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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
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