NEWSBYMARK ARNOLDY

Buy One Jar of _________’s Peanut Butter.

Give One Package of NepalNUTrition’s ready to-use therapeutic food (RUTF).

Save a malnourished child’s life in Nepal.

Buy one. Give one. Save one.

A simple concept that others tried before TOMS Shoes, but no one has perfected the One for One model like TOMS Founder Blake Mycoskie has, and they deserve an enormous amount of credit for showing the business world a better way and making more than 100,000 consumer-philanthropists out of TOMS Shoes buyers (along with, of course, delivering 140,000 thousand pairs of shoes SO FAR to children in need).

We are out to do the same, and here’s why:

The major cost of implementing this life-saving peanut butter program in Nepal is the cost of the product itself (b/c the program is implemented through the gov’t staff that already exist). Imagine bypassing the long, tedious, and uncertain process of getting a major donor to commit to buying large amounts of RUTF and instead acquiring hundreds of thousands of consumer-philanthropists. This way the program becomes more sustainable, it gives everyone involved more motivation to expand our market, and adds value to the consumer’s purchase.

It seems the model only makes sense if you can do at least a few things:

1. Make an incredible product so your buyers are not only “sympathy buyers,” and you can charge slightly higher than competitors without losing the market
2. Don’t pay anything for marketing. Instead create “evangelists” for your product.
3. Use your hybrid status as a “not just for profit” to get all sorts of free inputs (marketing, great press and partners, interns, volunteers, etc…)

TOMS has been able to do all this and more, which is why I am trying to learn more about their business model, best practices, successes, and failures. At the same time, I want to make a proposal to TOMS: Lets build an umbrella One for One marketing machine. If high-performing One for One’s create this collective credibility, this will become a major movement (Why? Because my friend Will who pays $44 dollars for a good pair of TOMS knowing a child in Argentina will also get a pair of shoes will also buy a high-quality, healthy organic peanut butter for 10 cents more than the nearest competitor because he knows it will save the life of a malnourished child in Nepal. And he will tell his friends about it.)

So where is NepalNUTrition headed? We have our eyes on one producer already, Justin’s Nut Butter (http://justinsnutbutter.com) for a few reasons:

1. They are based out of Boulder (so am I…at the University of Colorado)
2. They are fairly new and fairly small (so this could still become part of their identity
3. They have some great TOMS Shoes-type clients (including Starbucks, Boulder moms, and college kids.)
4. They produce higher-end, organic varieties of nut butter so a small price difference at this price level means less than the same price difference for Peter Pan peanut butter level.

I’m pitching this to a group of MBA students in a Social Entrepreneurship class at CU-Boulder to see if they will consult us to plan and scale this with a partner. With this and a little guidance from TOMS, I think you could soon be buying Justin’s Nut Butter that saves a life. (better than peanut butter with salmonella, eh?)

As always, your thoughts are appreciated in the comments section below : )

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Want to learn more about NepalNUTrition? Follow us on Twitter at @NepalNUTrition and visit our website at: http://nepalnutrition.org

Last Wednesday, the Government of Nepal “eclipsed” expectations when they declared a public government holiday because of a brief solar eclipse that took place before most government officials wake for their morning tea.

What does this have to with our work of trying to deliver a life-saving fortified peanut butter to Nepal’s severely malnourished children?

Unfortunately, a lot. A great product without a great distribution system is useless. And events like these by the Government of Nepal coupled with the usual historical criticisms of the Nepali government (neglect, nepotism, incompetence, laziness, corruption, and more) raise doubts about using the Government’s Logistics Management System (LMS) to deliver the ready-to-use therapeutic food (RUTF) we are working to produce.

No doubt there are some extraordinary, dedicated government employees (including the Chief Nutrition Officer at the Child Health Division, Raj Kumar Pokharel). But I have visited far too many derelict, unstaffed “government-run” health posts in rural Nepal (like the one pictured below in one of the richest hilly districts in all of Nepal) to believe that the few dedicated civil servants can ensure that this life-saving peanut butter would (a) make it to its destinations across rural Nepal and (b) actually be used in the appropriate way if it reaches its destinations.

