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Can there be too much life-saving peanut butter?

In Haiti, two different humanitarian groups have built new factories to make this product, which is used to treat severe malnutrition and maybe someday prevent it. The problem is, Haiti doesn't appear to need two of them. Each factory, all by itself, could satisfy Haiti's current demand.

This tale of two factories is also the story of two organizations with the same mission. It's also about the strange economy of philanthropy, with its mixture of altruism and self-promotion.

The first organization is Meds and Food For Kids, or MFK.

Pat Wolff, a pediatrician from St. Louis, set it up almost a decade ago, specifically to make that special peanut-based treatment for malnutrition in Haiti. She started small, in a rented house in Cap-Haitien, grinding peanuts and mixing them with sugar, dried milk, oil and lots of minerals and vitamins.

"We started doing this in 2003," Wolff recalls. "And in 2006 PIH contacted us."

PIH — Partners in Health — is much bigger than MFK, and it's world-famous for its work fighting AIDS in some of the world's poorest countries. Its founder, Paul Farmer, is one of the most charismatic figures in the whole field of global public health.

"They said, 'Oh, what a great idea; tell us more about that,' " Wolff says. "And we were totally transparent to them."

Wolff and her colleagues shared their recipes, their technologies, and PIH soon set up its own kitchen-scale production of enriched peanut butter, which it calls Nourimanba. PIH uses it to treat patients at its own clinics in central and western Haiti.

Then Meds and Food for Kids decided to do this on a much bigger scale. It raised $3.2 million, about $700,000 of which is a loan, and it built a factory. It just got up and running a few months ago. It has white clean rooms and expensive machinery made of stainless steel that spits out little foil-wrapped packages of enriched peanut butter.

UNICEF buys the product and distributes it to hospitals and clinics all over Haiti.

According to Wolff, this factory "can make everything that's needed for the whole country of Haiti."

Enter The Competitors

But now, Partners in Health is building its own factory. That factory is just as big, if not bigger. It's funded by a $6 million grant from Abbot Laboratories. If all goes according to plan, it will be up and running by the end of the year.

Jonathan Lascher, who's managing this project for PIH, insists that his organization is not competing with MFK. Partners in Health, he says, will not sell its product to UNICEF or the World Food Program. It will pass out this treatment for free to people who need it, in the regions of Haiti where PIH is active.

"I certainly think there are ample opportunities for MFK's operations to scale up, to meet most of the demand across the country," he says, and there will be opportunities for PIH to do other things. For instance, there will be so much excess capacity at PIH's new factory that the organization is considering using it to make commercial peanut butter, too. PIH could sell that product to help cover the factory's costs.

In any case, Lascher says, PIH decided to go ahead with its own factory in order to provide opportunities for peanut farmers in PIH's home area, in Haiti's central plateau. "When that center opens, farmers around that area are going to know that this center is a beacon of economic opportunity. They can bring their peanuts, and we'll purchase them."

Lascher and his colleagues at Partners in Health don't seem threatened by MFK's factory; it doesn't affect their plans much.

Meds and Food for Kids, on the other hand, is much smaller and financially more fragile. It does appear threatened.

"There's not enough local peanuts, and not enough need for this product in Haiti, to have two factories that hope to be sustainable into the future," says Wolff.

It's not just that a second factory could cut into MFK's sales. Wolff's colleagues say PIH's project also has sucked away funders and consultants who were donating their technical expertise.

Of course, the important question is probably not whether a second factory is good for MFK, but whether it's good for the people of Haiti.

NGO Businesses Are Just Like Other Businesses

We called up someone who knows both organizations: Mark Manary, a professor of pediatrics at Washington University in St. Louis. He's a pioneer in this field. Years ago, in Africa, he first showed Wolff how to make this peanut-based treatment for malnutrition. When PIH was thinking about building its new factory, people from that organization asked Manary for advice.

Manary doesn't really take sides. But, he says, looking at the situation from the outside, it does seem like a waste of money. "It seems like [having] two factories isn't appropriate for Haiti."

This kind of thing happens, he says, because nongovernmental organizations end up behaving like all other organizations. They compete; they try to attract recognition and funding, and to promote their own brand.

"Unfortunately, branding is a powerful force among many NGOs," he says. "And it is basically true, I think, that once an organization exists, it tries to survive." But that can prevent it from cooperating with other organizations, or stepping aside to let another organization thrive.

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