interagency activities to assure nutrition product quality background and progress update
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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
Type your title in this FOOTER area and in CAPS
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
Type your title in this FOOTER area and in CAPS
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
Type your title in this FOOTER area and in CAPS
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.
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