So this begs a difficult question that is applicable across all fields of development:

How can you design a program that provides what should already be a guaranteed public service without totally circumventing the public system and thus making it weaker and less accountable to the people it should be serving?

The potentially great thing about this Community-based Management of Acute Malnutrition (CMAM) that is being piloted in Nepal is that it could really enhance existing public health structures and programs (because it also includes protocols beyond only treating severe malnutrition with RUTF including de-worming, systemic infections, and vaccinations). It is currently being implemented not by some INGO but through the Government system in one district, and my recent trip to document the program indicates that it is working SO FAR.

But what happens when the pilot needs to expand beyond this one district that is quite accessible and has decent infrastructure? Will the LMS of the Government of Nepal guarantee this product reaches all the malnourished children that need it the most?

Experience suggests not, as many health posts remain unstaffed and are devoid of essential medicines that are all supposed to go through the LMS.

That’s why we are planning on working to design a distribution network for this product that operates as a Public-Private Partnership to identify and fill the gaps where the LMS doesn’t reach.

Our challenge is to do this in such a way that doesn’t completely replace the public system and relieve it of its rightful responsibilities. Any successful examples of doing this from around the world would be much appreciated…Thanks!

p.s. I have published a new photo album from my recent trip to rural Nepal to study the CMAM program. See the photos on Picasa here:

http://picasaweb.google.com/markarnoldy/NepalNUTritionPeanutButterCMAM?feat=directlink

or on Facebook here:

http://www.facebook.com/album.php?aid=2423516&id=10221248&l=3868ea7760

Unfortunately, my computer has crashed right as my friend Bryan Wilson and I are heading into rural Nepal to document the Community-based Management of Acute Malnutrition (CMAM) pilot program this week. This means I will be unable to compose posts while in the villages and send them off in our brief stints in places with internet. Posts will be back up a rolling after July 16th! My most sincere apologies.

But in the meantime, check out our newly launched website!  http://nepalnutrition.org  Please feel free to leave comments below on your impression of the site.

Also, a couple of updates:

- The presentation last Friday with the food producer went very well, and our partnership plan is set to move forward.

- We've attracted even more attention within the UNICEF circle internationally and within Nepal. This is good news to scale up production and the CMAM program.

Thank you for your readership and the ideas you have contributed so far. They mean a lot to us and are helping us move forward with creating a solution to the malnutrition problem here in Nepal.

Some really good posts (and pictures) to come upon return from our trip...

Mark

As soon as I told my Nepali friend that we have been contacted by one of the largest companies in all of Nepal because they share an interest in making this fortified peanut butter, she warned to practice caution because, in her words, “Some Big Sharks Eat Little Fish.”

This is certainly all the more true in a place like Nepal where the absence of a true legal system means that any contract negotiated between parties is always at the will of the most powerful partner.

So no doubt, there are some things I’m losing some sleep over since we’ve heard this news. But at the same time, this was actually part of the plan, and we (obviously) haven’t been working to conceal our intentions to start a social business to make this product. A good partnership with a quality food producer makes everyone’s life easier and holds the potential to drastically fast forward the start of production.

But this raises a tough question that is applicable across all fields:

What can be done if you and your partner don’t share exactly the same vision and values?

In my early experiences, it has already become clear that our plans and motivations are not exactly on parallel paths. As a young believer in a new framework for business, my beliefs don’t mirror that of Nepali businessmen in their 4th decades of moving up through a ruthless system where good intentions result in bad bottom lines.

So will the big fish eat the little shark? I don’t think so. Here’s why:
1.    We have a lot to offer if you look across the whole value chain inherent in this project. This requires much more than just producing a product. It also requires an intimate understanding of the program needed to distribute the product (which we have).
2.    We have built an entire movement, a project with thousands of followers and supporters (including our blessings from President Clinton himself).
3.     We have done very thorough, high-quality research. Knowledge is power in this case, and we have a lot of it that they need.
4.    And finally, people are supporting us because they believe in our intentions and our design. They aren’t supporting us because we are looking to make a high margin.

