1. Interagency activities to assure Nutrition Product quality Background and Progress Update

2. Overview  Interagency Group members  A brief historical account of the Humanitarian Aid sector  Growth of procurement of Nutritional products  Response in QA systems strengthening of agencies to the increase demand in Nutritional products  Story line of significant events in QA of agencies  Update on Consultation with WHO & FAO  Challenges with ensuring the Quality of Nutritional products  2015 planned activities UNICEFInteragency activities to assure Nutrition product quality. Alison Fleet UNICEF Supply Division

3. Interagency Group participation :  Interagency Group consists of the major purchasers of nutritional products and collaborates closely on Quality matters of common nutritional products  Collaboration also extends to partner UN agencies FAO and WHO when specific expertise is needed. UNICEFInteragency activities to assure Nutrition product quality. Alison Fleet UNICEF Supply Division

4. Growth of Supply from 2004-2013 HIV and Malaria Medicines:131 M USD Essential Medicines: 63 M USD Nutrition unit: 151 M USD

5. RUTF Procurement by UNICEF

6. small, niche beginnings… Treatment of SAM and MAM started with a grass roots industry with small scale manufacturers products UNICEFInteragency activities to assure Nutrition product quality. Alison Fleet UNICEF Supply Division

7. Manufacturing facilities of RUTF today UNICEFAn example of a new manufacturing facility for RUTF in South Africa

8. Challenges  Suppliers are often niche and therefore can be out of touch with industry best practice  Supplier base for relatively low volume products is difficult to widen, leading to less competition  Off shore (local) producers have limited access to good raw materials, testing laboratories and good technical staff  Specifications have been developed in isolation from manufacturers and can be ill-suited to modern day manufacture  The translation of program needs to product development has not been well integrated  Implementation of proper preparation, use and storage of products is still needed Challenges

9. UNICEF Mid 2000’s Scale up of CMAM - CMAM use RUTF begins to expand -Supply base of RUTF and RUSF expands 2006 Interagency Group - 2006 Joint Inspections UNICEF and MSF, - 2010 WFP, MSF, and UNICEF Collaborate - 2013 USAID join group 2012  Monitoring & Systems Strengthening - Meeting with 2012 FAO and WHO held - 2013 Interim criteria for microbiological safety set - 2013-2014- Agencies collect data 2014 F100 high potassium issue 2015- Systems Strengthening - Experts consultation  recall of MSI F100 result of increased monitoring - New supplier engaged Heat step in preparation agreed with WHO -2 nd Meeting with FAO /WHO to review data collected. -New criteria for RUTF/RUSF products - Codex standard in process RUTF/RUSF

10. FAO-WHO engagement: Review the 2007 Joint statement microbiological standards and update the specification for suppliers in alignment with best industry practice UNICEFFAO-WHO Revision of Microbiological Criteria for RUTF and RUSF

11. Consultation with WHO & FAO update on RUTF/RUSF UNICEFFAO-WHO Revision of Microbiological Criteria for RUTF and RUSF  UNICEF and WFP organised consultations with WHO and FAO.  Two experts groups were consulted in food safety: i. The 1 st group discussed applicability of Joint statement guideline on microbiological criteria.  Recommendation of an interim criteria and data collection ii.The 2 nd group was to review the data collected from the 1 st meeting and recommend a new microbiological criteria.

12. Conclusions: UNICEFFAO-WHO Revision of Microbiological Criteria for RUTF and RUSF  Pathogen of highest priority is Salmonella, other bacteria can be adequately controlled by food safety measures when controlling the risks for Salmonella  Risk of RUTF and RUSF for the target population is likely to be very low compared to the risk of infections from other sources (food, water, animals etc)  Lack of epidemiological data from end users was limiting for clear guidance from experts  The practice of adding LNS products to other foods (such as Plumpy Doz added to family foods) should be discouraged.

13. Recommendations UNICEFRecommendations from FAO / WHO  Manufacturers :  Continuous focus on preventative measures to prevent contamination coming into the manufacturing facility  Food safety programs should ensure that ingredients and the processing environment are free from Salmonella  Reject raw materials with high counts of Enterobacteracea (a hygiene indicator)  Focus on continuous Good manufacturing practice to verify their processes are under control  Purchasers should only use suppliers who meet the above requirements

14. Nutrition: Major projects 2015 Focused goal of Interagency harmonization of auditing standards, specifications for common products and quality standards Implementation of FAO/WHO expert group recommendations and new microbial specification for RUTF and RUSF. Surveys on Therapeutic Milk preparation and use within inpatient facilities new guidance on preparation of milk in inpatient care Collaboration with WHO on Therapeutic milk reformulation as a results of new ‘hot water’ preparation step Further system strengthening of Quality assurance both within agencies, with partners and also with suppliers.

15. What happens in …………. the last mile ? There is a need for data to be collected and shared on the health status of kids who are fed with RUTF/RUSF, F75 and F100 and The cause of their illness The agent(s) involved in the illness Side effects/adverse event from the product? Appropriate inclusion of this data collection in reporting program outcomes UNICEFType your title in this FOOTER area and in CAPS

16. Survey on Therapeutic Milk -UNICEF Supply division will be conducting a survey on the use, preparation and feeding of TM -Risk assessment of the current formula and its use in health clinics and hospitals -Can the product be improved to enhance its effectiveness and reduce the food safety risks? UNICEFType your title in this FOOTER area and in CAPS

17. Reporting of Quality issues: UNICEF and interagency have a process in place to manage : -Complaints and -Quality problems with products We want to know about side effects and adverse reactions in order to ensure the products deliver appropriate therapeutic effects How do we engage ? UNICEFType your title in this FOOTER area and in CAPS