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Focus on coverage assessment News Register now for coverage assessment workshop in Oxford Coverage assessment forum launched on en-net Valid International together with Mark Myatt is planning two sets of 2-day coverage assessment workshops from 27th to the 28th of March 2012 and 29th to the 30th of March 2012 respectively. The workshop is an introductory course to the various methods designed and used for assessing the coverage of the outpatient therapeutic care programme (OTP) and supplementary feeding programme (SFP) components of community-based therapeutic care (CTC) or community-based management of acute malnutrition (CMAM). These methods are Semi-Quantitative Evaluation of Access and Coverage (SQUEAC), Simplified Lot Quality Assurance Sampling Evaluation of Access and Coverage (SLEAC) and Simple Spatial Survey Method (S3M). The first workshop is aimed at mid-level managers and technicians particularly (but not limited to) those based at headquarters of international non-governmental organisations. The second workshop is intended for donors / funders and United Nations organisations. The workshop will be held at Jesus College, University of Oxford, UK. Each workshop is limited to 20-25 participants. At the end of the workshop, the participants would be able to differentiate between the different coverage methods and determine the programme contexts for which they are best suited. This will enable more informed decisions on planning and budgeting for appropriate coverage assessment methods for their programmes in different country contexts. The workshop is not meant to train participants on how to conduct coverage assessments. Each 2-day workshop will start with an introductory session on the methods, their history and development and strengths and weaknesses. This will be followed by sessions that detail the features of the individual methods. The sessions will be led by a team of four highly-experienced practitioners headed by Mark Myatt, the lead developer of all the methods currently used for coverage assessment. The workshop agenda is currently being finalised and will be made available to participants in February 2012. Participation in the two-day workshop costs £600. This includes workshop fees, workshop materials and lunch and refreshments for both days. Please note that participants will be responsible for their own travel costs to and from Oxford. Participants who wish to stay in Oxford will be responsible for their own accommodation. Various options including discounted rate at Jesus College as well as travel information are available online. Registration will start on the 2nd of January 2012. For further information and/or to signify your interest, visit the workshop webpage at http://www.validinternational.org/coverage or contact Basia Benda, email: basia@validinternational.org En-net is launching a new Coverage Assessment forum area for discussion of methods used in the assessment of programme coverage of the outpatient therapeutic programme (OTP) and Supplementary Feeding Programme (SFP) components of CTC/CMAM. This forum will also serve as a platform for discussing the use of these methods in assessing coverage of other programmes. The new forum area has five Technical Moderators on hand to provide support and advice to challenging questions: Ernest Guevarra, Lio Fieschi and Allie Norris of Valid International, Saul Guerrero of ACF-UK and Mark Myatt (Independent). The forum area will be overseen by the ENN Moderator, Tamsin Walters. All questions welcome. Visit www.en-net.org.uk To support the forum, a Coverage Assessment sub-section of the ENN Resource Library has been established to locate key resources. Visit: http://www.ennonline.net/library and select Technical Resources, then Assessment. Technical Reference for SQUEAC and SLEAC Methods, 2012 The Technical Reference for Semi-Quantitative Evaluations of Access and Coverage (SQUEAC) and Simplified Lot Quality Assurance Sampling Evaluations of Access and Coverage (SLEAC) Methods was developed by Action Against Hunger, Brixton Health, Concern Worldwide, Food and Nutrition Technical Assistance II Project (FANTA-2/FANTA-2 Bridge), UNICEF, Valid International, and World Vision International, and will be published by FHI 360/FANTA-2 Bridge with USAID funding in 2012. The Technical Reference comprises dedicated sections on SQUEAC and SLEAC methods and a series of case studies that address: • Assessing evidence and coverage in very high coverage programmes • Assessing evidence and coverage in moderate coverage programmes • Assessing evidence by wishful thinking (not a good idea) • Sampling without maps or lists • Using satellite imagery to assist sampling in urban settings • Active and adaptive case-finding in rural settings • Within-community sampling in an IDP camp • Within-community sampling in urban settings • The case of the ‘hidden defaulters’ • Applying SLEAC: Sierra Leone national coverage survey (see field article in this issue of Field Exchange) The appendices include additional technical information on SQUEAC and SLEAC, guidance on working with formulas, and a glossary of SQUEAC and SLEAC terms. When completed, the Technical Reference will be available for downloading from the FANTA website: http://www.fantaproject.org 45
By Jan Komrska Field Article Increasing Access to Ready-to-use Therapeutic Foods (RUTF) UNICEF Jan Komrska is a pharmacist working at UNICEF Supply Division leading Nutrition unit and responsible for procurement of products related to nutrition interventions of UNICEF. The author acknowledges the work of UNICEF Supplies Division reflected in this article. Test products Since 2007, the use of ready to use therapeutic foods (RUTF) to treat severe acute malnutrition (SAM) in young children has been endorsed by the United Nations and non-governmental organisations (NGOs), and received wide notice by the media. With the proven success of RUTF, more countries have adopted their use as part of community-based management of SAM (CMSAM), and demand for the products has soared. Since 2006, UNICEF, the world’s major purchaser of RUTF 1 , has taken a series of steps to shape the market and diversify the supplier base. As a result of this effort, the market has grown from one qualified manufacturer in 2000 to 19 today. This number is expected to increase in the coming