Unicef cuts threaten fight against climate-related malnutrition

RUTF is an energy-dense food paste made from peanuts, sugar, milk powder, oil, and vitamins/minerals, used to treat severe acute malnutrition in children.

The new Codex guideline classifies RUTF as a medical food, enabling governments to incorporate it into public health policies and enhancing access for treating severe malnutrition.

The Codex Alimentarius Commission, a collaborative initiative by the Food and Agriculture Organization and the World Health Organization, introduced a new guideline for RUTF in November 2022. This guideline classifies RUTF as a medical food, providing countries with a clear framework for its integration into national health systems. It establishes standards for nutritional composition, additives, and safety while permitting flexibility in ingredients, such as cereals and legumes, to cater to local preferences.

The new Codex guideline presents a vital opportunity for African governments and hospitals to assume the role of buyers. By designating RUTF as a medical food, the guideline enables countries to include it within their health systems. This could allow local health departments and hospitals to become direct buyers, ensuring ongoing treatment for malnourished children, even as UNICEF reduces its involvement.

Among the leading producers of RUTF in Africa are Insta, Nutrik, and Project Peanut Butter. Nutrik, a major RUTF producer in Africa, was established in Nigeria in 2019 by the Nutriset Group. By 2024, it had significantly expanded its production capacity through a $2 million loan from Proparco. Nutrik boosted its output by constructing a new plant in Kano, Nigeria, and strengthened partnerships with local peanut producers.

Insta Products, a prominent RUTF manufacturer in Kenya, experienced substantial growth after securing $11 million in funding from the International Finance Corporation (IFC) in 2016. This investment enabled the company to triple its production capacity, aiming to reach an additional 250,000 to 350,000 people. Insta's expansion has strengthened Africa’s self-reliance in addressing acute malnutrition, thereby reducing the need for imported RUTF solutions. Currently, Insta supplies over 350 health centres in Kenya and four other African countries with RUTF.

Project Peanut Butter (PPB) has been treating malnourished children with RUTF in Africa since 2004. Operating in Malawi, Ghana, and Sierra Leone, PPB provides hospitals with life-saving RUTF, ensuring rapid access to treatment for severe malnutrition. By prioritising local production, PPB supports local economies, diminishes reliance on imports, and strengthens health systems.

Without health sector involvement, the RUTF market is vulnerable to donor dependency. To maintain sustainability, it is crucial for governments and hospitals to become key buyers. With the existing strong manufacturing sector in Africa, delivery time is reduced and transportation costs lowered. This helps secure long-term access to RUTF, ensuring that malnourished children receive the treatment they need.

The RUTF market in Africa has long been influenced by UNICEF's efforts to combat malnutrition across the continent. UNICEF procures 75-80% of the global RUTF supply. In 2022, it ordered 121,000 metric tons of RUTF to treat children in several African nations, highlighting the ongoing need for life-saving interventions amid a worsening malnutrition crisis.

UNICEF has actively expanded its supplier base in Africa to meet growing needs, with 18 of its 21 RUTF suppliers now located in countries with high levels of severe wasting. This shift has boosted local production, reduced reliance on international suppliers, and improved supply chain efficiency. However, with UNICEF’s funding cuts, African healthcare must step up and embrace this life-saving business.