MALNUTRITION: The business of nutrition

The Irish Times - Tuesday, August 14, 2012

Dr Steve Collins examines a malnourished child in 2010.

Dr Steve Collins argues good business practice can change the way malnutrition is handledBRIAN O'CONNELL

DR STEVE Collins and his long dreadlocks bustle through the lobby of the International Airport Hotel in Cork. Wearing a smart suit and an open-necked shirt, he has just come from Westminster where he was lobbying MPs about malnutrition practices in the developing world.

Collins is anxious to get home to west Cork to check up on his herd of Dexter cattle, but over a pot of tea he describes how he is trying to change the nature of aid to the developing world and, in the process, to save millions of children dying from starvation and malnutrition each year.

His organisation, Valid Nutrition, is a humanitarian company set up to manufacture and distribute a range of ready-to-use therapeutic foods for profit. These foods treat and prevent severe malnutrition, and while the company is a charity registered in Ireland and the UK, it is also a fully fledged business looking to turn a profit.

Collins, a medical doctor, has strong views on how non-governmental organisations (NGOs) operate and why some funding models in the developing world are counter-productive. Far from his ideas being outside mainstream thinking, he received an MBE for his efforts in 2001 and the United Nations World Food Programme has now adopted many of his policies.

He is the first to admit that he has made many mistakes along the way. It’s not often, for example, you hear a medical professional confess they were responsible for a cholera epidemic.

The year was 1996 and he was employed as a doctor in Liberia with a UK-based NGO. “I was asked to set up a public health intervention in a village. We tested the water from the village well and it was pure. We prioritised feeding, because so many people were dying of starvation. This attracted people to the programme and, in turn, this overloaded the water source and cholera got in. It took hold very quickly. The war intensified and we had to leave for a few days. People died.”

In hindsight, Collins says he should have secured the water supply and delayed setting up the feeding centre until this was done. He said it taught him a valuable lesson about how to ask the right questions. When he asked villagers whether cholera was present, they said no. Many wanted the aid agencies to come to their village.

Had he asked what locals had died of, he would have found cholera was quite common in the surrounding areas. “It made me realise how hard it is when you are dealing with a new culture. I’d only been there a week. Afterwards, I wanted to publish information about the experience and the NGO involved, who are very good, said they were against it. They said it would damage public relations and damage their ability to raise funds. I thought we needed to encourage transparency and if understanding of emergencies is going to be limited, it would not help anyone.

“It struck me that this was a flaw in a model that generates its revenue from fundraising and charity rather than directly aligned with commerce arising from social need.”

While Collins is critical of some aid agencies, he is not opposed to charity and giving. He feels they are essential motivators in a civilised world but he says that charity alone is not enough to address chronic problems that exist.

“With a problem like chronic malnutrition, it causes irreversible damage in the first two years of life. The capacity of the charity sector or the UN is not big enough to address the 200-300 million children at risk annually. We have no alternative but to harness business.

“Many NGOs and the UN are involved in service delivery and they are not good at it. They tend to have supply-driven rather than demand-driven models. The key thing NGOs have to get over is that business is there to make money. The idea of wanting to make a profit out of poor people is actually a good concept. You have to show NGOs that an ethical model, albeit one that generates profit, can have a significant impact.”

In relation to Valid Nutrition, the company works with a combination of people from humanitarian and big business backgrounds. The current chief executive is Paul Murphy, who ran Unilever Ireland, while Howard Dalzell, who worked with Concern, is also involved.

To raise the capital needed to fund larger factories in Africa and other places, the company will soon issue shares. Those factories will be run by locals, who will benefit financially from their presence.

“The key difference is that we treat starvation victims who need our help as active clients rather than passive victims. Our product can be used at home. To make it work, we need to catch cases of malnutrition early and our packs have about 30 nutrients with a huge amount of science behind their development. All profits are invested back into the company at present, but in the future there will be returns for investors.

“There has been a crisis of capitalism in recent years and we are seeing that the unfettered pursuit of profit actually is screwing us all up. There is now, I believe, an appetite for less profit and a shared value concept.”

In the coming months, Valid Nutrition hopes to open more factories in sub-Saharan Africa, once capital funds have been raised.

Collins says a crisis is emerging in Niger and that Mali is also in difficulty. “I am critical of the way aid is reactive. I do acknowledge great improvement in the aid model, but there has to be change in the way we prevent malnutrition. There will always be wars, but a lot of these we know when they are coming. We knew Somalia was coming last year, and no one did anything. It is better in Niger now, but there is a crisis building in Mali and we need to be doing something there now, not when it is on television.”

Collins has been working in the NGO sector for over 30 years, and first experienced wholesale starvation during the Ethiopian famine in 1984. “The Band Aid food from that arrived so late that, where I was, we drove it out again as it was causing damage and instability. Now the strides we make in targeting areas are much better. Generally, emergency relief is more proactive.

“Famine response is generally triggered when you have pictures of starving children on television. By that stage it is too late.

“In Somalia we had high mortality rates before aid was getting in. It is not a good system.”

Collins moved to Bantry seven years ago and now lives on a small farm with his wife, Clare, and their two children.

He travels to Africa less these days and is more involved on a strategic level with the organisation. Also keeping him busy is a few acres in Bantry on which he has his herd of Dexters.

Despite bearing witness to thousands of deaths, Collins says he never has an unemotional response, particularly after becoming a father at 47.

“I still find it heart-breaking and incredibly emotional when I witness children dying. But when you are working in these situations you have got to blank it out. I have seen thousands of people die and some have died because I have made mistakes.

“In an emergency situation, shit happens. If you are there without resources, people die. We want to change that in a different way.”