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How WFP provided specialized nutritious

food to 1.5 million children in Pakistan

A Case Study on In-Country Production of LNS

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SUMMARY

In 2014, the WFP Policy, Programme, and Innovation Division initiated a project to support Regional Bureaux and Country Offices in knowledge

sharing through the documentation of a series of technical case studies in nutrition programming. The project was in response to numerous requests

from programme and nutrition officers for examples of how WFP has implemented nutrition-specific and nutrition-sensitive interventions. The first phase of the project highlighted flour fortification in Egypt, local

production of specialized nutritious food in Pakistan, nutrition-sensitive interventions in Ecuador and the Dominican Republic, and scaling-up

nutrition interventions in Niger and Malawi. WFP headquarters sent officers to each of the countries to interview stakeholders, review programming documents, and visit implementation sites. The nutrition programmes were

then summarized into these case studies, which focus on key success factors and lessons learned to date from each of the experiences. The

project also developed a template and guidance for writing technical case studies in order to facilitate further documentation of other experiences. The goal in sharing these case studies is to commend the hard work and

successes of WFP Country Offices, and to leverage the experiences to

support nutrition programming globally.

This initiative was made possible through the generous financial contribution

of the Children’s Investment Fund Foundation (CIFF).

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Cover Photograph WFP/Amjad Jamal Header Photographs WFP/Rein Skullerud/Amjad Jamal/Amjad Jamal

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Overview:

In the last 5 years, WFP has provided specialized

nutritious food to almost 1.5 million vulnerable children in Pakistan through local production of Lipid-Based Nutrient Supplements (LNS). WFP lead the development of Wawa Mum and Acha Mum, with the Country Office launching the initiative and providing technical assistance to the private sector in all steps from product development to final production. The

availability of production capacity in the food processing industry in Pakistan prior to the WFP

initiative was a key to the success of the local production of LNS. WFP made no direct financial investments in this process aside from own staff costs and procurement of the produced LNS

products. At the global level there is an increasing interest in LNS to both treat acute malnutrition and prevent acute and chronic malnutrition. The development of local capacity to produce LNS in Pakistan provides lessons learned and recommendations for other WFP local production initiatives.

Quick Facts:

Pakistan (population 180 million) is a Lower

Middle Income Country

Sufficient food is produced in Pakistan to feed

the population. Food insecurity and undernutrition are largely problems of economic access.

Acute and chronic malnutrition and micronutrient

deficiencies are recognized as serious public health concerns in Pakistan.

Pakistan is second globally, only after India, in

the number of acutely malnourished children.

Local production of LNS began in 2009. As of mid

- 2014 annual production capacity is 8,000MT.

How WFP provided specialized nutritious food to

1.5 million children in Pakistan

Cured and Healthy

Can you believe that the boys in these photos are one & the same?!

At age 4, Ram Lal weighed only 9 kg. He was so malnour-ished he could not even walk, so his parents brought him to a nutrition clinic in

Tharparkar where he received Acha Mum, a locally produced Lipid-Based Nutrient Supplement (LNS) for children under five that is made from chickpeas and fortified with vitamins. After eating WFP specialized nutritious food Acha Mum, he

gained 1.5 kilos of weight and is growing stronger every day. He is now doing well and has sustained his healthy growth and development.

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Key WFP Success Factors:

Leadership with an innovative vision for local

production

Forming private sector partnership with exist-

ing food companies

Food technology expertise to provide intense

technical assistance and training at produc-tion sites

Linking local production to nutrition program-

ming

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Context

Pakistan, located in South Asia, is the sixth most populous country in the world. Nutrition statistics are alarming with an estimated 1.3 million children under the age of five suffering from severe acute malnutrition (SAM) and 2.1 million children from moderate acute malnutrition (MAM).

Prior to 2008, WFP, the government of Pakistan and development partners did not prioritize malnutrition nor the interventions to address it. A number of crises including the 2007 floods in Baluchistan province, the 2008 spike in food prices, the 2009 population movements in Khyber

Pakhtunkhwa province, and the 2010 floods

catalysed the prioritization of nutrition in the country. An increasing number of development partners, including WFP, other UN agencies, international non-governmental organisations (NGO), and donors expanded their emergency responses to address the persistent and high levels

of malnutrition in Pakistan.