So now I’m faced with the onus of showing everyone involved how we can “do well by doing good” together. We are hoping to present our case this Friday. Good thing I’ve received some training from the extraordinary Transformative Action Institute, which teaches young people many needed skills including how to turn competition into collaboration. I will be putting all of TAI’s lessons to work later this week…

Anyway, it should be noted that the big shark and small fish do actually share a symbiotic relationship in real life. The small fish eats parasites off the shark to keep the shark healthy, and in turn, the shark keeps the fish safe…

We need your suggestions on the best short videos out there in the social/non-profit sector! Send us a link to your favorite videos as a comment, and we’ll send you some fortified peanut butter from Nepal someday! (hey, it’s the best we can offer right now…).

The need for compelling videos from the social/non-profit sector is the topic of this short and simple post because we are gearing up to make a film of our own.

Here’s the deal:
An awesome friend (Bryan Wilson, a recent UT-Austin grad) has come to Nepal to help share the reality of the malnutrition situation here with the rest of the world.  Soon we will be headed out to rural Nepal where a pilot nutrition program is being carried out the Government of Nepal in coordination with Concern Worldwide and UNICEF. This program is known as Community-based Management of Acute Malnutrition (CMAM). Scan below at my previous posts to learn a bit more about this program, and why it’s important.

But the short story is that CMAM is a vital component of ending acute malnutrition in Nepal. Without it, peanut butter or any other product is useless. It flips the current failed system of treating malnourished children on its head and takes treatment to the children instead of the other way around. But for this to succeed, donors need to be convinced this is the right program for Nepal.

Because we have a hunch that this is the right program for Nepal (or rather, the ONLY program that could reach Nepal’s malnourished children), we are setting out to highlight this work. We are going to the pilot district with our modest photo and video technologies, some notepads and pens, and our eyes and ears. We will capture an immense amount of material then find an editor who can hash together a video for us pro-bono. *Note: We also welcome recommendations for incredible editors who work for free (or peanut butter).

I’m interested in seeing what videos have been effective and compelling for you. If we base our video off models that have worked in the past, ours will have a better chance of success.

So please share links to videos that have inspired, informed, and moved you to act for a cause in the comments section below! We hope to create another one for your list…

To stay up to date on the NepalNUTrition Project and learn about how you can help, you can read blog posts here every Tuesday and Thursday or follow @NepalNUTrition or @markarnoldy on Twitter.

Hearing that “waiting to die” was the default treatment prescribed for most severely malnourished children in Nepal and knowing that 99% of these children don’t have a system designed for them broke my heart. Hearing that this “wasn’t an emergency” broke my patience and my belief that our development frameworks and rules are at all rooted in the concepts of social justice.

If 99% of all severely malnourished children in a country don’t have any treatment, how is that not an emergency?

Apparently this situation is not “bad enough” for some, and if we can’t prove that this is an “emergency” in the eyes of donors, the bad news is that this “non-emergency” will continue, because a big-time donors are only used to supporting CMAM (Community-based Management of Acute Malnutrition, as discussed in my last blog) in the “emergency context.” Traditional donors only fund for emergency situations and promoting this program in the “development context” instead of “emergency context” takes donors out of their traditional framework and comfort zone.

So here is a classic case of the “dangers of development talk.” Several of Nepal’s nutrition levels surpass the emergency cutoffs set by the WHO, yet it’s not being classified as an emergency because there hasn’t been a sudden, drastic deterioration of the nutrition situation in recent years. The argument seems to be that “because Nepal has always been in an emergency, we cannot qualify it as an emergency” --which I hope seems senselessly circular and completely irrational to more than just me.

This certainly lit an indignant fire under me. Now I understand why Paul Farmer refers to some of these international players as “TBMEs” or Transnational Bureaucrats Managing Inequality. But my indignant fire is likely to extinguish hopes of attracting donors funds for this program, as I’m sure no donors like to be told that “they don’t care about malnourished kids enough.”

