Volume 1, Issue 4-5 / March-April 2009
Refugees raise critical questions about the “product rollout” of a new nutritional supplement called Mix Me.
The World Food Program (WFP), in collaboration with UNHCR, has introduced a micronutrient product to improve nutritional status in Kakuma Camp. After conducting an alimentation survey, the Mix Me “product rollout” began during February’s food ration distribution.
But many unused sachets of Mix Me can be found scattered around the camp, discarded by unenthusiastic recipients. Refugees have raised critical questions about the supplement, and rumors have begun to spread.
Some of these rumors are wildly speculative. For instance, it has been suggested that Mix Me contains a chemical that causes impotence and decreases female fertility. Others have raised suspicions about the fact that Mix Me was introduced after the Sudanese repatriated, fueling rumors that certain communities are being targeted.
Other refugees believe there is a paradox in the fact that WFP distributes Mix Me, which increases the appetite, while current food rations are insufficient. Many say they would prefer that their nutritional needs be met with real food products such as milk and fresh vegetables, rather than powdered supplements.
Another common concern surrounds the actual ingredients of the Mix Me powder. Some cultures or religions prohibit eating certain animal products such as pork or beef, and people want to know the ingredients for this purpose. Ingredients are not printed on Mix Me sachets.
The Mix Me “brand positioning” declares that “Using a sachet of Mix Me per family member every day gives the family important nutrients that bring energy, strength and health!”
Although WFP has initiated a public awareness campaign in collaboration with Population Services International (PSI) and Film Aid International (FAI) on the usage and utility of Mix Me, it left many critical questions unanswered.
Is this a product trial or pilot study?
Most importantly, refugees want to know whether Mix Me has been piloted among other populations before being brought to Kakuma, and if so, what the results were.
According to WFP documents, a product trial was carried out which “showed high acceptability by mothers who acknowledged improvement in health of their children—looking healthy, playing, and going to school.” It does not mention whether objective indicators of improved health—such as iron levels or vitamin deficiency—were assessed in the trial.
Many refugees suspect that the distribution of Mix Me constitutes a form of research piloting or “product trial.” They cite the fact that WFP intends to conduct baseline and follow-up measurements of health levels in the camp using blood tests, the results of which will apparently indicate whether the product met its intended aim. The baseline survey has already been conducted.
These questions of crucial concern to refugees participating in the “product rollout” could not be answered because WFP officials refused to comment when the concerns were raised by KANERE journalists.
If the Mix Me product rollout in Kakuma Camp does indeed constitute a pilot or “product trial,” refugees say they should have been fully informed and asked to provide informed consent before participating.
Other questions
During an information dissemination session in Kakuma Two, one refugee asked why Mix Me is served only to refugees in Kakuma but not in Daadab, while the conditions and status are almost the same. A PSI representative replied that similar nutritional products can be found in Kenyan supermarkets in the form of mineral or vitamin sprinklers, but that they are different from Mix Me (which is not commercially available). Furthermore, the iron level in Mix Me has been reduced due to high levels of malaria in Kakuma, as it is known that mosquitoes are attracted by iron.
Refugees would also like to know about potential negative side effects of Mix Me, especially when taking more than one sachet as indicated. During a workshop on food-related matters for community and religious leaders on 21st February, WFP officials ensured beneficiaries that Mix Me is safe. If one takes more than is required, the body will absorb only what is needed and will reject the rest. This can cause some abdominal upset, they added, and mentioned the issue of iron and prevalence of malaria in Kakuma.
Refugees also ask why Mix Me is given to the entire population, rather than selectively given to people with nutritional deficiencies upon recommendation by nutritional experts. According to WFP nutritionists, Mix Me is not a medicine but a food supplement, and can offer health benefits to everyone.
Lack of information and transparency
A number of questions remain without answer not because they are unanswerable, but due to the approach towards public information dissemination. WFP and other partners involved in the Mix Me product rollout must be open to the questions raised by refugees. Staffs involved in disseminating Mix Me say they need intensive training because they are exposed to difficult questions from beneficiaries while collecting empty Mix Me packets door to door.
Two KANERE journalists sought comment from WFP officials who declined to speak, citing organizational policy. On 27th March, the WFP Head of Sub-Office, Ms. Lourdes Ibarra, stated that WFP officials will not give information to KANERE until the free press is registered as a community-based organization.