On October 13, Operation End Starvation (OES) held its first informational webinar for implementing partners. More than 100 colleagues registered, including representatives from NGOs, UN agencies, donor governments, research institutions, and manufacturers. Thank you to everyone who joined and shared questions.
Panelists included:
William Moore, CEO
Ellyn Yakowenko, Director, Global Programs
Karlan Jankowski, Director, Global Supply Chain
Keisha Effiom, Director, Contracts, Grants, and Compliance
Andrew Wang, Director, Cost Effectiveness and Innovation
Ramsey Day, Senior Advisor
CEO William Moore opened with why OES exists and the foundational principles. RUTF works, but for 30 years it has been funded through short-term, unpredictable grants, so treatment often stops just when children need it most. OES is designed to change that by bringing multi-year financing and planning to the treatment sector.
The team then walked through OES’s model across the full treatment pathway; our supply chain approach, from open international procurement to an agreed in-country handover point; and our delivery approach, centered on outpatient treatment of severe acute malnutrition and sachet-based dosing. They also covered how the forthcoming Expression of Interest process will work. The webinar recording will be available later this year.
Q&A
The live Q&A addressed country selection, award length, RUTF sourcing, data systems, and relapse, among other topics. As OES is in active discussions with the State Department to finalize our award, some details are still in development. We plan to share more information when it becomes available.
General
How is OES funded?
OES is a public-private partnership funded through a diverse set of government and philanthropic resources. The U.S. government is an anchor funder, as are the Eleanor Crook Foundation and CRI Foundation on the philanthropic side.
How do U.S. government and philanthropic funds fit together?
Public funds are focused on direct program implementation, including program delivery and supply chain. Philanthropy covers 100% of OES’s operating costs, provides flexible capital for advance purchasing and contingencies, and catalytic funding for research and innovation. For every $1 of private investment, OES aims to unlock at least $3 of public funding from donor governments and, where possible, host governments.
What portion of the total funding pot do you expect will be channeled to programming (outside of last mile delivery), and how much for last mile delivery?
OES has no specific or set split between product and programs; we expect these ratios to vary by contexts and also OES’s comparative value add in each context.
How are OES countries selected?
OES expects to focus initial resources towards Nigeria and Sudan. We expect the country portfolio to expand within OES’s first years of implementation, although no specific expansion countries have yet been confirmed.
When will the EOI be released, and how do organizations apply?
OES expects to release the Expression of Interest (EOI) for implementing partners within the coming months. It will be shared with all webinar participants, all individuals who have registered for notifications on our website (if you have not done so yet, please register here) and posted on the OES website.
The EOI is for implementing partners delivering treatment programs. RUTF manufacturers and logistics providers will be selected through separate competitive processes. Organizations seeking to apply must obtain a Unique Entity Identifier (UEI) through SAM.gov before receiving an award and are encouraged to begin that process early.
Does OES prefer consortia or single applicants?
OES aims to ensure a diverse applicant pool for its open, competitive selection process. At the current time, we expect no restrictions in regards to individual applicants or consortia, and we have no preference for either structure.
What criteria will OES use to select partners, and is co-funding required?
The EOI, once released, will identify selection criteria so that prospective partners can understand those factors that would provide a strong response. Since cost-effectiveness is OES’s north star, we do expect to evaluate applicants based on their ability to deliver cost-effective treatment but also note that we expect cost-effectiveness to be one among many selection criteria at the EOI stage. Co-funding is not required.
How many awards will OES make per country, and how large will they be?
OES has not established a fixed number or size of awards per country.
When does OES expect to make its first awards? Is the goal to have the product in-country and ready for programming in the first quarter of 2027?
OES anticipates making its first awards in early 2027.
Will OES require alignment with PHFFA?
The Promoting Human Flourishing in Foreign Assistance (PHFFA) policy applies to State Department-funded grants and sub-awards. It consists of three rules: Protecting Life in Foreign Assistance; Combating Gender Ideology in Foreign Assistance; and Combating Discriminatory Equity Ideology in Foreign Assistance. Where OES sub-awards are funded with U.S. foreign assistance, the applicable requirements will be included as standard provisions in award agreements. Under State’s published PHFFA rules, there is no separate certification; organizations agree to the provisions when they sign an award. The Expression of Interest (EOI) will ask applicants to indicate their current position on PHFFA, including if their review is still underway.
Will OES seek or support PHFFA waivers?
PHFFA waivers are determined by the State Department. OES cannot negotiate or secure waivers on behalf of implementing partners. The State Department’s FAQ sets out the waiver process and criteria. OES’s focus is on helping partners understand the policy so they can assess how it applies to them.
What will partners be required to report on?
