NUTRISET

On a freezing cold Tuesday in February, at nine o'clock in the morning, I was the only person to get off the Eurostar service at Frethun, Calais. Met by Beatrice Simkins (in charge of NUTRISET's international communication and development), we embarked on a two hour drive through fairly uninspiring Normandy countryside until we arrived at the NUTRISET premises nestled amongst fields of cows and horses. The distinctive blue and white building, although out of place in such a rural setting, seemed somehow appropriate for an organisation which is unique in the humanitarian field.

Loading onto trucks at the Nutriset site

On my arrival, I was introduced to two of the directors, Isabelle Sauguet and Michel Lescanne. Michel, who is the founder of NUTRISET, originally worked in the Research and Development section of a dairy industry. He had long wanted to set up a department specifically for developing food aid products within the industry but 'met with resistance'. Hence the birth of NUTRISET.

NUTRISET was established in 1986. It is a private company and was the first company to produce a fortified milk based product for nutritional rehabilitation of the severely malnourished. The now ubiquitous F100 and F75 therapeutic milks produced by NUTRISET were developed out of the work of the ACF Scientific Committee. NUTRISET's primary aim is to produce food exclusively for humanitarian emergencies. It is independent of any financial or industrial lobby and food is only provided for NGOs and UN agencies. NUTRISET has a production capacity of around 30 metric tons a day, with 35 staff working in production, logistics, development, finances and quality and research. As Isabelle explained, 'all new staff receive lengthy instructions about the ethics of NUTRISET and the fact that it is primarily geared towards helping children through humanitarian relief.'

Production line at the Nutriset factory

NUTRISET has a large research and development section, which devotes itself to improving and adapting products to emergency conditions. In other words, 'developing products that can withstand lengthy transport, harsh climates and can be used in areas where there is limited or contaminated water supplies'. Much of the department effort goes into improving product specification, e.g. increasing the shelf-life of products. Isabelle described how NUTRISET may occasionally be contacted by agencies who have not been able to use donated therapeutic milks due to excessive orders or mis-planning, i.e. predicting demand that never materialised. "This happened recently in Zimbabwe. Agencies may be worried about expiry dates and wastage. In these situations, NUTRISET are able to issue a checklist of questions and tests, which if followed, can show whether the product's shelf-life can be extended. If the product is still viable NUTRISET will re-issue a certificate with an extended shelf-life".

After dressing up in sterile clothing (blue and white), I was shown around the production plant. On the day of my visit, the plant was idle with no batches due for production. This allowed me to see the plant and hear about its workings and the rigorous quality control measures that are in place - food science was never my strong point.

Putting Nutriset packaging to good use in Sierra Leone

NUTRISET receives support from the French government agency for innovation (ANVAR) to develop products. However, if successful (and so far, most products have been), then the loan has to be repaid. Technical advisors include a nutritionist, biochemist and polymer scientist. The company is involved in many research projects with NGOs and academics striving to improve food products for emergencies. A large proportion of profits are re-invested in research, with 80% of products developed through research. Products are either standardised or customised.

Products¹ can be classified under four headings;

1. Foods for treatment of severely malnourished, e.g. therapeutic milks (F100 and F75), Plumpy'nut, ReSoMal, therapeutic CMV (Minerals and Vitamins Complex)
2. Supplementary food for the general population, e.g. SP 450
3. Micronutrient supplements, e.g. QBmix, zinc tablets, Plumpy'sauce
4. Foods for infants and young children, including a special food for children born to HIV+ mothers

Current new products include QBmix, designed to prevent micronutrient deficiencies (especially Niacin, B1 and C). This is an aromatic paste, which is a condiment for meals (see field article in this issue). NUTRISET are also working on designing new alternatives for infant milk formula for HIV programmes.

Packaging at the Nutriset factory

NUTRISET have introduced quality control standards that combine food and pharmaceutical industry standards. The factory follows the Hazard Analysis Control of Critical Points system (HACCP), which is acknowledged good manufacturing practice. There have been a number of successful audits by French government and clients. Each product has to receive a NUTRISET certificate of conformity before dispatch and all products are traceable to batch numbers and raw materials in case of problems.

NUTRISET have five packaging lines and are able to respond to emergencies all year round by working 1-3 shifts per day. The strategic location of the factory provides easy access to main European ports and airports and NUTRISET have their own customs clearance on site by special agreement with French customs. This obviously saves time. The company maintains stocks of fresh finished products, allowing it to meet any order immediately (around 40 tons of Plumpy'nut and 100 tons of F100). NUTRISET can organise transport to final distribution points if required, although "agencies like MSF want to use their own logistics systems". They can set up a 24 hour or day crisis unit if needed and load produce within an hour. When there are large emergencies, extra temporary staff will be recruited (many regularly work for NUTRISET). As Michel remarked "all staff feel responsible and there is a 'hands on deck' mentality when there is a need to prepare large quantities of food urgently". Their turnover of products is of about 80% to Africa and 4% to Middle East countries, with the remainder going elsewhere.

Isabelle explained that "as NUTRISET is a private company with only three directors, there is a lot of autonomy and little prospect of the ideals of the organisation being compromised". Unlike agencies in the public sector, they are able to work in areas they want to work in and the financial independence of the company means they don't have to look for funds to other shareholders who may subvert direction.

NUTRISET are constantly developing new products to assist in research. For example, there is currently a study in Malawi on a product based on the idea that amino-acid deficiency is a cause of Kwashiorkor. Another study is ongoing in Malawi on selenium and B vitamin tablets and their impact on HIV positive adults. A third study in Tanzania is comparing the impact of a combined zinc and iron tablet with placebos. Nutriset has developed quick dispersible zinc tablets for World health Organisation (WHO) studies on diarrhoea in India, Zanzibar and Nepal. This is now leading to a technology transfer in Bangladesh for scaling up nation wide. The WHO wants Nutriset to transfer this technology to other countries also.
Isabelle and Michel both agreed that the two biggest, and not unrelated, problems that NUTRISET face are the perception that they are like some kind of money seeking agribusiness, and the difficulties of getting NGOs to start using new products. Some donors are reluctant to fund NGOs for trials. MSF seem to be an exception and readily try new products.

Having spent a day meeting staff and being shown around the production plants and research and development areas, I was dropped off at the nearby medieval city of Rouen to spend the night before catching a train back to London. My over-riding impression of NUTRISET is that it is a unique entity, which although run along commercial lines, fulfils an essential role in a public sector arena where risk taking and innovation is unusual, unless born out of the necessity of crisis. Basically, NUTRISET stands or falls on the basis of producing affordable foods that do the job. Therein lies their accountability. In a profession where the knee-jerk perception of the private sector is negative, NUTRISET would seem to offer a refreshing antidote and an ideal model for potential private and public sector partnership.

¹All products are patented by Nutriset