On November 2, the New York Times published an article about Nourimanba, a peanut and vitamin supplement produced and distributed to malnourished children in Haiti by Partners In Health.
In Haiti, local communities grow and harvest the peanuts used to make Nourimanba.
“The uniquely Haitian product…is an essential medicine for about 10,000 severely malnourished children a year,” writes Duff Wilson in his article “Making Nutrition a Sustainable Business in Haiti.”
“Even before the 2010 earthquake heaped more misery atop the poverty in Haiti, one in four children had stunted growth,” continues Wilson. “An estimated 2.2 percent of Haitian children under the age of 5 had severe acute malnutrition, according to the United Nations Children’s Fund.”
In early 2008 Abbott Laboratories began supporting PIH projects in Malawi and Haiti. “In early 2009 we began thinking about how we could work with Abbott in a more comprehensive fashion, we decided to focus on our nutrition work in Haiti,” says PIH’s Brandie Conforti. “In December 2009, Abbott leadership toured our work in Haiti and then in May 2010 we formalized our partnership and began laying out plans for a Nourimanba facility. By June we were working on the design.”
“Groundbreaking on the new factory was delayed this year by an outbreak of cholera,” writes Duff. “Now groundbreaking is planned for January and production before the end of 2012.
“While the rudimentary production plant makes about 70 tons of Nourimanba for 10,000 children a year, the new one will push capacity to more than 350 tons and 50,000 children,” according to PIH’s Andrew Marx. “Children receive it daily for six to eight weeks. The new operation will also expand on the 300 or so farmers who have a guaranteed market for their peanut crops.”
“The relationship with Abbott goes beyond the Abbott Fund and it engages their employees,” continues Conforti. “It really has buy-in from the entire company and it models a new trend in corporate giving. What’s unique about this factory is the notion that eventually Nourimanba production will be self-sustaining.”
Read the New York Times article in its entirety.
New video from PIH!
"I don't think there will be large scale change without a movement, and this could be part of that movement...What if it was a coalition of parents around the world saying my kid's not dying, and your kid shouldn't die either?" -- Dr. Joia Mukherjee
In an interview by Two Degrees, Dr. Joia Mukherjee, PIH's Chief Medical Officer, discusses the tragedy of preventable childhood deaths from malnutrition and the importance of such campaigns in raising public awareness and empathy for childhood starvation. Two Degrees, a health food company, is a partner organization of PIH's that provides RUTF treatment for PIH patients in Malawi, based on our the model of programs built in Haiti.
Watch these short videos (link below) about childhood malnutrition and the importance of locally-sourced and produced RUTF in reversing it.
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PIH uses two therapeutic foods to treat and prevent severe pediatric malnutrition. Nourimanba is a “Ready to Use Therapeutic Food” made from a peanut butter base combined with milk powder, vegetable oil, sugar and a specially formulated vitamin mix for malnourished children. Nourimanba can be offered as an outpatient treatment; receiving treatment at home means that children are prevented from being needlessly exposed to other ill children in the pediatric ward, which is a particular risk for children whose systems are compromised by malnutrition. Having to tend to a hospitalized child is also particularly difficult for many impoverished families we serve in Haiti, who often have several other children at home and live at great distance from clinic, so this outpatient aspect of the treatment is crucial. For children who are who are moderately malnourished or transitioning off Nourimanba, Zanmi Lasante provides a locally produced mixture of milled grain and legumes called Nourimil.
Both Nourimanba and Nourimil are prepared and packaged in Zanmi Lasante’s production and distribution center in Cange. Local in-house production of Nourimanba and Nourimil stimulates the local economy by employing the local workforce and encouraging local agriculture. Because the Cange production facility is too small, we are currently working with a partner to build and equip a new facility to produce Nourimanba and Nourimil. This facility will allow for better quality control and potential future expansion of our operations.
Even with the smaller space, Zanmi Lasante produced over 60,000 5lb bags of Nourimil, and over 56,000 kgs of Nourimanba in 2010. Attached you will find a monthly breakdown of production:
Zanmi Agrikol, which translates to “Partners In Agriculture” in Creole, uses agricultural initiatives to both encourage local production of crops used in the treatment and prevention of pediatric malnutrition and to increase food security for families of malnourished children. Zanmi Agrikol has three main components: the local production of therapeutic foods (called Nourimanba and Nourimil) used to treat and prevent malnutrition; the operation of two farms and contracts with local farmers who grow crops (mainly peanuts) used to make these foods; and the Family Assistance Program, an agricultural assistance program for the poorest families, many of whom are identified because their children have been treated for malnutrition. Launched as a pilot program in one site, Boucan Carré, Zanmi Agrikol now encompasses all of Zanmi Lasante’s sites in the Central Plateau.
Through Zanmi Agrikol, Zanmi Lasante produces Nourimanba and Nourimil to meet the pressing need for effective and cost-efficient treatment for malnutrition, which affects a third of children living in Haiti. Producing these therapeutic foods locally means that we are creating jobs and contributing to the local economy. Nourimanba is a “Ready to Use Therapeutic Food” made from a peanut butter base combined with milk powder, vegetable oil, sugar and a specially formulated vitamin mix. It is used for severely malnourished children and has the advantage of being a home-based treatment: children are treated with Nourimanba in hospital for two weeks (in which parents and caregivers are trained in how to give the treatment) and then continue their treatment at home for another four weeks. Nourimil is made of beans and rice or corn and is used on an outpatient basis for moderately malnourished children to prevent further deterioration. In FY 2011, PIH and Zanmi Lasante anticipate treating approximately 6,000 malnourished children with Nourimanba and Nourimil.
