in

QA

2011

C. S

akaz

akii

Issu

es in

RU

TF

and

RU

SF

2012

FA

O/W

HO

1st

con

sult

atio

n –

Fo

cus

on

EB

an

d

Sal

mo

nel

la

2013

Inte

rage

ncy

QA

Gro

up in

clud

es

US

AID

2013

Bes

t pra

ctic

e

in Q

A a

pplie

d to

stra

tegi

c pr

oduc

ts

2013

QA

m

onito

ring

GM

P

Insp

ectio

n

stre

ngth

enin

g

2013

F10

0 R

ecal

l due

to in

crea

sed

mon

itori

ng

2014

2nd

FAO

/WH

O

cons

ulta

tion

on

RU

TF/R

US

F

Furt

her

syst

ems

stre

ngth

enin

g

amon

gst i

nter

agen

cy

grou

p

Join

t Ins

pect

ions

UN

ICE

F an

d M

SF

Interagency Group participation :

Interagency Group consists of the major purchasers of nutritional products and collaborates closely on Quality matters of common nutritional products

Collaboration also extends to partner UN agencies FAO and WHO

when specific expertise is needed.

UNICEF Interagency activities to assure Nutrition product quality. Alison Fleet UNICEF Supply Division

TOR - Under development

• Interagency group focused on product related activities

Work-streams include:

I. Specification development and common specs if possible

II. Normative / regulative work (Codex, WHO consultations) on common products

III. Shared inspections of manufacturers

IV. Alignment with communication to partners and governments

V. Product improvements

UNICEF TOR for Interagency Group

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Feedback?

How can the interagency best get feedback from the GNC on products?

How can the interagency best communicate with partners so that information flows ?

UNICEF

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Current Interagency Activities: LNS Products1. LNS – ingredient optimization at the factory level RUTF, RUSF, MQ-LNS and SQ – LNS are made of

similar ingredients WFP leading work to optimize pre-mix used in these

formulae to help local manufacturers Current nutrient levels on label remain unchanged Starting work with MQ-LNS (PlumpyDoz) and RUSF Food safety tests for LNS to be aligned with best

industry practice following FAO/WHO expert consultations

UNICEF

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Current Interagency Projects : Therapeutic Milks2. Therapeutic milk specs: Original product specification not exactly aligned

with WHO guideline for inpatient care of SAM MSF and UNICEF working together to amend the

spec so the product delivers the nutrient levels from ‘Appendix 5’

Other changes investigating – GNC feedback Scoops for TM Tins as an alternative packaging format to sachets

UNICEF

Nutrition: Major projects 2015

• Focused goal of Interagency harmonization of auditing standards, specifications for common products and quality standards

• Implementation of FAO/WHO expert group recommendations and new microbial specification for RUTF and RUSF.

• Surveys on Therapeutic Milk preparation and use within inpatient facilities new guidance on preparation of milk in inpatient care

• Collaboration with WHO on Therapeutic milk reformulation as a results of new ‘hot water’ preparation step

• Further system strengthening of Quality assurance both within agencies and also with suppliers.

PLANNED NEEDS ASSESSMENT FOR RUTF

Survey on RUTF recipe, its appropriateness

Alison Fleet

UNICEF Supply Division, 1 July 2015

BACKGROUND

We want a local

product

Foods should be aligned

with cultural

practices

We don’t want imported, foreign

foods given to our children

A product made from

local foods will be more

sustainable

A local product will be

cheaper

PURPOSE OF THE SURVEY

To inform Unicef’ s strategic focus on developing new recipes for specific countries and regions

Identify countries and regions that could benefit from new a new RUTF recipe

To increase coverage in countries where the current recipe is a road block to SAM treatment

Improve access and affordability of RUTF in a local or regional context

MULTI-LEVEL SURVEY CONDUCTED IN ALL REGIONS WHERE RUTF IS SUPPLIED

Nutrition officers in each region

Ministries of health

UNICEF’s major partners in implementing CMAM programs

End user feedback (those that work in Community heath centres administering RUTF)

SNAPSHOT OF THE SURVEY

Total: 576 15 were hand-written and 561 were completed online (survey monkey)

Total included for analysis: 520 51 % of 135 countries in the UNICEF regions responded

80% of the responses came from the 15 countries with the highest ‘Global burden of SAM’

Chad, Bangladesh and the region of South East Asia are very interested in using the FOND tool to develop their own recipe

Data analysis is ongoing

WHO RESPONDED?

Organisation No. Respondents  

MOH 122 22%

UNICEF 93 17%

Another UN organisation 22 4%

Health Facility 10 1.5%

Research Institution 35 6%

NGO (various) 132 24%

MSF 10 1.5%

Save the Children 53 10%

ACF 55 10%

Concern Worldwide 12 2%

Independent consultants 9 1%

TOTAL 553 100%

WEST AND CENTRAL AFRICA

Countries are quite happy with this recipe – peanut based, the same in every country, the taste is acceptable

Should be more investment in supply chain infrastructure (sugar, oil, peanuts)

Governments need to understand the added value if the product locally produced

Local production is more expensive in most cases

Local suppliers have difficulties in producing at a large scale

Lead time is an issue – this would be helped if production was closer to recipients in some of the harder hit countries

EASTERN AND SOUTHERN AFRICA

Issues with supply chain – Need exceeds supply

Faced with continual emergencies – many of the countries with are medium to high risk countries – floods, drought, political unrest

Does not have the impression that new formulations are needed

Rather there is a need for improvements to the supply chain management - for those already producing – Quality and Capacity

Study being conducted at the moment on RUTF supply chain management

SOUTH EAST ASIA AND THE PACIFIC

SOUTH EAST ASIA AND PACIFIC REGION

Indonesia : Priority Country – 9.5% SAM burden. Will not accept imported RUTF

Most countries in this region have very little infrastructure for CMAM programs

Linked with their health care system – community based health an uncommon model

Inappropriate inpatient treatment prevalent (eg providing F100 for parents to use with children at home; length of SAM treatment not long enough for full recovery)

Many countries don’t have funds for RUTF – major bottle neck

Vietnam has successfully developed their own recipe, based on Moon Cake. This is preferred to the original peanut based RUTF. Vietnamese government purchase and run programs using this product.

Regulation of RUTF is challenging for this region, is it a food or is a medicine? Need to first classify the product before allocation of MOH funds, and inclusion on the countries essential medicine list. Funding foods presents challenges.