WPHNA World Public Health Nutrition Association

Last month I was getting ready to attend the African Nutrition Leadership ProgrammE (ANLP) as a member of the support team, and in my previous column I said I would report back. Here I share some of the new things I learned on the course. You see, the beauty of the ANLP is that you always learn new stuff, no matter how many times you attend. All the members of the organising team can testify to this. I’m sure this is true of the European and South-East Asian programmes too. Plus I have found out some more about the ‘miracle’ ready-to-use-therapeutic-foods (RUTFs). The politics of RUTFs are rough stuff. So I begin this month’s column with my calming picture of sunset over the river Elgro, in the interior of South Africa.

Leadership in Africa

Unleashing people's potential

This year’s ANLP was held between 16-26 March at the Elgro Lodge in Potchefstroom, in the North-West province of South Africa. It was the eighth African nutrition leadership programme, following the 2009 programme pictured above, and recorded the largest number of country representation, with participants from 16 African countries, with many different specialities within nutrition. Everybody had a common interest, to promote and protect the nutritional health and well being of the public, especially vulnerable groups.

The organising team for all the African programmes, led by Professor Johann Jerling, is a group of capable and committed people, always there to provide the needed support. The team has proved that programmes such as this can be organised in Africa in a successful and sustainable manner. Moreover, the resource persons are seasoned professionals in the field of leadership training. Forgive me Johann, I know you don’t want to be called professor, because when we are working together we don’t use any titles. We don’t disregard them, so don’t get me wrong, but we do not focus on them and hence there are no barriers. Altogether since its inception, the African programmes have been attended by close to 200 participants from over 20 African countries. Their leadership capacities have been built, and many are doing extremely well in Africa and beyond.

The 2010 programme was divided into seven sections: teambuilding, communication, leadership, self awareness, advocacy and lobbying, social responsibility, and the ANLP declaration. I am going to share with you one new thing I learned from each section:

Teamwork and trust

Here I learned about trust. For instance some of the team-building activities such as walking along high ropes required that participants fully trusted their team members, knowing that if they slipped off the rope, they would not fall because they were held by their team members. This is important because though most of us work in teams, we don’t sometimes trust other team members. When this happens, either a few people in the team end up doing everything and then often give up so nothing gets done, because no one can do everything, or else are immensely ineffective. Sometimes, we don’t even trust the systems that support us as well.

You may think, but what about when people are not trustworthy, how can I still trust them? Well I will leave that to you to judge, but there are times when we do not even give people the chance to prove themselves.

Effective communication

Here I learned to communicate in a clear, concise and succinct manner, making sure (not assuming) that I am understood by getting feedback. This reminded me that nutritionists should publish research findings regularly, especially those who are doing wonderful and novel research in Africa. If it has to do with protecting and promoting the health of the public, we should lobby the decision makers including the governments to commit and act, not by just describing the problem but by providing proposals for feasible and effective solutions.

The new style of leadership

Here I learned about the new style of leadership. This is about unleashing the potential of others by providing support, care and motivation. Let others shine. For instance when you observe an orchestra performing, the conductor may be centre stage, as in this picture, but the task of the conductor is to enable us to focus on the music, the harmonious and I integrated sound that the orchestra makes. At the end of the performance, people will often say ‘oh they really played well…’ and that means the conductors has successfully unleashed the potential in the players. Remember people do not normally say ‘oh he really conducted well’ but the conductor’s job is so important in creating the needed harmony and the beautiful music.

If team leaders were to train others, and encourage the so-called subordinates, the new and young scientists in their teams, we will be more likely to be successful and make a difference, and also there will be others to take over from us when we are retired or dead and gone. Notice the gap between current leadership in many fields including nutrition – the professors, senior lecturers or heads of departments and research institutes in Universities across Africa and probably globally – and you would most likely will notice a generation gap. It looks as if there’s a group close to retiring but very few have been trained to take over.

Know yourself

On self awareness, I learned more about my strengths, weaknesses, personality and character. Self awareness is important because the different people in our different teams can complement each other. There is no need to force ourselves into roles and positions we know we are incapable of performing.

Be the change

Regarding advocacy and lobbying, I learned that usually the change starts with us and when we first change, we are more able to effect change in others. It is like looking at your own self in a mirror. Who do you see? Of course you! So maybe there are some things about the practice of public health nutrition which should change. I’m just saying maybe, and you can disagree with me, but it’s worth considering.

We are responsible

On social responsibility I understood that as nutritionists we may find ourselves working in industry, government, academia, or in the civil society (non-government organisation) sector. Wherever we are placed, we still have a social responsibility to promote and protect health and well-being based on both humanitarian and professional principles. A good example is the ready to use therapeutic food (RUTF) issue, and I am coming to that… I have also learned another rule, which is not to take myself too seriously.

Ready to use therapeutic foods

Problems with Plumpy

Last month I shared my views as well as those of other nutritionists, regarding the policies and politics of food aid, and specifically of ready to use therapeutic food (RUTFs) My feeling has been that politicking is hindering the promotion and protection of the health and well being of vulnerable groups and even whole countries. I also asked if lack of leadership among public health nutritionists is part of the problem.

