Making Nutrition a Sustainable Business in Haiti

Plumpynut revolutionized the treatment of acutely malnourished children.  In Haiti, Partners in Health (PIH) has produced a local variant, Nourimamba, since 2007.  The Abbot pharmaceutical company is working closely with PIH to further improve Nourimamba and to expand production.  The opening of a factory is scheduled for end 2012.  This is good news for malnourished children, the health care providers who treat them, and the farmers who produce the ingredients for Nourimamba.  An article by New York Times writer Duff Wilson on the PIH/Abbot partnership follows.  

Pharmaceutical companies around the globe are donating billions of dollars in free drugs to third world countries grappling with poverty and disease.  The Illinois-based company is donating the time of dozens of workers with expertise in food sciences and engineering, in addition to $6.5 million cash, to build a charitable, self-sustaining nutrition enterprise in Haiti, the poorest country of the Western Hemisphere.  On the central plateau of Haiti one day recently, 18 women sat in the shade hand-sorting peanuts in wide, flat baskets.  “You know the misery we live in,” said one of them, Francilia Joseph. “I have six children at home. With this money, I’m able to send three of them to school.”  Other workers roast the peanuts on gas stovetops, blend them in food processors with oil, powdered milk and vitamins, and spoon the sticky mix into plastic jars.  The uniquely Haitian product, called Nourimanba, is an essential medicine for about 10,000 severely malnourished children a year. It is distributed to clinics by Partners in Health, a Boston-based nonprofit organization that is the largest provider of health care services in rural Haiti.  A few hundred yards away lies a roadway of rocks leading to an empty lot. Rising soon: an 18,000-square-foot manufacturing plant to produce the vitamin-enriched peanut butter on a much larger scale. In addition, some regular peanut butter may also be exported for sale to sustain the business.  If Abbott can build an oasis of locally grown, nutritious food manufacturing in Haiti, it will be a little bit of green in a notoriously dark place, where it is difficult to make any real difference in people’s lives.

“If you’re going to see a transformational change in a place like Haiti, it’s going to take a strategy beyond philanthropy,” said Katherine F. Pickus, Abbott’s divisional vice president for global citizenship and policy. “We saw this as an opportunity for Abbott to not only give its products, but its expertise as a nutrition business.”  Even before the 2010 earthquake heaped more misery atop the poverty in Haiti, one in four children had stunted growth. An estimated 2.2 percent of Haitian children under the age of 5 had severe acute malnutrition, according to the United Nations Children’s Fund.  Now it is worse. The quake killed 316,000, according to the government, and forced hundreds of thousands of people to leave the devastated capital city, Port-au-Prince, for the deeply impoverished plateau. Nourimanba is a high-calorie, high-protein, peanut-based paste that does not require mixing with water or refrigeration. It is a ready-to-use therapeutic food for severe malnutrition.  “We’ve been producing locally grown therapeutic food since 2007,” said Joan VanWassenhove, associate coordinator for nutrition in Haiti for Partners in Health. “But Abbott’s involvement will help with quantity, as well as quality, and help with higher levels of food safety and sanitation standards. In our eyes, it’s going to be an astounding success.”  As one small part of its work there, the health organization runs the Nourimanba operation near Corporant, about 30 miles north of Port-au-Prince. The group, affiliated with Harvard Medical School and Brigham and Women’s Hospital in Boston, was founded in 1987 to help Haiti. It has about 15,000 employees around the world.  While the rudimentary production plant makes about 70 tons of Nourimanba for 10,000 children a year, the new one will push capacity to more than 350 tons and 50,000 children, the health group’s spokesman, Andrew Marx, said. Children receive it daily for six to eight weeks. The new operation will also expand on the 300 or so farmers who have a guaranteed market for their peanut crops.   “An alternative to poverty and disease is to have a virtuous cycle of health, well-being and opportunity,” Mr. Marx said.  “I’ve seen some children who are malnourished in my community receive Nourimanba,” one of the peanut farmers, Wesley Louis-Jean, said. “They regain their strength quickly with it. I’m happy to see that.”  Abbott and its foundation previously worked with the health group in Malawi, Africa, to pay for a new clinic. “But this is a departure,” Ms. VanWassenhove said. “It’s not Abbott coming in and saying we have an idea we can do. It’s more like saying we want to take your vision and make it the best possible.” The charity is also a point of pride for a drug company that has been involved with some dark chapters in pharmaceutical history. Just last month, Abbott set aside $1.5 billion in anticipation of settling criminal and civil investigations that it had illegally marketed the epilepsy drug, Depakote, to elderly patients with dementia, for whom it was unsafe.

Peanut Butter Plus Abbott, which had a $4.5 billion profit on $38.4 billion in sales in the 12 months ended Sept. 30, has been listed by The Chronicle of Philanthropy as one of the most generous companies in the United States. In 2010, The Chronicle found, 91 percent of Abbott’s giving, or $572 million, was in the form of products, the fourth-highest ratio among major companies.  The view from Abbott is one of being thankful to work on such a meaningful project as the nutrition factory, according to Daniel Schmitz, a scientist and laboratory director of Abbott Nutrition in Columbus, Ohio, who is leading the nutritional team on the project. Abbott is donating the time of food scientists, chemists, microbiologists, formulation developers and process engineers, he said.  Their work starts with the recipe. Nourimanba is made of peanuts, milk powder, vegetable oil, sugar and a specially formulated vitamin mix. It’s “a very good recipe, and it provides everything we need for malnutrition,” Mr. Schmitz said. But Abbott is looking at alternatives to the milk powder because it is imported and expensive. “We’re going to look at things that are a viable crop in Haiti,” Mr. Schmitz said. That may include soybeans, beans or other legumes — locally sourced ingredients that could cut that cost in half. “I’m excited about that part of it because that’s really a true R.& D. effort, and it just offers the potential to build in something that is truly Haitian,” he said.  Then there is the factory. Groundbreaking was delayed this year by an outbreak of cholera that caused 6,000 deaths in Haiti. Now groundbreaking is planned for January and production before the end of 2012.  “We’re building it to be a very robust, simple operation,” Mr. Schmitz said. For instance, the women picking out bad peanuts will be inspecting them on a table with a vibrating conveyer belt that aligns the nuts and bounces them so workers can see the tops and bottoms.  “They’re still manually picking, but it’s much more efficient because you’re not rolling peanuts around a basket,” Mr. Schmitz said.  The pickers said they appreciate this job, any job. “I didn’t have any work at all before this,” said one, Marie-Jo Louis-Beatrice.  Half the number of pickers will be needed in the new place, but the others will be trained for other jobs, Mr. Schmitz said. Total employment is expected to rise to about 60 workers from 40 as the plant capacity expands fivefold.  And that’s running just one shift. Mr. Schmitz said the plant could run many more hours if it finds more supplies and children to help.

Ben Depp contributed reporting from Haiti.  This article has been revised to reflect the following correction: An earlier version of this article incorrectly reported that Nourimanba was “Unicef-approved.” It has not been approved or disapproved by Unicef.