Guidance on reporting requirements will be provided to all prospective partners at the expression of interest (EOI) and request for application (RFA) stages; however, OES aims to build on partners’ existing data systems and minimize duplicate reporting, while still ensuring common and consistent reporting standards. Specific indicators, reporting frequency, and formats will be communicated as requirements are finalized.
Program
What will OES fund?
OES focuses its resources towards high-impact, cost-effective nutrition interventions. In its initial phase, OES will prioritize funding towards the products and programs associated with the outpatient treatment of uncomplicated cases of severe acute malnutrition (SAM) in children 6 to 59 months.
How much input will OES have on program design?
Outpatient treatment of severe acute malnutrition follows global guidelines set by the World Health Organization, which are adapted at national levels in high-burden countries. Within this normative framework, partners are encouraged to design programs that will be cost-effective in their context. The only directional input from OES is on the dose of RUTF, where OES will prioritize resources towards programs leveraging optimized, sachet-based dosing of RUTF. OES will request that prospective partners document locally-relevant administrative approvals to implement sachet-based dosing or the process through which they propose to obtain such approvals, and OES will verify approvals through its due diligence process. Finally, OES notes that sachet-based dosing does not require a MUAC-based admissions approach; it can be used equally with programs that use both weight-for-height z-score and MUAC. OES do not take any position on admissions criteria.
What evidence supports sachet-based dosing and will OES share it?
Sachet-based dosing has achieved widespread implementation at-scale in high-burden countries in recent years and it is supported by a robust evidence base. OES will share a transparent rationale setting out its interpretation of this evidence soon.
How will OES define high-risk MAM in IPC Phase 4 contexts?
OES expects to provide programmatic support for the management of high-risk moderate acute malnutrition (MAM) with RUTF in emergency settings—specifically geographic areas classified as IPC Phase 4 or projected to become IPC phase 4 in coming months. Beyond geographic targeting, OES does not take a stance on other targeting criteria (e.g. individual child or societal factors), but encourages prospective partners to align with national guidelines and other operational guidance relevant to their local context.
Will OES support therapeutic milks (F-75 and F-100) for children with complicated SAM?
OES’s focus is on outpatient treatment of uncomplicated cases of SAM in children 6-59 months of age with RUTF. Upon presenting to a treatment facility or over the course of treatment, some children will be identified as having medical complications that require referral to inpatient care. These children face a heightened risk of mortality that necessitates timely, quality, and responsive care. In areas where OES funds outpatient treatment programs, strong referral pathways for children with medical complications are essential. Where pathways are weak or essential commodities—i.e. therapeutic milks like F-75—are unavailable, OES will consider time-bound, targeted resources to bolster this referral pathway. However, OES has made no determination about the relative amount or type of resources that could be made available for inpatient care.
Supply
How will OES procure RUTF?
OES will procure ready-to-use therapeutic food (RUTF) through a competitive bidding process that will be open to all qualified manufacturers across the world. While OES will actively advertise these opportunities, we encourage all partners to sign up for our mailing list to be automatically notified when opportunities are posted.
Will OES buy RUTF produced outside the United States?
No determination has yet been made as to the company or the location from which OES products will be procured; selection is anticipated to follow the open, competitive process identified above where donor funding provisions allow.
How will OES address applicable shipping requirements while managing costs?
OES will comply with all applicable shipping requirements and incorporate them into its competitive procurement process. OES will evaluate shipping options to identify cost-effective arrangements that meet regulatory requirements and support reliable, timely delivery. Specific arrangements will be determined as requirements are finalized.
Will OES build a new system for sharing supply chain data, or use an existing one?
OES’s goal is to improve supply chain visibility, forecasting, and cost-effectiveness while building on systems already in use. We have not yet made any final determinations on the scope of OES’s data system but will share transparently once those decisions are made.
Will RUTF require specific branding?
OES-procured RUTF will meet any applicable branding, packaging and marking requirements, in accordance with applicable regulations and finalized award terms.
Cost-effectiveness & innovation
How does OES define and measure cost-effectiveness?
OES defines cost-effectiveness in terms of our ability to reduce the cost of treating a child with SAM while maintaining or improving expected recovery outcomes. We will therefore measure our success in terms of cost per child treated and cost per child recovered.
Will applicants need to state cost-per-child treated and recovered, and will OES share its formula?
Guidance will be provided to all prospective partners at the expression of interest (EOI) and request for application (RFA) stages. Any formula used by OES in assessment of submissions will be shared transparently after the review process concludes so as not to bias submissions.
How will OES account for equity and harder-to-reach populations?
