This is the accessible text file for GAO report number GAO-12-862 
entitled 'International Food Assistance: Improved Targeting Would Help 
Enable USAID to Reach Vulnerable Groups' which was released on 
September 24, 2012. 

This text file was formatted by the U.S. Government Accountability 
Office (GAO) to be accessible to users with visual impairments, as 
part of a longer term project to improve GAO products' accessibility. 
Every attempt has been made to maintain the structural and data 
integrity of the original printed product. Accessibility features, 
such as text descriptions of tables, consecutively numbered footnotes 
placed at the end of the file, and the text of agency comment letters, 
are provided but may not exactly duplicate the presentation or format 
of the printed version. The portable document format (PDF) file is an 
exact electronic replica of the printed version. We welcome your 
feedback. Please E-mail your comments regarding the contents or 
accessibility features of this document to Webmaster@gao.gov. 

This is a work of the U.S. government and is not subject to copyright 
protection in the United States. It may be reproduced and distributed 
in its entirety without further permission from GAO. Because this work 
may contain copyrighted images or other material, permission from the 
copyright holder may be necessary if you wish to reproduce this 
material separately. 

United States Government Accountability Office: 
GAO: 

Report to the Committee on Foreign Affairs, House of Representatives: 

September 2012: 

International Food Assistance: 

Improved Targeting Would Help Enable USAID to Reach Vulnerable Groups: 

GAO-12-862: 

GAO Highlights: 

Highlights of GAO-12-862, a report to the Committee on Foreign 
Affairs, House of Representatives. 

Why GAO Did This Study: 

In fiscal year 2011, USAID spent approximately $1.7 billion on food 
assistance reaching over 46 million people in 48 countries. USAID 
targets food assistance so that benefits accrue selectively to only a 
portion of the overall population, typically the most vulnerable. 
Effective targeting is important to maximize the impact of limited 
resources, especially as USAID begins to use more nutritious but more 
costly specialized food products to address hunger and malnutrition 
among vulnerable groups. GAO was asked to (1) describe in-country 
factors that USAID and its implementing partners face in targeting 
vulnerable groups, and (2) examine the extent to which USAID’s 
targeting process supports effective targeting. GAO analyzed program 
data and documents; interviewed relevant officials; convened a 
roundtable of food assistance experts and practitioners; and conducted 
fieldwork in Ethiopia, Guatemala, Sri Lanka, and Zimbabwe. 

What GAO Found: 

In-country, the U.S. Agency for International Development (USAID) and 
its implementing partners face a range of factors that, to varying 
degrees, affect their ability to target food assistance effectively to 
vulnerable groups. These factors include (1) the quality of data used 
to identify and reach recipients, (2) host government policies, and 
(3) sharing of rations among recipients and community members. 
Targeting effectiveness is reduced when data quality is poor, host 
government policies cause distortions in program design and 
implementation, and sharing prevents food rations from being consumed 
by the intended recipients in the intended amounts. USAID and its 
implementing partners try to mitigate such challenges by, for example, 
employing technology to improve data quality, coordinating closely 
with government officials to foster better relationships, and 
educating recipients about proper food usage to reduce sharing. In 
some cases, host governments have facilitated targeting efforts by, 
for example, establishing national targeting guidelines that set a 
common standard, or national statistical offices that assist in 
collecting data. Nevertheless, ensuring that food assistance reaches 
intended recipients remains difficult. 

Weaknesses in the design, monitoring, and evaluation phases of USAID’s 
targeting process hinder targeting effectiveness, although the agency 
is taking actions to make improvements. In the design phase of the 
targeting process, USAID does not provide sufficient guidance on 
whether and how to target specialized food products. Specifically, USAID
’s guidance on design currently is neither up-to-date nor complete, 
and does not adequately address key benefits and risks that inform 
decisions on whether and how to target specialized food products. In 
USAID’s monitoring and evaluation phases, weaknesses limit targeting 
effectiveness and hinder decision making. USAID currently does not 
require monitoring of key indicators needed to determine the level of 
targeting effectiveness. For example, during implementation USAID does 
not monitor actual recipients in its emergency programs. Furthermore, 
its evaluations do not systematically address targeting effectiveness. 
Without adequate guidance, monitoring, and evaluations, USAID cannot 
ensure targeting effectiveness in its food assistance programs. USAID 
is taking some steps to improve both guidance and monitoring. For 
example, USAID is updating guidance and plans to track indicators such 
as detailed age breakdowns that are key to better understanding 
targeting effectiveness. However, these steps do not fully address the 
weaknesses in USAID’s targeting process. 