So what would you do? We are a small player trying to make a big impact in shaping the future of Nepal’s nutrition program. Knowing what you know about the situation, if you were placed in a boardroom with donors who may or may not fund the scaling up of a community-based nutrition program, what tools, methods, and strategies would you use to convince them this is vitally important and worth their money?

Please share your ideas because it looks as if this theoretical situation will become real in the very near future. The Head Nutrition Officer at the Child Health Division of the Government has asked me to work with UNICEF to bring all the key players together for a meeting as soon as possible. Your thoughts and advice are much appreciated.

To stay up to date on the NepalNUTrition Project and learn about how you can help, you can read blog posts here every Tuesday and Thursday or follow @NepalNUTrition or @markarnoldy on Twitter.

Last week I tried to grant you an inside look at how malnutrition emerges and effects people here in Nepal by sharing Laxmi Bhattarai’s story (see it below). Laxmi’s set of circumstances don't even begin to encapsulate the wide variety of reasons children here become malnourished. There are many culprits—with poverty, poor education, and predatory actors within the liberal food market taking a big burden of the responsibility. But there also things you might not consider like the cultural perception, in some places, that rice is “rich mans food” or even that a cleft palate prevents children from nursing as it did for Dev Bahadur Khardka pictured here.

The point is that we could spend a lifetime identifying determinants of malnutrition and debating long-term routes to counteract those determinants. But what about now? Can we respond effectively to the immediate and disturbing injustice that is before our eyes? No country in the 21st century should be in a situation where 13% percent of its childrens' bodies are consuming their own body tissues so they can survive.

Fortunately, we can respond. And our response can reach all these children regardless of the complex reasons they became malnourished. How?

With Female Community Health Volunteers equipped with a color-coded armband and peanut butter.

Okay, this is a VAST oversimplification. But its best to understand a program many great organizations like Concern Worldwide are trying to get in place here known as CMAM (Community-based Management of Acute Malnutrition) in simple terms. The current system of treating malnourished children in Nutrition Rehabilitation Homes is completely inadequate (though this work is still incredibly valuable and the Nepal Youth Opportunity Foundation deserves much credit for the many lives they have saved). Using this method, 99% of acutely malnourished children are left without any treatment at all because there are not enough facilities (Nepal would need 90,000 more using current treatment capacities) and mothers can’t travel long distances and abandon work at home to stay at these NRHs for long periods of time.

So instead, CMAM flips this system on its head. It takes treatment to mothers and children by utilizing Nepal’s vast force of 48,000 Female Community Health Volunteers. The FCHVs are equipped with a color-coded arm band that measures the circumference of a child’s arm and tells the workers immediately how malnourished the child is. If malnourished, the mother is sent home with a 1-2 week supply of fortified peanut butter.

It only takes 6-8 weeks of this for a child to fully recover. Women don’t have to abandon their other work that is critical to the family (and other children) staying afloat nor does she have to cook 5-7 times day, which is what would be demanded without this peanut butter product. Oh, and by the way, this enhances the public health programs and systems that are already in place.

So what could stop this from happening? That’s the subject of Thursday’s blog titled, The Dangers of Development-Talk: “Non-Emergency Emergencies”

It seems fashionable these days to degrade “service” in some social entrepreneurship circles as if service is just some trivial, unsustainable act reserved for naive do-gooders. But I wholeheartedly disagree with this notion for this reason: Service creates a vital visceral connection we need to witness the suffering and realize the key “emotional insights” that ultimately drive a true social entrepreneur.

Today’s blog is named after one of those key emotional insights discovered by a world-renowned servant: Mother Teresa. Her key emotional insight that we are numbed by mass suffering but moved by the plight of the individual drives the philosophy behind today’s blog.

This is Laxmi Bhattarai and her 7-month old daughter, Pratishya, who is suffering from severe acute malnutrition. Laxmi is from a village of 100 people where the only health services available are referral services made from a health post without medications. The nearest hospital is a miserable, three-hour bus ride away.

