Letter on commercial production of RUTF, by Michel Lescanne

Dear Editor

The widespread application of CTC (Community-based Therapeutic Care) in emergencies and stable situations raises the question of the availability of Ready to Use Therapeutic Food (1) (2). This relatively new development in the treatment of severe malnutrition makes it necessary to consider strategies for ensuring sustainable availability of plumpy'nut. When, in 1996, NUTRISET designed plumpy'nut in partnership with the IRD (French Institute of Research for the Development), our objective was to provide NGOs with a practical and nutritionally equivalent alternative to F100 that could be eaten by a child on their own, without preparation and without any health risk, and that could be used at home (3). Several clinical trials and studies conducted with plumpy'nut show that its nutritional impact is at least equivalent to F100 therapeutic milk (4).

When Valid International started developing the CTC concept, the compatibility between plumpy'nut and this new type of intervention seemed natural. It became the first RUTF used in CTC programmes.

Plumpy'nut was also designed with local production in mind. NUTRISET elected to use raw materials which were available in most developing countries (via local markets or via donors like theWorld Food Programme), using transferable and relatively inexpensive technology and equipment. The first local production trial was conducted in Burkina Faso in 1997. Various other routes were then explored. We conducted and/or participated in various pilot studies with local production, (Concern worldwide, Valid international, St Louis Children Hospital, MSF, Dakar University, Caritas, etc.).

The cost of plumpy'nut is mainly comprised of the raw materials used. Although we believe that milk products are preferable for optimal recovery of children from severe malnutrition, we have also developed cheaper formulae for the nutritional management of moderate acute malnutrition, people living with HIV/AIDS etc. These new plumpy-nut related alternative products are already available and can be locally produced, using the same technology and the same equipment.

Facts and figures show that the practical and nutritional advantages of a solid spread food are increasingly being acknowledged. In order to reach as many acutely malnourished people as possible, we think it is preferable to build on the acceptability and efficiency of plumpy'nut.

Statement

Nutriset's strategy with regard to Plumpy'nut is to strengthen the capacity of local producers to manufacture the product. From the results of various experiences we have now developed two basic approaches which can be used to bring this about. Underlying these approaches is an ethical position which we will strongly adhere to, i.e.

• Assurance of the quality of the local product.
• Professional ethics of the local partner in dealings with the humanitarian world.
• Awareness of, and adherence to, the appropriate use of locally available plumpy'nut.
• A strong commitment by the producer to make plumpy'nut available.

Beyond a simple technology transfer, these local producers must be independent, yet federated. This is why we advocate and support the establishment of a network of franchised producers.

We advocate 2 manufacturing options that should be adapted to the field situation.

First option: Production by an NGO.

This option will be suitable for programmes with needs below 50 tons of plumpy'nut per year.

Nutriset will provide the NGO with the special preparation (including the mineral and vitamin premix), as well as a production guide. Technical support, training modules and stock management tools, will also be available to the NGO on request. Under this option, the NGO is solely responsible for the quality of the finished product and for the proper use of the plumpy' nut. If the guide is followed properly, production poses no major problem. This simple option makes it possible for plumpy'nut to be accessible to any small-scale nutritional programme or to any humanitarian or social stakeholder.

Second option: Production for sale in the context of a network of franchised manufacturers.

This option will suit countries where needs for plumpy'nut are structurally higher. The franchising system as offered by Nutriset is based on the transfer of Nutriset 'know-how' to a local independent producer (known as franchised producer).

This know-how includes the manufacturing process, quality assurance and quality control, specifications of raw materials, the management tools (stocks, etc.), the communication policy and the charter for good commercial practice, the use of the patent licence and of the registered trade name. The transfer of knowhow is effected via training sessions organised in France at our production site.. By making a commitment to respect and follow protocols, the producer enters the franchise network. The setting-up and running of the franchised network will be financed by the sale of the special plumpy'nut preparation to the franchised parties.

Proposed services

NUTRISET have developed a specially adapted quality system, based on the HACCP guidelines. We implement it individually with each franchised producer, taking into account specific circumstances and constraints. In this way we are able to validate, and if necessary improve, the quality of the plumpy'nut manufactured by these producers.

Quality starts with the selection of raw materials and suppliers, who receive strict specifications requiring batch traceability. For instance, peanut suppliers must make a commitment to follow good practice in the growing and the storage of their product, and to accept spot checking and product analysis.

The producers will also be supplied with a 'production-management-by-batch software package', with traceability of the ingredients and of the finished product. Reference laboratories have been selected for each producer and routine analyses are conducted for each batch of plumpy'nut produced.

The products manufactured within the framework of this franchised network will bear the name of plumpy'nut or of plumpy'nut associated with a local name (e.g."Chiponde Plumpy'nut" manufactured by PPB in Malawi).

The network of franchised producers

The group of franchised producers will form a network through which they will be able to share their experience and carry out communal actions aimed at optimising the system (e.g. Aflatoxin analysis network, etc.). This network will communicate through an internet forum, and various meetings and gatherings will be organised. An appointed committee comprising network representatives will also be formed. The relationship between Nutriset and the network will be managed by this committee, which will also ensure that basic principles are adopted and followed. The committee will also co-opt new producers.

To date, 3 producers have entered this venture with Nutriset: the NGO "PPB" (Project Peanut Butter) in Blantyre, Malawi, a company called "STA" (Société de Transformation des Aliments) in Niamey, Niger, and a company called "Jongea" in Lubumbashi, DRC. Plumpy'nut is already available from these three producers, and we are open to new applications from other potential producers.

Michel Lescanne Founder,
Chairman and Managing Director of Nutriset

For more information, please contact: Adeline, Nutriset, BP 35, 76 770 France, nutriset@nutriset.fr Liyaka Nchilamwela (liyaka_elly@hotmail.com) for PPB. Fatchima Cissé (sta@intnet.ne) for STA, and Mrs Kabwe (kabwesabwa@wanadoo.fr) for Jongea.

References:

1. Introduction, of the Special Supplement Series of Field Exchange,; « Communitybased Therapeutic Care ». November 2004 4-5.
2. FANTA « A Guide for Nutritional Care and Support »,. 2004; Chap 6, p 91.
3. Briend A. « Treatment of Severe Malnutrition with a Therapeutic Spread » Field Exchange, 1997; No 2 p 15
4. www.nutriset.fr/products/en/malnut/ plumpy.php.
5. Nutriset is a private, independent company. In 2004 NUTISET employed 35 staff and had a 10 million euros turnover. 20% of staff are dedicated to R&D and the R&D budget is 5% of turnover.