Dear colleagues,
Many thanks for sharing your thoughts and concerns.
As stated in our initial post, ACF decided to conduct a study on whether RUTF should be added on the Essential Medicines List (EML) of WHO and of countries as it has been a long standing debate amongst actors so far.
These last years a lot of work has been done in identifying major barriers to SAM treatment that as some of you rightly stated remains shockingly low. One of the barriers listed relates to the product. The study therefore intended to assess whether or not having RUTF on the EML would be one of the steps to advance SAM treatment coverage globally.
Recently the CMAM forum developed a digest of the study ACF made and it responds to a lot of the concerns raised in this discussion. We would like to invite you to click on the link and read this short digest:
http://www.actioncontrelafaim.org/en/content/ready-use-therapeutic-food-rutf-and-who-essential-medicines-list
There is no conflict of interest for Action Contre la Faim to follow WHO’s recommendations to use RUTF as a solution for SAM treatment.
ACF is an independent international NGO. Our sole mission is to fight malnutrition worldwide and we believe in the right to food and in the right to nutrition. While we promote a multisectorial approach to treat malnutrition we strongly favor working on the nutritional status of the populations in need. We also tackle the underlying causes of malnutrition by aligning nutrition programs with Health programs, WASH interventions, Food Security and Livelihoods, and Mental Health and Care Practices initiatives.
We agree that food-based approaches are and will continue to be essential in promoting healthy diets and preventing malnutrition. RUTF does not replace these; it’s a therapeutic food specifically used to treat severe acute malnutrition, a disease that does not only occur in emergencies. And as stated by Sameh in his post, any country with an endemic and seasonal burden of children suffering from SAM should ensure that their health system is able to provide treatment to those that are affected, in the same way that patients should have the right to access treatment for any other condition.
To respond to Paul, the document submitted does not necessitate restricting the 'dosage' to that recommended in this submission. The composition as listed in the application is not binding. Indeed the duration of treatment is rather an average and is not binding either. As of today, we understand there is no international authority that binds the composition of RUTF. The codex is the only authority on the composition of RUTF.
The submission proposes to add RUTF on the list as a ‘miscellaneous item’, not as a medicine.
Placing RUTF on the WHO EML would not transform it into a medicine nor, would RUTF need to be a medicine prior to it being listed on the WHO EML. The WHO EML has a category for miscellaneous items such as sterilized water. RUTF is to fall into this category.
Countries are not bound by the WHO list and will choose to add it or not to its national EML. Therefore all countries can decide whether or not to apply the international recommendation and to find the right way to do it (in our study digest you can find a list of countries that have decided to list RUTF and the various ways possible to do so).
Adding it to the international EML is just a step to help countries to consider RUTF as an essential commodity.
As stated in the digest of the study published by the CMAM forum, there is no silver bullet for increasing access to SAM treatment but adding RUTF to the WHO EML can act as a catalytic initial step in this process. Global action could influence countries to integrate the product into national EMLs, ultimately leading to increased prioritisation of SAM treatment with RUTF, increased budget allocation and improved inclusion within the health system and supply chain. These are critical factors to increase the availability and access to SAM treatment. Given the potential implications, an application to adding RUTF to the WHO Essential Medicines List should be strongly considered.
We are very happy to engage in a further conversation.
ACF-F Nutrition & Health Team