Figure: Weaknesses in the Targeting Process: 

[Refer to PDF for image: illustration] 

Interlocking, continuous circle: 

Design: Insufficient guidance; 
Monitoring: Key indicators unknown during implementation; 
Evaluation: Not systematic. 

Figure: Targeting Effectiveness Unknown: 

[Refer to PDF for image: illustration] 

Overlapping circles: 
Less overlap: less effective targeting; 
Total overlap: More effective targeting. 

Correctly targeted recipients: those without: 
Exclusion error: 
Intended recipients who are not reached by the food assistance program; 
Inclusion error: Actual recipients who are reached by the food 
assistance program but should not be, according to the targeting 
criteria. 

Source: GAO analysis based on USAID and other sources. 

[End of figure] 

What GAO Recommends: 

GAO recommends that the Administrator of USAID improve USAID’s 
targeting of specialized food products to vulnerable groups by (1) 
issuing, as appropriate, improved interim guidance to assist 
implementing partners in deciding whether and how to target 
specialized food products; and (2) establishing and reporting program-
specific indicators related to targeted vulnerable groups, to assess 
effectiveness in reaching such groups. USAID agreed with the 
recommendations and provided examples of recent efforts to address 
them. 

View GAO-12-862. For more information, contact Thomas Melito at (202) 
512-9601 or melitot@gao.gov. 

[End of section] 

Contents: 

Letter: 

Background: 

Various In-Country Factors Affect USAID and Implementing Partners' 
Ability to Target Food Assistance Effectively to Vulnerable Groups: 

Weaknesses in the Design, Monitoring, and Evaluation Phases of USAID's 
Targeting Process Hinder Targeting Effectiveness, Although Some 
Improvements Are Under Way: 

Conclusions: 

Recommendations for Executive Action: 

Agency Comments and Our Evaluation: 

Appendix I: Objectives, Scope, and Methodology: 

Appendix II: Organizations That Participated in GAO Roundtable: 

Appendix III: Cost Differences between Traditional Food Products and 
Specialized Food Products: 

Appendix IV: USAID New Specialized Food Products Pending Introduction: 

Appendix V: Comments from the U.S. Agency for International 
Development: 

Appendix VI: GAO Contact and Staff Acknowledgments: 

Related GAO Products: 

Tables: 

Table 1: Illustrative Examples of Cost Per Ration of Different Types 
of Food Products, for Children 6 Months to 2 Years of Age, Based on 
2012 Prices: 

Table 2: New Specialized Food Products Purchased with USAID Funding, 
Fiscal Years 2010 to 2012: 

Table 3: Relative Costs of Traditional and Selected Specialized Food 
Products (in U.S. dollars): 

Table 4: Number of Days Grain-Based or Corn Soy Blend Ration Could Be 
Provided for the Cost of Providing Selected New Specialized Food 
Products: 

Figures: 

Figure 1: Prevalence of Stunting as an Indicator of Hunger and 
Malnutrition among the Countries That Received Title II-Funded 
Emergency Assistance in Fiscal Year 2011: 

Figure 2: Commodity Value of USAID Title II Emergency Program by 
Product, Fiscal Year 2011: 

Figure 3: Overview of the Food Assistance Targeting Process: 

Figure 4: Targeting Effectiveness Is Measured by the Magnitude of 
Targeting Error: 

Abbreviations: 

APS: Annual Program Statement: 

CSB: corn soy blend: 

CSB+: corn soy blend plus: 

CSB++: corn soy blend plus plus: 

FANTA: Food and Nutrition Technical Assistance: 

FAO: Food and Agriculture Organization: 

FAQR: Food Aid Quality Review: 

FFP: Office of Food for Peace: 

IFRP: International Food Relief Partnership: 

LNS: lipid nutritional supplement: 

MFFAPP: Micronutrient-Fortified Food Aid Products Pilot: 

NGO: nongovernmental organization: 

RUSF: ready-to-use supplementary food: 

RUTF: ready-to-use therapeutic food: 

SUN: Scaling-Up Nutrition: 

UN: United Nations: 

