Expanding access to a life-saving treatment
Wasting claims the lives of 1 million children each year – an unthinkable, yet preventable tragedy. For over two decades, UNICEF has worked to reach them with ready-to-use-therapeutic food (RUTF)
2-year-old Amira from Niger faced a harrowing battle for survival. As her parents struggled to buy enough food to feed a family of five, she became increasingly frail and was fighting for her life.
“She suffered a lot because she didn’t eat at all. The few times she did, she ended up vomiting and was cranky”, says her mother Chafa'atou.
Amira’s story is like millions of others who suffer from wasting – the most visible and life-threatening form of malnutrition which can result in developmental delays, disease and death. Children in Sub-Saharan Africa and South Asia are the most severely affected, where challenges such as poverty, food shortages, and conflict make this deadly condition so much more common.
There are more than 45 million children under 5 who suffer from wasting, with over 10 million requiring therapeutic feeding to survive. Amira was one of those children – and it was a course of ready-to-use therapeutic food (RUTF) distributed by UNICEF that helped to turn things around.
A lifesaving sachet
RUTF is literally a lifesaver for children with wasting. Packed with calories, vitamins, and minerals, RUTF helps malnourished children gain weight and recover quickly. It comes in a foil sachet, has a shelf life of two years, and doesn’t require refrigeration even after opening – making it easy for children to receive vital nutrition both quickly and safely. It is the only food given until a child’s weight is at a healthier level.
A limited market
In the early 2000s when RUTF became commercially available, the global supply was so limited that there was not enough to feed every child who needed it. UNICEF – procuring from the sole global supplier of RUTF – faced high costs, product shortages, and long waiting periods to deliver it to the children who needed it.
This problem was the catalyst for UNICEF to begin work to incentivise new suppliers to enter the RUTF market so that volumes could be scaled up and prices reduced through competition. If successful, it would be a major boost towards rapidly treating children with wasting, no matter where they lived.
UNICEF got to work quickly and provided potential manufacturers with product specifications and standards. This A-to-Z guide not only outlined quality and safety requirements but also projected global demand for RUTF, extending beyond UNICEF to include countries and other organizations interested in procuring it.
Bulking up the pool of suppliers
One major advantage UNICEF had at the outset was its buying practices. Normally UNICEF sets up long-term contracts with manufacturers and makes regular, high-volume orders that give suppliers confidence that there is demand for their product from a trusted buyer over a long period of time.
In 2006, signs of progress began to materialise. UNICEF partnered with the first RUTF supplier to establish local franchises across Africa, the Americas and Asia. As new manufacturing plants opened, the volume of RUTF that UNICEF could procure began to rise. By 2016, half of UNICEF’s RUTF was produced and procured from the countries that would need it most.
Amira from Niger benefitted from exactly this. In Niger, local production of RUTF began after a franchise agreement was reached with a French manufacturer. Within five years, Niger no longer needed to import RUTF, meaning children like Amira could be reached faster and more affordably than if the RUTF was procured in Europe or further afield.
And while the global volume of RUTF increased, the price began to drop. Since the mid-2000s, the price of RUTF has fallen 21 per cent as manufacturers produced larger volumes and reduced their costs, a broader supplier base emerged, and competition increased.
In 2022, for the first time, the average price of RUTF from suppliers in countries in which UNICEF has a country programme dropped below that of European suppliers – highlighting the advantages of market shaping in countries close to where RUTF is needed.
The outlook today
UNICEF has been delivering RUTF to countries facing drought, food instability and political upheaval for over two decades, making us the largest buyer of the product globally. In 2022, UNICEF delivered 68,000 metric tons of RUTF – enough to fill more than 500 Boeing 747 aircraft.
The RUTF supplier base has grown remarkably over the years. Today, UNICEF procures this life-saving product from 21 companies, of which 90 per cent are located closer to where children require treatment. UNICEF also procures 80 per cent of the global supply – enough to treat 3.6 million children under 5 years of age each year.
UNICEF RUTF procurement sourced by region 2006-2022
Because of UNICEF’s work to expand and diversify the market, the global supply of RUTF has grown seven-fold in 15 years. Between 2016 and 2020 alone, UNICEF bought enough RUTF to treat over 30 million children in over 70 countries – underscoring the scale of the response.
Despite the disruptions to supply chains caused by COVID-19, UNICEF's network of suppliers ensured consistent delivery of RUTF. In 2022, to reach children living through nutrition crises in regions such as the Horn of Africa and the Sahel, UNICEF took proactive measures. By securing funds for upfront payments to suppliers, the production and delivery of RUTF were maximised to help reach over 4 million vulnerable young children.
While more progress is still needed, UNICEF’s pivotal role in growing the RUTF market has been instrumental in getting this proven, cost-effective treatment into the hands of malnourished children worldwide.
Perhaps there is no better way to understand the impact than from a parent whose child’s life has been saved:
“I am really happy,” says Amira’s mother, Chafa'atou. “When you see that your child who was sick is now able to stand up on her own and express her needs, of course I am happy.”
