USAID's Office of Food for Peace will consider proposals for the use of Non-Fat Dry Milk (NFDM) for therapeutic feeding under the following conditions:

1. The need for therapeutic feeding (TFP) is justified through reliable data which includes malnutrition and mortality rates of the affected population(s), clearly defined entry and exit criteria, and the expected duration of the program.

2. Therapeutic/High Energy Milk² incorporating NFDM is mixed and provided according to international standards (WHO, UNHCR/WFP), using clean water, vegetable oil, and a vitamin/mineral mix under hygienic conditions. The product is prepared and consumed in the controlled environment of an organized and medically supervised therapeutic feeding center or health clinic, and should not be used as a take-home ration.

3. NFDM containers for use in Therapeutic/High Energy Milk will be marked with a use-by date, and labeled "for use in preparation of therapeutic milk."

4. The Cooperating Sponsor (CS) will ensure that NFDM is stored in a secure and clean facility, and program controls and end-use monitoring are sufficient to prevent the inappropriate use or distribution of NFDM by program staff and/or beneficiaries. Further, CS must ensure that regular market checks are carried out to identify and deter possible leakage of NFDM into local markets.

5. Staff members receive training and supervision on the appropriate uses of NFDM for feeding programs. This will include the promotion of breastfeeding and protection of the International Code of Marketing of Breastmilk Substitutes. CS will ensure that guidelines for the proper use of NFDM are available in the appropriate language and that feeding centers are monitored on a regular basis by technically qualified personnel and are accessible to USAID personnel for monitoring purposes.

6. CS provides to USAID periodic reports (quarterly/six months) regarding any special problems, e.g., lactose intolerance or adverse impacts on breastfeeding, in accordance with international guidelines. CS will include information (monthly/quarterly) on recovery rates, death rates (case fatality rates), default rates, weight gain, average length of stay.

7. The Director of the Office of Food for Peace must approve any exceptions to the above policy.

¹ Therapeutic feeding is aimed at rehabilitation of severely malnourished persons to reduce excess mortality.

² NFDM should not replace the use of F75 and/or F100 for therapeutic feeding when obtaining these products is a viable option for the Cooperating Sponsor.