While it is often more costly for programs to deliver treatment to harder-to-reach populations, the impact of quality programs delivered for these populations is also often high. OES will assess costs relative to the impact expected in each specific program context and does not currently set any specific cost-effectiveness threshold.
How does OES value research and innovation?
Innovation is central to OES’s approach. Philanthropic funding allows OES to test and scale innovations within the programs and activities we fund. OES expects to prioritize investment towards those innovations with the greatest potential to improve the cost-effectiveness of our approach.
Will OES work with research partners?
OES will work with strategic resource partners and also expects these partners will include organizations with specific expertise in conducting research in areas relevant to OES programs.
Questions received
As part of our commitment to transparency, we are sharing all questions received for this webinar.
Will stated in his opening that OES would not be reliant on one donor, but the OES model notes that it leverages funding from the US government. Can you clarify this?
Is the $100m USG funding matched by the philanthropic $33m, the same as the $100m macro award? Or distinct/additional?
You mentioned that the USG is one source of funding for OES, with the goal of reaching $3 of public funding for every $1 of private funding. What other donors does OES anticipate working with, are those discussions leading to actual funding determinations, and how will non-USG money be treated within the OES structure? I.e., will there be a single large funding pot that comprises all public funding, or will different donors’ monies be programmed differently, with different reporting and eligibility requirements?
What portion of the total funding pot do you expect will be channeled to programming (outside of last mile delivery), and how much for last mile delivery?
You mentioned “OES countries” in the opening remarks. How are these countries selected? Will the list be flexible and subject to change over time?
The $133M covers how many countries? What is the procurement approach (local or international)?
The presentation has also emphasized OES’s independence. With significant funding from the US Department of State, will politics and US diplomatic priorities influence country selection for OES?
Will OES fund projects in countries like Somalia, where State is not providing no funding but wasting needs are great?
Would OES prefer to see applications by a consortium at country level vs. applications by a single entity?
How many awards per country do you anticipate funding? Do you anticipate a preference for applications in consortia or single organization applications?
What will the award ceilings/floors likely be for the initial RFA, and is OES looking to make multiple awards or a single large award per country?
Is there a maximum funding allocation per implementing partner?
Existing rationalization in countries to be considered — for example, one partner per province/per state in order to avoid fragmentation of services?
You’ve mentioned that this should be a multi-year, lasting program, but also that DoS funding has been secured on a limited basis. Can you give an idea for implementers on the anticipated length of awards?
What is the required duration for projects to be eligible?
When does OES anticipate that the initial procurement and funding opportunities will go live?
What will the mechanism(s) be for interested organizations to apply?
Will you expect an Expression of Interest to be just on the programming approach and others on the supply chain approach or bridging both?
In addition to geographic presence and capacity, what criteria will be used for selecting partners for funding?
Is there any expectation on co-funding/leverage - will this be a scoring criteria?
Is there an expected timeline for the first RUTF procurement awards? Originally Ellyn had shared that the goal was to have product in countries ready for programming within Q1 of 2027. Is that still the case?
How will the process and the approach be similar to (or different from) more traditional models of U.S. government-funded global nutritional assistance?
Will OES fund delivery of SAM treatment, or only RUTF?
Does the initiative fund both existing OTP programs and newly established ones?
How much input will you have in the design of the program once food reaches the program at the delivery stage?
In an IPC 4+ context, all children with MAM would be considered ‘high-risk,’ given they live in a ‘high-risk context.’ What additional criteria would OES consider to define high-risk MAM in IPC 4 or would all MAM children in IPC 4 be considered high-risk?
How about SAM children with medical problems? The need for therapeutic milk (F75, 100) is as well very high and consistent pipeline breaks. Is there a possibility this could be included as part of the package?
There is so much in this that sounds like it will displace funding from sustainable child centred integrated approaches to apply it to very narrow treatment only RUTF based approaches. So far everything feels like it will cost the system a LOT more rather than targeting the cheapest cost effective approaches that prevent and support early action and end us in a point of the cheapest treatment only.
In the Lancet series, things like breastfeeding were shown to be one of the most cost effective life saving interventions. With such a product centric approach, how are we not ending up costing the system more overall?
How does the initiative intend to address the link between acute food insecurity, malnutrition, and the breakdown of essential health services, particularly among children under five and pregnant and breastfeeding women. How will OES promote integrated, multisectoral responses rather than isolated food assistance interventions?
Can the OES team please share the evidence base about sachet-based dosing with attendees either on-call or post webinar? Thanks!
If fixed-dosing is not agreed as a blanket/ sustained protocol across a country, what challenges do you see? How would you expect partners to manage that?
Many thanks for this informative session. The most recent studies on sachet-based dosing/fixed dosing show longer length of stay (approximately 6 days) - the opportunity cost for the extra visit for the families and additional RUTF to be considered in the cost effectiveness.