In 2007, UNICEF

introduced

Community

Management of

Acute Malnutrition

(CMAM) to Pakistan

with a package that

included SAM

treatment with a

lipid-based nutrition

supplement (LNS),

ready-to-use-

therapeutic-food

(RUTF). In 2008,

WFP engaged in

CMAM programming

to support the

treatment of MAM and increase coverage of

treatment programmes for acute malnutrition in

disaster-affected areas. In response to the 2010

floods, WFP extended its involvement in CMAM

programmes to over 40 districts throughout the

country.

The findings of the 2011 National Nutrition Survey,

coupled with the success of expanding CMAM

throughout Pakistan, advanced the nutrition agenda

within the Government of Pakistan. In 2014,

interventions to address malnutrition feature in

evolving national and provincial government policy

agendas and strategies. Unlike in other countries in

the region, Government and development partners

have embraced the use of LNS products as part of

an appropriate nutrition response to crises. The

acceptance is attributable, at least in part, to the

acceptance of a locally produced product. However,

as nutrition is further integrated into programmes

run by Pakistan’s Ministry of Health, there are

emerging questions regarding the cost-

effectiveness and affordability of locally produced

LNS. Pakistan has the four main components

necessary to locally-produce a LNS product: access

to raw materials at competitive prices, a mature

food processing industry, a regulatory body, and

quality assurance standards. Nonetheless

sustainability issues remain and cost-effectiveness

will need to be further explored.

Programme overview

In 2008 WFP initiated development capacity for the

local production of LNS in Pakistan. WFP’s strategy

was twofold: first, to develop a chickpea-based LNS

recipe because chickpeas are a traditionally eaten

food in Pakistan and the region; second, to partner

with existing private food manufacturers to

enhance their capacity to produce LNS products.

WFP’s strategy included provision of technical

assistance and procurement of the final product,

but WFP would not commit any financial investment

in private food manufacturers.

Following strict research and development

protocols, WFP designed, developed and tested a

chickpea-based LNS product for the prevention of

acute malnutrition to be distributed in conjunction

with general food distribution. Developers carefully

considered nutrition specifications, taste

preference, and product stability.

According to the 2011 Pakistan National Nutrition Survey:

Global acute malnutri-

tion (GAM) for children under 5 was 15.1%.

Severe acute malnutri-

tion (SAM) was 5.8% and moderate acute

malnutrition (MAM) was 9.3%.

43.7% of children under

five were stunted, while 61.9% were anaemic.

Just over 50% of wom-

en aged 15-49 years were anaemic. LNS

Lipid-based nutrient supplements (LNS) are a family of products providing the majority of the energy from lipids (fats). All LNS provide a range of vitamins and minerals, but unlike oth-

er multiple micronutrient supplements, LNS also provide energy, protein, and essential fatty acids. LNS formulations and doses can be tai-lored to meet the nutrient needs of specific groups and to fit in particular programmatic

contexts. Ready-to-Use-Therapeutic-Food (RUTF) is an example of LNS for the treatment

of SAM. Ready-to-Use-Supplementary-Foods (RUSF) are also LNS and, depending on the dosage and ingredients, can be used for ad-dressing micronutrient deficiencies, preventing stunting and acute malnutrition, or treating MAM.

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Through this process, the product reached a point of stability, quality, and safety in accordance with international quality standards, and nutrient requirements in terms of energy density and

micronutrient content.

In line with its procurement standards and according to technical requirements, WFP identified a private food manufacturer with the capacity to produce the LNS. By the end of 2009, the first company began production of Wawa Mum (“good food” in Pashto), a medium-quantity LNS for the

prevention of acute malnutrition. The first Wawa Mum reached beneficiaries in 2010, in response to the population displacements in northern Pakistan.