years, especially in countries where RUTF is used. RUTF are high-energy foods fortified with vitamins and minerals, packed in individual portions providing energy intake of 500 kilocalories. They can be in the form of a soft paste or a crushable biscuit that is easy to swallow. Individual packaging allows easy handling and prevents contamination of the product between feedings. UNICEF requires RUTF to be manufactured by qualified suppliers in accordance with stricter quality standards than normal food products. The product most in demand and the subject of this article is RUTF in peanut paste form. The first peanut paste RUTF was developed jointly by the French Institute of Research for Development and the manufacturer Nutriset in 1996 as a fortified peanut spread, now marketed under the name Plumpy’Nut ® . UNICEF Supply Division is responsible for procurement of specific products (including RUTF) for UNICEF country programmes and external partners, assuring transparency in using public funds and maintaining agreed product quality. UNICEF procurement of RUTF in the period 2000-2010 UNICEF began to procure RUTF in 2000, when Nutriset was the sole qualified supplier and annual demand was below 100 metric tonnes (MT) 2 . The first long-term RUTF supply arrangement (LTA) was established with Nutriset on a sole-source basis in 2001. Under an LTA, Supply Division places orders with suppliers, based on requisitions from UNICEF country offices. Suppliers are responsible for manufacturing the product and delivering it to the nearest seaport for shipment by sea freight or, in urgent cases, to an agreed airport for air shipment. Further transportation of RUTF to the beneficiary countries is assured by UNICEF-contracted freight forwarders. Therefore, RUTF prices referred in this article exclude shipping costs. By 2004, demand began to rise as more countries began piloting the use of RUTF, and it became increasingly urgent for UNICEF to identify new sources of RUTF. During 2006, Supply Division began to work with manufacturers in countries where the product could be manufactured for local use, and approved suppliers in Niger and Ethiopia for local purchase in 2006 and 2007 respectively. With the publication of the UN Joint Statement in 2007 3 , demand increased dramatically, outpacing global production capacity. The situation became critical in 2008, when a hunger emergency in the Horn of Africa caused a spike in demand in the second half of the year. Even after a second global supplier (Vitaset, located in Dominican Republic) had been approved, the 11,000 MT ordered by UNICEF, still largely from Nutriset, did not meet peak in demand. As a result of this experience, Supply Division made three key decisions in 2008: a) to initiate competitive bidding for RUTF in order to open the market for new suppliers b) to begin conducting annual forecasting for RUTF with individual country programmes, and c) to conduct a study on RUTF supply chain performance in order to identify weaknesses and propose solutions. These efforts were part of a larger procurement strategy developed by Supply Division through which UNICEF could leverage its buying power to influence the market, promote increased competition and ensure a diverse and sustainable supply base. Implementation of the Procurement Strategy In 2008, in line with its procurement strategy, Supply Division launched the first competitive bidding exercise for the supply of forecasted 20,000 metric tonnes (MT) of RUTF, for the period 2009-2010. This exercise was preceded by a lengthy, multi-year process of advocacy for increasing production capacity with existing suppliers, identification of potential new global and local suppliers (usually existing food companies), and the development of manufacturing standards coupled with inspection of various manufacturing facilities. For the majority of products, UNICEF typically would establish a LTA, based on the results of competitive bidding, for a period of two to three years with the supplier making the lowest acceptable offer, and eventually a backup LTA with the supplier making the second lowest acceptable offer. However this approach was not applicable in the case of RUTF, because it would not encourage any further market development and would leave UNICEF with one or two suppliers. Therefore, it was decided to distribute total forecasted quantity among all companies meeting UNICEF technical requirements for manufacturing facilities as well as product specifications. Proposals were received from 13 companies and seven proved to be able to meet defined requirements for global supply of RUTF. LTAs were established subsequently with all seven suppliers, expanding significantly the supplier base (for more details see Table 1). The second competitive bidding exercise for supply of forecasted 54,000 MT of RUTF for the period 2011-2012 was issued by the end of 2010. The forecasted quantity was based on the assumption of continued expansion of CMSAM to new countries and scaling up of existing programmes. Proposals were received from 27 companies out of which 12 met UNICEF requirements for global supply of RUTF. LTAs were established subsequently with all 12 suppliers listed in Table 2. It is important to underline that RUTF products manufactured by UNICEF-approved manufacturers comply with the Joint statement specifications and they can be used by country programmes interchangeably. A key part of the procurement strategy was to support the development of local production in countries where RUTF is used, particularly in Africa, in order to bring the supply closer to the beneficiaries and reduce delivery lead times. After successful audits of the manufacturing sites by Supply Division’s Quality Assurance Table 1: UNICEF-approved RUTF Suppliers, 2005-2011 Global suppliers 2005 2006 2007 2008 2009 2010 2011 1 1 1 2 6 7 12 Local suppliers 0 1 2 2 4 7 7 Total 1 2 3 4 10 14 19 1 UNICEF is the largest, but not the only, purchaser of RUTF. Other major purchasers include MSF, the Clinton Foundation and different NGOs. 2 1 MT contains 72 cartons of RUTF. It takes approximately one carton to treat and save a child, so that each MT can save the lives of 72 children. 3 WHO/WFP/UNSCN/UNICEF. Community-Based Management of Severe Acute Malnutrition. A Joint Statement by WHO, WFP, UNSCN and UNICEF, May 2007 46
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