Strong public-private sector partnerships can help to reduce undernutrition

Global progress towards reducing undernutrition has been made through enlightened public policies, targeted development assistance, private sector actions and commitments from civil society. Yet every year, the deaths of more than 3.5 million children under the age of 5 can be attributed to undernutrition.

Evidence informs us that much more can be done to reduce undernutrition. It is also increasingly clear that well focused, strategic partnerships between the private and public sectors can make these further contributions happen.

Ready-To-Use Therapeutic Foods

An emerging area for potentially strong public-private partnerships is the production of Ready-To-Use Therapeutic Foods (RUTFs). These soft, crushable foods, which can be easily consumed by children from 6 months old, can contribute to the treatment of Severe Acute Malnutrition (SAM).

• Preparation of RUTFs does not require water. This means that bacteria cannot grow in them and they can be used safely in people's homes. Also, health centre and community health staff can prescribe RUTFs, decreasing the pressure on in-patient health facilities.
• RUTFs are only recommended for use in treatment of SAM. Efforts to solve the problem of undernutrition should also focus on prevention, through educating caregivers to make the best use of locally available foods and other effective interventions.

RUTFs have been highly effective at reaching and treating large numbers of children in their own homes in many African countries (including Ethiopia, Malawi, Niger, and the Democratic Republic of Congo) and increasingly in Asia (including Sri Lanka, Indonesia and Pakistan).

The United Nations Children's Fund (UNICEF) is working with partners to support the private sector in increasing the scale of RUTF production. This is needed to supply the increasing demand, meet industry standards and keep a balance between global and local production of RUTFs. If successful, this has the potential to save up to a million lives each year by reaching and treating the majority of children with SAM.

Infant feeding

Challenges remain, however, in reaching a shared vision about infant feeding amongst the public and private sectors. Guidelines from the World Health Organization and UNICEF clearly recommend and promote exclusive breastfeeding during the first six months of a child's life, and appropriate complementary feeding in addition to breastfeeding from 6 to 24 months. These are among the most effective interventions in preventing child mortality, ensuring optimal nutrition and development, and protecting against long-term chronic disease.

However, these efforts are undermined by the aggressive marketing of breastmilk substitutes by some manufacturers. Substitutes are often nutritionally inferior, incorrectly diluted and may depend on contaminated water, leading to diarrhea and undernutrition. UNICEF is strongly committed to supporting governments in enforcing the International Code of Marketing of Breastmilk Substitutes. This seeks to protect parents from commercial pressures to purchase infant milk substitutes.

In addition to breastfeeding, children need appropriate, safe and high quality foods to complement their diets after 6 months of age. If a common public health goal can be agreed between the public and private sectors, a promising area of collaboration would be the production of optimal complementary foods. These would need to be affordable, acceptable to local people and readily available to all sectors of society.

Nicholas Alipui
Programme Division, UNICEF Headquarters, UNICEF, 3 United Nations Plaza, New York, USA
T +1 212 3267407
nalipui@unicef.org

Undernutrition

Undernutrition includes a wide range of effects including intrauterine growth restriction resulting in low birth weight; being underweight (indicated by low weight-for-age); stunting (low height-for-age); wasting (low weight-for-height); and less visible micronutrient deficiencies. Undernutrition is caused by a poor dietary intake that may not provide sufficient nutrients, and/or by common infectious diseases, such as diarrhoea.

Source: The Lancet's Series on Maternal and Child Undernutrition, Executive Summary, January 2008