How does OES define and estimate cost-effectiveness? Is there an existing model, and does it look primarily at averting mortality?
will you expect a cost per child treated and cost per child recovered to be stated in the proposal and will you make the formula you are using at proposal stage?
I’m interested in the mechanism you plan to use to drive cost effectiveness. Are they both donor and partner facing or only partner facing?
How will OES incentivize equity in cost-per-child treated/cost-per-child recovered analyses? Implementing partners may inadvertently be incentivized to expand coverage/reach to easier-to-access areas to show a low cost-per-child treated #. How can we incentivize partners to expand coverage into harder-to-reach areas, where cost-per-child will naturally be higher?
If the primary outcomes to be measured for cost-effectiveness are cost per child treated and recovered, will there be any part of the model that looks at higher-need populations, i.e. populations that are higher cost to reach but face much higher risk of mortality, so it would actually be cheaper per life saved? In addition, how does the model take into account third party costs, such as MoH and UN agencies? Worried that an over-emphasis on cost-efficiency would reward only places that are fairly stable and cheap to implement in, high counterfactual of other funding, and low-risk
Will equity be a key consideration within your cost-effectiveness analysis - e.g. it will cost more to reach SAM children in rural Afghanistan than in peri-urban Nigeria?
In Nigeria and Sudan, and in terms of cost-effectiveness, what is the threshold that you’re going to set? Malnutrition treatment will always struggle to cross a threshold as compared to other simple life-saving health interventions. And that will also limit where treatment can take place, such as where mortality is greatest, where a health system is functioning and where complexities and then costs will be lower. What will the threshold be and what flexibility is there for humanitarian contexts?
will cost-effectiveness estimations be compared to others in the same country/context or are they all “competing” with each other?
Great to know that you will be tracking both cost per child treated and cost per child recovered. Will you also be tracking rates of relapse? And working toward ways to reduce it?
How does OES value research/innovation in their cost-effectiveness measurements?
Please describe the RUTF procurement model and how OES will be faster.
Will RUTF produced outside of the US be allowed?
What is OES role and approach to promote increased local production of RUTF? I assume a twin track approach with the aim of a progressively increased % of RUTF coming from local production over time. Is that correct?
Is scaling other RUTF production capacity, outside the US, part of OES’ theory of change, given the ambition of ending malnutrition worldwide?
Is the DOS funding subject the US carrier flag requirement?
Won’t US cargo preference essentially mean that US-produced RUTF is not cost competitive from total-landed cost perspective?
Do applicants need to provide proposed transportation costs for delivery of the product, or is this also set by OES?
There will be significant risks to delivering RUTF in a context such as Sudan - risks that often the UN currently will not take - how far will OES accept/ absorb the risk of theft/ damage? and/or provide support deeper into difficult areas of the country (e.g. through a conflict zone) so the partner can manage last mile from there?
In terms of shared data around supply chain - is this a system that OES plans to set up, or use something already in existence (and have all partners use this)?
Will there need to be USG branding (ie. the US flag) on the RUTF?
Will RUTF product require any specific branding?
The presentation mentioned that applications should not include product costs, as OES will be procuring the product directly. Should applicants include transportation costs (ocean freight, ITSH, etc.) or will OES also manage the shipping process?
Related, if applicants have existing relationships with customs agencies and warehouses in country that allow for smooth and cost-effective import and storage, can/should they share this with OES during the application process?
Can you please describe if your team has any focus on evidence generation, learning, and using that evidence and learning for scaling?
What metrics are required for partners to report on?
In addition to implementation partners will you be engaging thought leadership or research partners? For example on issues like data systems, measurement, etc.
We would welcome more information on OES’s approach to monitoring, evaluation, learning (MEL), and data analytics, particularly how these functions will support cost-effectiveness, accountability, and evidence-based decision-making.
Does OES anticipate outsourcing any of these functions, including independent verification, performance monitoring, evaluation, and learning? If so, how does OES envision engaging external technical partners to support these efforts across its grant portfolio?
Will you request to align with the PHFFA policy?
Can OES negotiate for PHFFA waiver on behalf of partners?
Will OES be open to supporting any PHFFA waivers with the DoS?
Next Steps
We expect to release the Expression of Interest (EOI) for implementing partners within the next one to two months. Our initial focus is Nigeria and Sudan. The EOI will be shared publicly on our website; we encourage organizations that don’t yet have a Unique Entity Identifier (UEI) from SAM.gov to start that process now.
This was the first in a series of briefings and listening sessions. To learn more about forthcoming opportunities, sign up for our mailing list.