As WFP’s nutrition programme expanded so did the demand for LNS. To meet the growing demand, WFP formed partnerships with three additional

manufacturers for LNS production. The increase in number of manufacturers ensured sufficient production capacity to meet the acute increases in demand during crises. In addition, complying with WFP procurement rules and regulations required that multiple manufacturers could compete to produce the LNS.

Based on the successful production and distribution of Wawa Mum, and the increasing number of children suffering from MAM, WFP began development of a LNS product for the treatment of MAM. Based on the Wawa Mum recipe, WFP together with the existing manufacturers developed Acha Mum (mix of Urdu and Pashto languages

meaning "pleasant food"). This large-quantity LNS went into production in 2011. These factors and further investments made by the manufacturers led to an increase of total LNS production capacity from 100 metric tons (MT) per year in 2009 to over 10,000 MT in 2013.

Getting to Success: How WFP supported

local production of LNS (2008 - 2014)

WFP leadership with innovative vision

In 2008, a new WFP Deputy Country Director with previous experience in capacity development for recipe formulation and local production arrived in

the Pakistan Country Office. His arrival coincided with an increased attention to nutrition in the country. The high burden of malnutrition in the country and the large number of WFP beneficiaries in the 2008 population displacement created the need and demand for a response to malnutrition. The new Deputy Country Director introduced the

innovative concept of locally producing LNS in Pakistan, initiated the initiative, and led the programme for the duration of his assignment in Pakistan. With technical support from a food

technologist from the Regional Bureau in Bangkok, and in close collaboration with the WFP

procurement team, the Country Office began the lengthy process to successfully produce LNS locally.

Formimg a private sector partnership

Pakistan for many years has had a mature food processing industry for confectionary, biscuits and snacks such as chocolate, candies, crisps, and

other food products. The industry had an annual turnover of more than US$100 million and well-established domestic and international markets.

Importantly, the technology and equipment required to produce LNS were already in use for confectionary and similar products. Manufacturers were knowledgeable of production processes and

equipment needed for the LNS. WFP considered the existence of such production capacity a pre-requisite to forming a partnership with private sector manufacturers as it reduced the cost to produce LNS. In addition, WFP expected private partners to make a financial investment to open the

new production lines necessary for LNS production.

The identification and selection of food manufacturers was a collaborative effort between the Regional Bureau food technologist and the Pakistan Country Office procurement team. As such, the Regional Bureau provided the technical specification required while the WFP Pakistan

procurement team identified potential manufacturers and facilitated site visits. WFP’s selection criteria included not only the technical capacity of potential manufacturers, but also the

commitment of the senior management of the manufacturers to invest in a longer-term partnership with relatively low financial returns.

WFP was transparent with the manufacturers regarding the fact that demand would likely fluctuate for a product used in humanitarian programming, and financial investments to be made, while limited, would come entirely from the manufacturers.

Key WFP Success factors for LNS production in Pakistan

Leadership with an innovative vision for local

production

Forming private sector partnership with exist-

ing food companies

Food technology expertise to provide intense

technical assistance and training at production sites

Linking local production to nutrition program-

ming

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WFP embarked on discussions with potential partners fully aware that the partnership would not function as a traditional business model. WFP defined the relationship with private manufacturers

as one that combined business elements with a certain commitment to social responsibility. Not all potential manufacturers were interested in such an approach and finding the optimal partners required a significant investment of time and human resources on the part of WFP. A key success factor in the finalization and management of the

partnership agreements was the engagement of senior management on all sides (i.e. WFP leadership and the CEOs of the companies). After WFP invested 9 months into this process, a

manufacturer agreed to produce the first batch of 100MT LNS.

WFP provided technical assistance

Development of a product recipe

Local LNS production required an acceptable recipe that met nutrient and quality standards. WFP

developed the recipe by starting with a product

developed in India and making minor adjustments. The recipe met the nutrient requirements for the prevention of acute malnutrition. Initially, a food technologist from Regional Bureau provided all

technical support for the programme; however, the amount of technical support that partners needed necessitated additional capacity in the Country Office. In order to ensure quality technical supervision of product development and production, the Country Office recruited a full-time food technologist.

