GHANA’S EXPEREINCE with Ready to Use Therapeutic Food (RUTF) holds important lessons for Maharashtra, which in spite of warning by international experts, is going ahead with using RUTF for severe as well as moderately malnourished children.
The Ghana government’s decision to take over procurement of RUTF in 2018 after the UNICEF supply stopped, has already led to huge shortage of the packaged food due to its high cost.
As Maharashtra becomes the first Indian state to launch RUTF for severely acute malnourished (SAM) and moderately acute malnourished (MAM) children, international experts have warned against the move, stating that the government will find it hard to financially sustain the programme.
Globally, RUTF is advised only for certain SAM children. In January, state Women and Child development Minister Pankaja Munde had announced to go a step ahead and provide RUTF to even MAM children.
“It is not wise to introduce RUTF for MAM. These children should be guided to eat local family food unless there is an underlining disease condition,” said Esi Amoaful, Deputy Director in the Ghana Health Service.
“We must remember that RUTF is not a magic bullet. Malnutrition is preventable. Focus should be on this,” Amoaful added.
Ghana records 1.5 per cent of all children aged less than six as SAM. At 1.4 per cent, Maharashtra records similar figures. Data from Integrated Child Development Systems (ICDS) shows that Maharashtra had 81,361 severely underweight and 5.28 lakh moderately underweight children till November 2018.
“Because of the large numbers, RUTF is not sustainable for all children. It presents a challenge to sustain financially,” said Oluwatosin Kuti, who heads the health and nutrition division in UNICEF, Ghana.
In 2018, the UNICEF had shifted the responsibility to procure RUTF for SAM children on the Ghana Health Service. Within months, in the country’s northern limits, government-run Tamale Teaching Hospital started battling a shortage of RUTF due to lack of funds.
“We are looking at local alternatives to RUTF to reduce cost,” said nutritionist Dr Ernestina Yirkyio, who gets at least 25 SAM children every month in the hospital. She added that MAM children are provided local nutritional support to improve weight. “RUTF is strictly used for SAM.”
Apart from high cost, there are other concerns as well. While 75 per cent of children given RUTF recover from severe malnourishment, relapse is possible in about 10 to 15 per cent of them.
“We have now started capturing that data, to see how many children relapse and return to hospital after RUTF is stopped,” said Tamale hospital paediatrician Dr Peter Kwarteng.
According to UNICEF, RUTF was procured by 63 countries for 2.6 million SAM children in 2017. As the market rate of one RUTF packet is Rs 25, a single child’s treatment with three RUTF doses a day will cost the Maharashtra government Rs 2,250 a month.
Dr Patrick Aboagye, Director of Daily Health Division, Ghana Health Service, said that since UNICEF transferred RUTF procurement to the Ghana government, the health budget has been stretched.
“In a lower income country, there is a challenge of funding. India will put a huge pressure on its financial resources if it starts RUTF for MAM,” he added.
A public interest litigation opposing Maharashtra government’s move to start RUTF is underway in the Bombay High Court.
In 2017, the state WCD had to stall the process of procuring RUTF after the Centre issued notification against any policy decision on RUTF.
In 2018, however, the state WCD revived its efforts to start RUTF procurement after the PMO opined that it was on the state to decide on whether to start RUTF for malnourished children.