Global Acute Malnutrition (GAM) is a composite of severe acute malnutrition and moderate acute malnutrition that has continued to present a challenge for communities around the world. To treat (and prevent) GAM, supply chains have been developed to allow NGOs or ministries of health to deliver Specialized Nutritious Food (SNF) through health facilities, community volunteers or mobile clinics. The strength in supply chains, like the last-mile supply chain, ensures that target populations receive the right quantity and quality of SNF safely and on time. However, the stability of these avenues has been questioned as access to treatment and preventive measures has become strained over time and GAM prevalence increases.
Particularly in Chad, GAM is prevalent among 7.9 percent to 9.4 percent of the population. Nearly 1.8 million children under 5 years of age are suffering from acute malnutrition, and a quarter of those are experiencing severe acute malnutrition. In South Sudan, roughly 16 percent of the population is suffering from GAM, including about 1.4 million children under 5. As in Chad, about 25 percent of those children are experiencing severe acute malnutrition. To make matters worse the World Food Programme (WFP), which is the largest humanitarian agency in the world, is experiencing major funding shortfalls and has reduced aid to both countries. Climate change is a major factor, along with conflict and global food insecurity due to rising costs.
In fragile contexts, turning our attention to the supply chain and access to treatment is imperative. SNF supply chain disruption in Chad and South Sudan occurs due to a combination of bottlenecks, including poor planning, limited production and high variability of demand, no local suppliers, limited access to distribution points, and lead-time constraints. The resulting effective coverage of SNF is far below what it needs to be to prevent and treat acute malnutrition in those countries.
As the grateful recipients of an NYU 2023 Climate Change Initiative Award, we are working with the WFP to develop efficient delivery models that bring nutrition treatment services closer to communities in Chad and South Sudan. It is the first award at GPH that is explicitly designed to strengthen the nutrition supply chain for malnourished children in low-resource, fragile contexts.
Although supply chain management is so crucial to public health, it’s relatively scarce in the curriculum and more often taught in business schools. We hope that this project will increase the focus in public health education on logistics.
Along with six current and former GPH students, we are collaborating with the WFP regional bureaus in Nairobi and Dakar, and the country offices in South Sudan and Chad, to:
- Assess the SNF downstream supply chain distribution model, coverage levels, and costs in each country;
- Identify and prioritize downstream supply chain bottlenecks in each country;
- Assess the differential impact of climate change-related factors on downstream supply chain coverage; and
- Develop cost-effective strategies to improve the geographical coverage of SNF in the most vulnerable regions of Chad and South Sudan.
The students are organized into two teams and are starting with drawing systems maps, an approach familiar to public health.
SNF are delivered via Targeted Supplementary Feeding Programs (TSFP). The systems maps will use the percentage of children treated through TSFPs compared to those who need it and will lay out the factors that directly or indirectly influence that percentage. The maps will then be validated by professionals and community members in Chad and South Sudan, before the teams begin prioritizing and quantifying the effects of key bottlenecks. Then strategies will be evaluated to reduce those bottlenecks and estimate the needed investments.
We expect this project will lead to funding support for a larger implementation study including: 1) an investment case proposing a pilot distribution model to be implemented in the most vulnerable regions in Chad and South Sudan; and 2) implementing and evaluating the impact of the pilot distribution model on reducing SNF coverage bottlenecks in these regions.
Chris Dickey, DrPH
Clinical Associate Professor, Global Health
Moaz Abdelwadoud, DrPH
Visiting Assistant Professor, Global Health
Kieran Bligh
MPH Student; Supply Chain Officer, World Food Programme