Initially food manufacturers produced only small batches of LNS while WFP and the manufacturers honed efficiency and quality. Simultaneously, the

WFP food technologist worked closely with the manufacturers on continuous product and packaging improvements. WFP also collaborated

with local and international scientific research laboratories for shelf life and stability studies. As of mid-2014, three studies were still in progress with results expected by the end of 2014. Preliminary findings suggest that recipe improvements have extended the shelf life of the LNS. In 2011, WFP also began working in close collaboration with the

food manufacturers on a large-quantity LNS product for the treatment of MAM.

Key lessons learned for WFP from the

start-up of the initiative:

Senior management stewardship and support

from onset was vital

Establishing a partnership with the right

manufacturer was essential

Having production capacity in the food

processing industry in country made the

programme feasible and is a prerequisite for

success

Figure 1: Flowchart of required aspects of LNS local production.

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Development of local production capacity in line with international quality and safety standards

In principle, the selected manufacturers had capacity and equipment to produce LNS at the

onset of the programme. However, there was a knowledge gap in quality assurance and control mechanisms required for the safe production of LNS according to international standards. WFP capitalized on the expertise of the Country Office food technologist in international food quality and safety standards for capacity development of the

food manufacturers. WFP focused its technical assistance on ensuring compliance with international standards. The WFP food technologist

invested a significant amount of time and effort at the production facilities. To meet standards, manufacturers had to, among other things, move

equipment to detached areas away from other production and establish production lines separate from their previous manufacturing processes.

Manufacturers had to improve hygiene standards and adapt or create new standard operating procedures for smooth production processes. The food technologist provided extensive training to

management and factory floor staff, as well as, regular follow up. He also performed technical assessments and factory audits. As a result, a strong relationship developed between the WFP food technologist and the food manufacturers that

facilitated the continued collaboration between WFP and the food manufacturers.

WFP’s technical support extended to quality control and monitoring. WFP contracted a third party inspection company to perform quality control inspections throughout the production process. All WFP Pakistan LNS tenders and contracts provide detailed lists of required standards and guidelines for

raw materials, composition, storage, processing,

macro- and micronutrient content, manufacturing processes, packaging and quality testing.

Quality control also required laboratory testing of LNS ingredients, as well as, the final product for safety and

nutrient value. Initially, international laboratories conducted food safety and nutrient content testing; however, over time domestic laboratories became accredited. The manufacturers upgraded their laboratory equipment and trained staff on the required testing. Furthermore, WFP identified a laboratory in Pakistan with the sufficient technical capacity to carry

out all required testing. Domestic product testing considerably reduced production-related costs.

Linking local production and nutrition

programming

The high prevalence of malnutrition in Pakistan was the impetus for WFP’s engagement in local production of LNS. WFP linked its nutrition programming demands to local production supply.

Continued crises in the country created sufficient

domestic demand for specialized nutritious foods, such as LNS, to support a somewhat stable market for manufacturers. WFP’s prioritization of nutrition and stakeholders’ and development partners’ heightened awareness of the critical need for

nutrition programming sustained the increased demand for LNS in Pakistan.

The demand for LNS in Pakistan increased considerably with WFP’s engagement in CMAM, coupled with the increasing needs caused by recurrent floods. In 2009 the demand was 100MT

and increased to a maximum of over 4,000 MT in 2012.

Example of standards in food quality used

by WFP

Codex Standard for Canned Baby Foods,

CAC/STAN 73-1981

Guidelines for Formulated Supplementary

Foods for Older Infants and Young Children, CAC/GL 08-1991

Recommended International Code of

Practice: General Principles of Food Hygiene CAC/RCP 1-1969 Rev 4 - 2003

including Annex “Hazard Analysis and Critical Control Point (HACCP) System and

Guidelines for its application”

General principles for addition of essential

nutrients to foods: CAC/GL 09-1987

(amended 1989 , 1991)

Key lessons learned for WFP from recipe

and capacity development:

WFP’s technical expertise in food

technology was vital for success

Intense and continuous technical support in

food technology was required

Key lessons learned for WFP from linking

local production and nutrition program-

ming:

WFP Country Office prioritization of

nutrition enhanced domestic demand

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Summary

Establishing stable demand is a remaining challenge for sustained LNS production capacity in Pakistan. WFP continues to be the primary market for the manufacturers; however, WFP’s emergency operations have diminished since 2010 and, therefore, demand has decreased by approximately

50%. The reduced demand forced two manufacturers to discontinue production of LNS.