Currently, Zanmi Lasante operates a small production center in Cange where local workers mix ingredients, produce, and package Nourimil and Nourimanba. To further reduce cost and stimulate the local economy, Zanmi Lasante operates two farms in the nearby village of Corporant and Lachteau, where 79 farmers are employed to grow corn and beans used for Nourimil. We also buy peanuts for Nourimanba from local farmers around Corporant. Zanmi Lasante provides initial seeds to these farmers (who return an equivalent amount of seeds at the end of the growing season) and pays a fair market price for their entire peanut crop. This arrangement provides the farmers with predictable revenue and in sufficient quantity to invest in new tools, land, and other inputs. Currently over 200 farmers are involved in growing peanuts for Zanmi Lasante. Plans are currently underway to complete the construction of a main depot in Corporant where the production of Nourimanba and Nourimil can be housed. In FY 2011, PIH and Zanmi Lasante will support 279 farmers to produce roughly 43,000 kilograms of Nourimanba and 184,600 lbs of Nourimil (based on last year’s production totals).
The third component of Zanmi Agrikol is the Family Assistance Program which helps extremely destitute families improve their basic household food supply in order to battle long-term food insecurity. Typically, Zanmi Lasante has enrolled families of children who are being treated for malnutrition at a Zanmi Lasante site. Each family is assigned an ajan agrikol – a local resident employed by Zanmi Lasante as an outreach worker – who works with each family to boost their household production of food. Practically, this means the ajan agrikol provides tools, seeds, training, and at least bi-weekly visits to families enrolled in the program. Each ajan agrikol is responsible for 10 families, visiting them weekly or every other week; there are 240 families who have been enrolled in the project over the past two years. Immediately following the earthquake, Zanmi Lasante hired 20 additional ajan agrikol (bringing the total to 42), and expanded the Family Assistance Program to meet the pressing needs of families, most of whom have taken on survivors from the earthquake who fled Port-au-Prince. We have also started the farm at Lachteau, mentioned above, which will have dedicated areas for demonstration and farming plots for families to practice new techniques and grow crops. Zanmi Lasante has identified 50 kombit (groups) of 20 families, meaning thatin FY 2011 the Family Assistance Program will now serve 1,240 families who are extremely food insecure.
Monitoring, Evaluation, and Key Partners
The project will be monitored and evaluated with the following indicators:
Evaluation will be overseen by Marie Flore Chipps, coordinator of Zanmi Agrikol. The first indicator listed will be reported by the clinicians in the pediatric wards of Zanmi Lasante clinics. The remaining indicators will be monitored and reported by Zanmi Lasante’s three lead agronomists. Two Boston-based Haiti program managers and one Haiti-based nutrition coordinator will provide ongoing monitoring of program progress and assistance with budgeting and reporting to donors.
To further assess the impact of the project, in FY 2011 PIH and Zanmi Lasante are continuing our partnership with a local organization, Fonkoze, a local NGO that provides microcredit opportunities and has begun screening families in their program for malnutrition. Fonkoze trains their community agents to screen families for malnutrition and then refers them to Zanmi Lasante clinical sites, and also trains them in following up with these families after referral. Because increased screening will likely lead to greater identification of pediatric malnutrition and more need for treatment, Fonkoze is also working to find donations of additional RUTF for these families.
The health of children has always been one of Zanmi Lasante’s central concerns, as children are often the most vulnerable to falling ill in the impoverished communities we serve. Of every 1,000 children born in Haiti, 72 of those young boys and girls will die before the age of 5. In the US that number is 8. Following the earthquake, PIH/ZL knew that sick and malnourished children would comprise a large portion of the patients in need of our services. So the team focused on strengthening pediatric and nutrition services at both our existing facilities in the Central Plateau and Artibonite regions, and in the new clinics serving displaced survivors in Port-au-Prince.
An estimated 40 percent of the 146,940 patient encounters logged thus far at the PIH/ZL clinics at the four settlement camps in the capital city were with patients under the age of 20, and roughly half of these were with children under the age of 5. Many of the illnesses these young people present with are related to malnutrition. In response, the team significantly bolstered its pediatric malnutrition program. Over the past 6 weeks, they’ve enrolled 1,191 children, and have distributed Nourimil* and Nourimanba**, locally produced highly nutritious therapeutic foods. So far, 12,255 pounds of Nourimil and 2,016 pounds of Nourimanba have been distributed.
To support mothers caring for young children, the PIH/ZL clinics located in the spontaneous settlements, in partnership with UNICEF, set up special tents. Here, mothers can receive education on nursing and nutrition, weigh and monitor their baby’s progress, and, if needed, receive infant formula. So far, these tents have logged roughly 2,600 visits.
Many families in the Central Plateau and Artibonite regions have taken in relatives and friends fleeing from the chaos of Port-au-Prince. With support from the American Jewish Joint Distribution Committee (JDC), ZL’s existing clinics in these regions have expanded their pediatric nutrition program to help local households affected by the earthquake, with the goal of eventually expanding its capacity to treat an additional 2,200 children, growing by over 30 percent.
ZL’s hospital in Boucan Carre, roughly 2 hours by car north of Port-au-Prince, has already logged a spike in the number of children enrolling in their program. “Since the earthquake, we’ve had more children [in the malnutrition program] than we’ve ever had before,” says nurse Thony Magdala, who was recently hired to help manage the growing need. “Every day we are having more and more children coming to the clinic and entering the program.” She estimates about 2-3 children a day on average, but as many as 5-6 on some days. Since she’s started in March, the program has grown from 329 children to over 600. She’s also begun running mobile clinics in some of the remote areas on the fringes of the hospital’s catchment area, all in an effort to help Haiti’s poorest families.
*Nutrient enriched, locally produced mixture of rice, corn, and beans
**Nutrient enriched, locally produced peanut butter-based Ready to Use Therapeutic Food (RUTF)
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