28 October 2016

Have micronutrient powders been rolled out too fast? Yes and no.

Yesterday at the Micronutrient Forum in Mexico, there was a fascinating debate set up to answer the question: "have micronutrient powders been rolled out too quickly?".

Putting the case for "no, they have not" was Prof Stan Zlotkin and the case for "yes they have" was put forward by Dr. Omar Dary. Interestingly, both of them are on the GAIN Board!  Disclosure: GAIN works with partners to do work on scaling up micronutrient powders.

My former colleague Marie Ruel of IFPRI was the person tasked with penetrating the arguments and finding the areas of agreement and core differences.

The arguments seemed to boil down to why, when and how micronutrient powders are rolled out.

First, we need to demonstrate that there is a need to be met: is there widespread iron deficiency in infants and young children and might that deficiency be addressed through the better functioning of an existing program or interventions? Second, even if there is a deficiency and no way of meeting it with existing programs, does it make sense to address with micronutrient powders?  For example, can they be produced at the right quality at a low enough cost and is there a demand for such products? Finally, is the infant and young child nutrition infrastructure strong enough to support scale up and, indeed, will it be strengthened or undermined by such a scale up?  If the answer to these questions are in the affirmative then the scale up is probably going to make a positive contribution.

So the answer (at least this was my own takeaway) was, yes scale up if there is a need that cannot be met by existing interventions and if it is done thoughtfully in an evidence based way that supports health and food system infrastructure, but no, don't scale up where these kinds of conditions have not been met.

There should be more of these kinds of sessions in nutrition meetings: we faced a thorny issue head on, we showed that reasonable people can disagree without rancour, and we found some common ground in a serious but good natured way.  Lets keep it up!

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