Well I must say that the policies and politics of RUTFs have taken on a different turn following legal battles against Nutriset, the company that owns the patent for the RUTF Plumpy’nut, which I call the ‘undernutrition miracle product’ though some call it the ‘hunger wonder-product’. As I began to write this column, I received an email from a colleague with the subject ‘Legal fight over Plumpy’nut’ with a web link, which led me to a BBC news story from Paris by Hugh Schofield, accessible at http://news.bbc.co.uk/1/hi/world/europe/8610427.stm, with the question: ‘Should a revolutionary humanitarian food product be protected by commercial patent, when lifting restrictions might save millions of starving children?’

I learned from this that two US-based not-for-profit organisations have filed a suit at a Washington DC court to have the patent on Plumpy’nut overturned, because this stops them manufacturing their own, cheaper RUTF: http://imtf.org/page/rutf/. However in response Nutriset says the patent is needed to safeguard production of Plumpy’nut in low-income countries, and to stop the market swamped by cheapened US surpluses.
I decided to search further, and found that Medecins Sans Frontieres (MSF) wrote a letter to Nutriset concerning the intellectual property: http://globalhealthreport.blogspot.com/2009/04/msf-challenges-nutriset-on-plumpynut.html. (For those new to MSF, it is an international humanitarian aid organisation that provides emergency medical assistance to populations in danger, in more than 70 countries). In the letter, MSF reaffirmed the major role Nutriset has played in the development of products used in the battle against undernutrition. However, they said, there are problems. .

Interested parties

The first problem MSF mentioned in the letter was that an increase in the consumption of RUTF can create stresses in the food supply chain. In the second quarter of 2008 such shortages were experienced. Second, the success of RUTF has aroused interest among producers, which can create conditions for better availability and lower prices. Nutriset currently allows NGOs to produce RUTF, but only under their franchise. These agreements include restrictions and limitations that can discourage other producers. MSF urged Nutriset to make public a proposal made at a meeting in Rome in 2007: http://www.nutriset.fr/index.php?option=com_content&task=view&id=78&Itemid=49. This would grant licenses to producers in the South for the manufacture of RUTFs in return for the payment of a fair royalty in the countries where patents are in force.

Perhaps the main point made by MSF is that the intellectual property pertaining to nutritional products of a humanitarian nature must be handled differently from that pertaining to commercial products. Licences should be offered to third parties on a flexible terms and conditions to ensure availability. The MSF letter concluded that agencies working in the battle against undernutrition cannot and should not have to depend on a single source of supply for RUTF.

So going back to the news item on BBC, I realised that there are sound arguments from both parties. The US companies filing the suit argue that Nutriset is preventing undernourished children from getting what they need to survive. However Adeline Lescanne of Nutriset says that no child in the world has even been denied access to the product as a result of the patent issue.

In response the US companies stressed that worldwide demand for RUTF can only be met if supply is opened up, especially in the US with its large peanut industry. They stated that currently only one to two million undernourished children are given Plumpy’nut or equivalents. From the perspective of Nutriset however, if the US companies were able to beat the patent, it would mean the end for local partners in Africa, because companies in Africa where Nutriset has a network of partnerships and franchises to produce RUTF in a sustainable way can’t compete. This is because although the US is the world's biggest food donor, US laws require that 99 per cent of aid money be spent on American-grown surpluses.

In the midst of all these debates and battles, who suffers? Do these parties only have the world’s undernourished children at heart, or do they have other interests? I can’t answer that. Maybe some readers of this column can. Let’s hope that they all want to help. If so, an amicable solution should be reached sooner than later.

Capacity building in nutrition

What commitment means

To look at the way forward I would like to share the 2010 African Nutrition Leaders Programme Declaration with you. It states:

‘We as the participants of ANLP 2010 hereby declare our commitment to advocate for affordable, sustainable and evidence-based nutrition interventions and policies in Africa. Through our networks, we will practice and promote effective leadership by mentoring, empowering and building capacity on the African continent. Our actions and vision will be guided by integrity, honesty, passion, responsibility and respect’.

I believe that providing leadership training of this kind, associated with commitment from participants to make a difference, is a step in the right direction. I commend the companies and institutions which provide support for this programme. I urge them to continue.

I also believe that the World Public Health Nutrition Association has a role to play in the issues discussed here. This column itself gives me the opportunity to raise awareness, encourage political will, engage the public, and increase interest in our field. Correspondingly, we need more people to join the Association, to give a big unified voice. So if you are reading this and have not yet applied to become a member, please do so. You can do this in one visit to the site – click out of this column, once you have read it, and click on ‘membership’ If we have numbers, we can do more lobbying and advocacy – that is leadership.

We need to be committed if we truly desire to make a difference in the world. Ask not what the Association can do for you. Ask what you can do for the Association. Reflect on these things.

Request and acknowledgement

I would like to thank the organising team for the African Nutrition Leadership Programme: Johann Jerling, Onno Korver, Edelweiss Wentzel-Viljoen, Jane Badham, Averalda van Graan , Marlien Pieters, Namukolo Covic and Sanet Vermeulen.

You are invited please to respond, comment, disagree, as you wish. Please use the response facility below. You are free to make use of the material in this column, provided you acknowledge the Association, and me please, and cite the Association’s website.

Please cite as: Annan R. Unleashing people’s potential, and other items. [Column] Website of the World Public Health Nutrition Association, May 2010. Obtainable at www.wphna.org.

The opinions expressed in all contributions to the website of the World Public Health Nutrition Association (the Association) including its journal World Nutrition, are those of their authors. They should not be taken to be the view or policy of the Association, or of any of its affiliated or associated bodies, unless this is explicitly stated.

regvies@yahoo.com

May blog: Reggie Annan

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