Laxmi made that miserable bus ride seven months ago to bring a premature Pratishya into this world via a cesarean operation. Laxmi’s first child was a premature baby girl because Laxmi herself was malnourished while pregnant (she barely gained 4 pounds during the pregnancy and experienced severe weakness because of iron deficiency). Yet Laxmi left the hospital without a single doctor warning her that Pratishya may be extra-vulnerable to malnutrition (although she clearly was).

So Laxmi returned to her village and attempted to breastfeed Pratishya, but soon realized that she could not produce enough breast milk to keep her well-nourished. Without money or access to appropriate complementary foods, Pratishya’s body started to waste, or consume it’s own body tissues, to provide the vital nutrients to keep her alive. Because Laxmi was never afforded basic, primary education and no health services were available in her village, she took Pratishya to a traditional healer. By pure coincidence, Pratishya started looking a bit better after visiting the healer until, that is, she came down with diarrhea, which immediately pushed her dangerously close to death.

In desperation, Laxmi boarded a bus with her nearly dead 6-month-old daughter and returned to the same hospital where Pratishya was born. Luckily, Pratishya’s life was saved because this hospital is 1 of 8 across Nepal’s 75 districts that have a Nutrition Rehabilitation Home (NRH) attached to it.  Without this geographical luck, Pratishya’s treatment would have been, as locals described it, “waiting to die.”

“Waiting to die” is the default treatment prescribed by the current system to more than 100,000 severely malnourished children like Pratishya with mothers like Laxmi--mothers whose children become malnourished by no fault of their own.

But it does not have to be this way, and it will not be this way with your help. The program and product that can put an end to this situation will be the feature of Tuesday’s blog.

To stay up to date on the NepalNUTrition Project and learn about how you can help, you can read blog posts here every Tuesday and Thursday or follow @NepalNUTrition or @markarnoldy on Twitter.

I used to hate peanuts. It’s impossible to remember how many times accidental consumption of them has created a bit of terror in my life. Yet I will never forget the allergic reaction that took place on my first visit to Nepal in 2007.

On this fateful day, all motor transportation was stopped by a countrywide strike. So when I ate half a plate of nut sauce by mistake, the beginning stages of anaphylaxis were made all the more frightening by the fact that it would be near impossible to get to a hospital if needed.

I survived that day thanks to the bottle of Benadryl that never leaves my side. But this scare gave me a rare (albeit temporary) glimpse of empathy into the plight of each Nepali child who dies every 14 minutes from a simple lack of nutrition.

By chance, I soon learned the very product that threatens me with death could provide life to children threatened by malnutrition. It turns out that a fortified peanut butter, known as a ready-to-use therapeutic food (RUTF), is the recommended treatment for acutely malnourished children (see the joint statement by WHO, WFP, UNICEF, and UN Standing Committee on Nutrition).

This fortified peanut butter is a game-changer in the treatment of malnutrition for a lot of reasons: It requires no water or preparation, has a long shelf life, and allows for treatment in the home by non-medical professionals instead of forcing families to make long, arduous journeys to inpatient settings that are costly, time-intensive, and less effective.

We are in the midst of creating a social business to produce this fortified peanut butter locally in partnership with Himalayan HealthCare in an effort to create health AND wealth is Asia’s poorest country.

The need for this social enterprise is severe and urgent. Nearly 500,000 children under five (13%) suffer from either severe or moderate acute malnutrition and could benefit from eating this fortified peanut butter.

So I invite you to not just follow our blog, but to become an active member in our movement to end acute malnutrition in Nepal. I will use this blog to engage you in all of our most pressing debates and dilemmas, and your creative ideas and advice will be used to overcome our biggest challenges. Please comment liberally with questions, concerns, and advice because I look forward to working with you to solve this urgent problem denying so many children the right to a healthy life free from malnutrition.

Please also follow @NepalNUTrition and @markarnoldy on Twitter to get 140 character microblog updates on our work.