The pervasive theft of therapeutic foods and nutritional supplements intended for malnourished children is critically undermining efforts to provide life-saving assistance to millions nationwide. Minister of Health Lia Tadesse (MD) revealed last week that ready-to-use therapeutic foods (RUTFs), designed to supplement nutritional programs supported by donors, are subjected to illicit trade after being siphoned from organisations.

UNICEF procures approximately 80pc of the global production of therapeutic food, equivalent to nearly 50,000tn a year, and distributes it to countries where malnutrition and stunting are widespread, including Ethiopia. Yet, despite these efforts, the number of malnourished children nationwide has skyrocketed to an alarming 1.3 million due to conflicts and drought. The rampant illegal sale of supplements like plumpy nuts at kiosks and online chat groups mirrors a recent scandal that garnered significant media attention, where food aid intended for war-affected areas was found on sale.

Hiwot Darsene, the lead executive officer at the Nutrition Coordination Office within the Ministry and chair of the National Food & Nutrition Technical Committee, says the diversion of supplements occurs during transportation from Djibouti ports and 20,000 health posts across several regional states. Although a few sachets can be removed from carton boxes carrying 50 pieces during transport, the proliferation of these products in the market suggests a coordinated operation involving multiple actors.

"It's a large-scale operation that may include some officials," Hiwot said, disclosing several active cases under investigation, in joint operations with the federal police commission and intelligence agencies. "This approach is necessary due to the expansive scale of the operation."

International donors have submitted several reports to the Ministry revealing large-scale theft and misuse throughout the country. The 500-calorie peanut-based supplement is favoured for its high nutritional content and ease of consumption, as it requires no cooking. On sale for 40 Br a sachet, it is more affordable than a decent meal. However, Hiwot warned that regular consumption could cause imbalances and hinder access for the malnourished. She also highlighted a severe lack of public awareness.

A report published by the United Nations (UN) last month disclosed that 34pc of Ethiopian children under five suffer from stunting, while 6.2pc are victims of wasting. Shockingly, 28pc of child deaths in the country are associated with under-nutrition, while 21pc are underweight. The report also revealed that 25 million people are grappling with severe food insecurity due to war and disrupted agricultural cycles.

Tigray Regional State, one of the war-stricken states, faces a severe shortage of supplements.

Abraha Gebregziaber (MD), medical director of Ayder Hospital, emphasised the critical importance of therapeutic foods for treating malnourished children in their facility. Although Ayder is a referral hospital, where most patients require immediate assistance and are discharged after recovery, Abraha noted that efforts are made to reintegrate undernourished patients, primarily children, back into regular diets after a period of care.

However, several health posts in the regional state displayed notices declaring: "We're out of plumpy nuts". While some of these posts were looted during the two-year conflict, disrupting the supply chain, Abraha suspects that the illicit vendors might have sourced their supplies from therapeutic foods diverted during transportation. Although therapeutic milk availability is relatively better, he noted that health posts in the regional state consistently run out of supplements like Plumpy Nuts, despite their availability in numerous shops.

"We never have enough to get us past the month," he told Fortune. "It's perplexing how the shops manage to receive their supplies."

Regional states like Somali and Afar have also experienced similar predicaments. Mdecins du Monde (MDM), a French charity involved in humanitarian medical aid, has operated in Ethiopia since 1988. Its Country Representative, Shimelis Gebeyehu, witnessed the plight of malnourished children in the Somali Regional State. After rainfall ceased for three years, beginning in October 2021, the predominantly pastoralist community was engulfed by rabid hunger.

Shimelis recalled that stabilisation centres operated by MDM were inundated with children in the last stages of hunger, highlighting the crucial role of therapeutic foods in helping children recover and regain health during emergencies.

"The demand is consistently higher than the available supplies," Shimeles told Fortune. One child needs about 100 sachets consumed over the course of six weeks to recover.

The diversion problem resurfaces worldwide. A report by Doctors without Borders (Médecins Sans Frontières) in response to allegations of parents selling off the prescribed therapeutic foods in Nigeria indicates that large quantities are a result of diversion by people working in the health system and non-governmental organisations.

PlumpyNut, a peanut-based paste developed by André Briend in 1999 for treating severe acute malnutrition, is the most widely consumed nutritional food globally and locally. It is hailed as a miracle food for its effectiveness in combating malnutrition worldwide.

Hilina Enriched Foods Plc has been Ethiopia's sole manufacturer of plumpy nuts since 2007. The company produced 240,000 cartons this year and 345,000 the preceding year for its primary clients, UNICEF and the World Food Programme (WFP). General Manager Hilina Belete revealed that the company employs a tracing mechanism for production. Although the company considered incorporating barcodes into its products, the idea was shelved as health facilities nationwide would need barcode readers.

Hilina urged enforcing more stringent legal measures for those involved in the illicit trade as a deterrent. She recalled legal actions a few years ago where individuals possessing therapeutic foods were sentenced to a two-year jail term as a positive course despite not being thoroughly followed up.

PUBLISHED ON Aug 26,2023 [ VOL 24 , NO 1217]

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