Food Safety and Healthcare, PHR Presentation

February 12, 2009

Hunger and malnutrition are both major causes of illness and major obstacles to effective treatment of many diseases. Malnutrition weakens immune systems, and greatly increases the likelihood of falling ill with and dying from many common infectious diseases.

During the Physicians for Human Rights Conference, Donna Barry of Partners In Health presented on the topic of Food and Health Safety and how this applies to the health and economic development of developing countries. She explained how Partners In Health is addressing this crisis of malnourished children and families through their work in Haiti, where they are providing  food supplements and lunches to the children in the community. While current food programs are providing meals for those in need, the majority of the time the foods provided lack the general nutrition required by malnourished people. Not all food aid delivered to developing countries is good. For example, Haiti has become a food dependent country, where 92% pf the families are in food security programs. The staple to this program is a simple peanut butter like supplement called Nourimil. Now I cannot imagine how appealing it would be to eat peanut butter every meal of the day, however by providing children in Haiti with Nourimil,people in the community have experience dramatic health improvements. While it is a more expensive option, people in Haiti are spending less time in the hospital, which in the long run is saving money for the local health system.

Another benefit of Nourmil, is that it is locally produced. PIH has partnered with local agricultural farms to create a vertical supply chain to produce the Nourimil peanut butter product. In this way, they are providing jobs for local people and stimulating the economy. This is an important aspect of development programs, the ability to work with the local community while addressing crucial issues of health and economic development. Below is a summary of this collaborative project of PIH.

Community-Based Treatment of Severely Malnourished Children

According to UNICEF, almost a quarter of Haiti’s children suffer from chronic malnutrition, as evidenced by their stunted growth. Our nutrition program meets the immediate needs of severely malnourished children through a nutrition treatment which uses two products called Nourimamba and Nourimil – both produced through our Zanmi Agrikol program – given to children identified in our clinics and by our accompagnateurs, or community health workers. In cooperation with Zanmi Agrikol, PIH and ZL treated nearly 3,464 malnourished children in 2007 across Central Haiti and the Artibonite District, and created opportunities for agricultural training and production for over 100 Haitian farmers and families. We are also providing meals to over 9,000 children daily through our school lunch program.

    Treating Childhood Malnutrition

Through nine clinics across Central Haiti and the Artibonite District, ZL clinical staff plays a key role in improving the health of our malnourished patients. In addition to patients who arrive at our clinics, our community health workers (whom we call accompagnateurs) also encounter children suffering from malnutrition during home visits in the community. They refer these children and their families to our clinical sites, where children receive medical care and nutritional support until they regain a healthy weight.

For our most severely malnourished patients, PIH and ZL have been using a therapeutic food treatment program since November 2006, called Nourimanba. Nourimanba, a “Ready to Use Therapeutic Food” (RUTF), is made from a peanut butter base combined with milk powder, vegetable oil, sugar and a specially formulated vitamin mix for malnourished children. Because of its oil and peanut butter base, Nourimanba has a low water content, which resists bacterial growth and allows it to be safely stored for months. As it is “ready to use,” no cooking is required, allowing parents to easily feed it to their children at home, eliminating or reducing the amount of time children need to spend in the hospital. Although used in Africa and Asia, ZL was one of the first organizations in Haiti to begin treating severely malnourished patients with RUTF. Moderately malnourished children are prescribed a food supplement made from a cereal-legume blend made of beans and either rice or corn, called Nourimil. Once severely malnourished children have responded to Nourimamba, they receive Nourimil as a part of their treatment plan. Based on the results of our initial trial in November 2006 (where 30 children at two of our sites saw significant weight gain after just two weeks) in 2007 PIH/ZL scaled up the use of these two foods to eight of our nine sites, which benefited 3,464 malnourished children in 2007.

    Producing Nourimanba and Nourimil

Through a program called Zanmi Agrikol (“Partners in Agriculture”), we produce Nourimanba and Nourimil at our main site in Cange, and when ZL first began using these products for the malnutrition program in late 2006, we purchased all of the necessary ingredients. The initial success of Nourimanba/Nourimil treatment and our subsequent scale-up has created a unique opportunity for poor farmers: once we saw the effectiveness of the RUTF, we began growing the main ingredients—peanuts, corn, and beans—at a 35 acre production farm that Zanmi Lasante operates at Corporant, located near our main site in Cange. In 2007, 45 Haitian farmers were employed at the production farm in Corporant. Because of the growing need for the ingredients of Nourimanba/Nourimil, in addition to the production farm, PIH/ZL also purchases crops from local farming families. In 2007, PIH/ZL provided the seeds and use of our tractor to 40 local farming families in Corporant. We then bought the crops they yielded for our Nourimanba/Nourimil production.

Both Nourimanba and Nourimil are prepared and packaged in our processing center in Cange, where we have employed and trained local men and women in the roasting, mixing, packaging and distribution of these products. In 2007, we employed 13 local women and 3 local men who produced and packaged 22,280 kilograms of Nourimanba and 87,200 lbs. of Nourimil for use in our clinics.

    Providing Daily School Lunches

An important component of our solution to the short-term consequences of malnutrition among poor Haitians is to offer daily lunches to school-children through our education program. For years, parents in central Haiti have faced a terrible choice. They could send their children to school with empty stomachs, in the hope that they might gain the skills to someday escape poverty. Or they could keep them at home to help produce or secure much-needed food and water for the family to survive. PIH and ZL saw this need, and in 2006 we launched a lunch program at schools near our clinic sites.

In each of the communities where we provide school lunches, PIH employs local women to prepare the meals from hundreds of giant sacks of rice and beans. The benefits of this program are enormous, and yet the cost is minimal – just 27 cents per child per school day. Now that parents no longer have to choose between education and food for their children, school attendance has increased significantly, and so have the attention spans and classroom performance of the children once they get to school. In 2007, 9,315 children and 266 teachers received daily school lunches free of charge through the program, as we increased our reach to include 27 schools, up from the 21 schools we served in 2006.

It costs only $125 to treat a severely malnourished child with Nourimanba, only $60 to supplement a moderately malnourished child with Nourimil, and a mere $49 to provide a child with an entire school year’s worth of daily lunches. Currently, PIH and ZL are able to use these immediate interventions to meet the combined needs of approximately 12,800 children.

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