Domestic production capacity has likewise dropped

to around 8,000MT in 2014. While the manufacturers recognize that making large revenue from the LNS production is not likely, they cannot afford to have employees and machinery sitting idle when demand is too low. Without active production lines, production scale-up in response to future crises will be hampered and supply for WFP at risk.

A sustained baseline demand is needed for sustainable local production capacity of LNS.

The Pakistan LNS local production programme was based on a strong partnership between WFP and private food manufacturers. WFP leadership worked with the upper management of food manufacturers,

and WFP provided technical assistance to the manufacturers. Existing production capacity in the Pakistan food industry was important for programme initiation. Nonetheless, WFP’s extensive training and continuous technical support were also key to improving the products and production

processes and scaling up production capacity.

WFP’s leadership and investment established previously non-existent LNS production capacity in

Pakistan. The local production of LNS in Pakistan provides insight into requirements for feasible local production, and the common challenges. For other countries interested in local production, Pakistan provides insight into the complexity of such an endeavor and how to achieve success.

Options to sustain local production capacity

Option 1: Link manufacturers with international WFP and external market WFP or others could

issue tenders for the production of LNS products for use in humanitarian aid, for other programmes, or for

commercial use. For example 500MT of LNS is being used in WFP Afghanistan and one manufacturer ex-ported a LNS to an organization in Kenya. The limited shelf-life of 6 months was an initial barrier to expor-tation; however, current shelf-life has already been extended to 9 months and preliminary results from the ongoing shelf-life studies indicate that an extension to 12 months or possibly even longer might be feasible during the second half of 2014.

Option 2: Expansion to Ready-to-Use Therapeutic Food production Though not directly managed

by WFP, WFP could assist the manufacturers in expanding to RUTF production. In March 2014, WFP in collaboration with UNICEF and MSF audited one potential manufacturer of RUTF. This manufacturer is now engaged with UNICEF in preparation for international RUTF tenders. Provincial governments in Pakistan,

under their provincial nutrition strategies, are already planning to use RUTF in nutrition programming. They would likely consider Acha Mum for MAM treatment as well, depending on funding levels. Provincial governments are legally prohibited from submitting tenders for international products. Local production would allow the provincial governments to procure LNS directly. Local production for LNS is, therefore, important and WFP could play a supportive role in sustaining and extending production.

Option 3: Develop national quality standards for the commercialization of LNS in Pakistan

Provincial governments are interested in commercialisation of LNS to allow reach of the products into the large urban areas where an important part of the health care provision is managed through the private

sector. To safely achieve this reach, Pakistan needs a national quality standard for LNS to legally ensure the minimum contents and microbiological criteria for LNS products. Having an established standard would prevent the marketing of products of lower quality and nutritional value under the pretext of being special-ized nutritious food. WFP could provide technical expertise to support development of such a standard.

Option 4: Use of Vouchers Using the government’s census data to find catchment areas with a high

density of beneficiary families needing assistance, WFP could leverage its expertise in cash and voucher programming to support establishment of a programme to exchange vouchers in stores for LNS. Such a programme would allow WFP to provide the manufacturers with a set purchase amount of LNS, allow stores to receive reimbursements for the products that they sell to both beneficiaries and the general pub-

lic, and increase the market for LNS products.

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Key success factors, lessons learned and

recommendations

Tables 1 and 2 summarize the key success factors, main lessons learned, ongoing challenges and

recommendations that were identified in the Pakistan case study and can be applied to other local LNS production initiatives.

Table 1:

Key success factors used in the WFP Country Office in Pakistan and recommendations for applying them in other programmatic settings

ACTIVITIES Used by WFP Pakistan to

develop local LNS production

KEY SUCCESS FACTOR Or

LESSON LEARNED

RECOMMENDATIONS For applying success factors or lessons

learned to other programmes

Engagement and technical expertise Senior management

(DCD) leadership and direct involvement ensured success.

Office requested tech-

nical support from Re-

gional Bureau on multi-ple occasions to ensure progress.

Senior management re-

cruited highly qualified staff to fill newly created food technology and

nutrition positions.

Senior management direct

involvement is crucial for success.

Clearly define skills required,

create additional positions if not available within team, and

recruit the right staff.

Senior management leadership and active engagement is required throughout the project timeframe. In addition:

The importance of having specific tech-

nical expertise in food technology with strong food industry background and

nutrition technical expertise needs to be part of staffing plan.

Close collaboration with Regional Bu-

reau/Headquarters and/or look to hire consultants with expertise in food tech-nology and nutrition to assist the team further, as appropriate (look for Re-gional Bureau/Headquarter advice on potential candidates).

Establishment of private sector partnership to support production

WFP evaluated the private

manufacturers’ production capacity and interest in engaging in a longer term partnership with WFP and humanitarian activities.

The WFP food technologist

provided intense training and continuous technical support to the manufac-turers.

WFP was transparent

about terms of financial investments and potential financial gains.

WFP must set and adhere to

clear criteria for the selection of a manufacturer.

Manufacturers need to under-

stand and agree to these cri-teria at the start of the part-

nership.

Continuous intense technical

support by WFP is required.

Consider not only technical capacity,

but be clear with the private sector on the type of engagement. Minimum technical capacity, e.g. being able to apply ISO 22000 standards, is required or production is not possible.

Buy-in from the private sector is nec-

essary and WFP needs to be ready for a longer term engagement.

Required investments need to be

clearly discussed with manufacturers. WFP needs to be transparent about the level of possible financial commitment (if any).

Nutrition needs to be a priority with programmes at scale to generate demand

In Pakistan, WFP made

nutrition a priority for the Country Office that, in turn, supported demand for the product.

WFP is working with oth-

er stakeholders within and outside of Pakistan to develop a more stable market.

In-country production is only

advisable when there is demand. This demand is linked to malnutrition in country and to the level and/or type of governmental

nutrition programming (e.g. use of LNS in social safety net programme).

WFP cannot be the sole de-

mand for a sustainable mar-ket.

Nutrition programming within WFP can

support the demand side of the value chain; however, WFP can support a sustainable market by a) effectively engaging other nutrition stakeholders to add LNS to their programming if

appropriate (e.g. UNICEF, Govern-ment, NGOs); and b) facilitating safe commercialisation of LNS products.

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Table 2:

List of challenges that surfaced during local production programme in Pakistan and possible solutions that other programmes could consider.

Challenges Possible Solution (s)

Shelf life limitations

Shelf-life limitations have a di-rect effect on the possibility to

store and export the products.

Consider shelf-life studies from the beginning of a LNS production ini-

tiative involving new recipes.

Involvement of WFP research and scientific partners for shelf life stud-

ies like KEMIN, DSM

Learn from the Pakistan experience on how to increase shelf life of

similar products (6 months to 24 months at 30 degree C).

LNS suppliers are primarily responsible to conduct shelf life studies

and it is on-going process.

Low demand

WFP demand cannot be the sole driver for the market demand

because of the inconsistent de-mands of the humanitarian market.

For WFP, other humanitarian organisations and governments requiring LNS products for programming, in-country production capacity is critical

for low-cost and easily accessible products. A market for such products needs to exist to ensure production. Options, where WFP can take direct action or can assist others, include:

Manufacturers being able to compete in international tenders

(WFP and others)

Extension of production to other LNS products like RUTF

Creation of national quality standards (similar to Codex Alimentarius)

as a basis to allow for safe commercial production and sale to avoid

products of lower quality and nutritional value being marketed under the false pretext of being highly nutritious foods

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