UNDSS: United Nations Department of Safety and Security: 

UNICEF: United Nations Children's Fund: 

USAID: U.S. Agency for International Development: 

USDA: U.S. Department of Agriculture: 

WFP: United Nations World Food Program: 

WSB: wheat soy blend: 

[End of section] 

United States Government Accountability Office: 
Washington, DC 20548: 

September 24, 2012: 

The Honorable Ileana Ros-Lehtinen: 
Chairman: 
The Honorable Howard L. Berman: 
Ranking Member: 
Committee on Foreign Affairs: 
House of Representatives: 

As the largest international food assistance donor, providing about 
half of global food assistance, the United States plays an important 
role in addressing hunger and malnutrition among vulnerable groups 
around the world.[Footnote 1] Nearly 1 billion people suffer from 
undernourishment, which contributes to more than one-third of child 
deaths globally, according to United Nations (UN) sources.[Footnote 2] 
In fiscal year 2011, with funding authorized under the Food for Peace 
Act,[Footnote 3] the U.S. Agency for International Development (USAID) 
reported that it spent approximately $1.7 billion on food assistance 
that reached over 46 million people in 48 countries.[Footnote 4] Of 
this total, USAID spent approximately $1.2 billion on emergency 
programs to help alleviate hunger and malnutrition in countries 
affected by natural or man-made disasters, such as drought or 
conflict.[Footnote 5] USAID programs provide three types of food 
assistance products: (1) traditional food products, such as wheat, 
corn, and sorghum; (2) traditional specialized food products, such as 
corn soy blend (CSB), a nutritionally enhanced commodity; and (3) new 
specialized food products, such as ready-to-use supplementary or 
therapeutic foods.[Footnote 6] Both traditional and new specialized 
food products are intended for vulnerable groups. 

USAID's goal is to focus its food assistance efforts on the reduction 
of hunger and malnutrition in vulnerable groups through targeting. As 
defined by USAID, targeting is any method by which an intervention is 
designed or implemented so that benefits can accrue selectively to 
only a portion of the overall population. Targeting may be categorized 
by geographic area or eligibility criteria, which are usually defined 
by recipients' characteristics, such as age, gender, income level, 
asset level, or nutritional status. For the purposes of this report, 
we define the effectiveness of targeting as the degree to which USAID 
and its implementing partners are able to (1) accurately assess needs 
and identify recipients using appropriate eligibility criteria, and 
(2) ensure that the food assistance provided reaches and is consumed 
by the targeted recipients as defined by the eligibility criteria. 
[Footnote 7] While targeting may never be perfect, targeting error 
indicators can be used to assess effectiveness. These indicators 
include the percentage of intended recipients that did not receive 
food assistance or the percentage of people who were not eligible for 
assistance but still received it.[Footnote 8] 

Effective targeting is important, particularly in the context of 
constrained resources, continuing humanitarian and food emergencies, 
and increasing focus on addressing malnutrition in vulnerable 
populations. USAID's food assistance budget has declined from 
approximately $2.3 billion in appropriations in fiscal year 2009 to 
less than $2 billion in fiscal year 2011. The demand for international 
food assistance remains high as the threat of drought and famine 
persists in the Horn of Africa and other regions. Moreover, USAID has 
begun to introduce, for limited use, some new but more costly 
specialized food products designed to improve nutritional outcomes for 
vulnerable groups, such as children under 2 years of age. However, as 
we previously reported, providing food that is more nutritious but 
also more costly, within a fixed budget, would result in fewer 
recipients fed.[Footnote 9] 

As part of our work on international food assistance,[Footnote 10] you 
asked us to (1) describe in-country factors that USAID and its 
implementing partners face in targeting vulnerable groups, and (2) 
examine the extent to which USAID's targeting process supports 
effective targeting. 

To address these objectives, we met with officials from USAID and its 
implementing partners, including the UN World Food Program (WFP) and 
nongovernmental organizations (NGO). We also met with academics, 
experts, and practitioners associated with research institutes and 
universities, as well as officials from the U.S. Departments of 
Agriculture (USDA) and State (State). In addition, we reviewed USAID's 
targeting framework, including guidance, related to the food 
assistance targeting process. We analyzed data from USAID and WFP to 
identify trends in food assistance funding, the use of specialized 
food products, and the costs of these products as compared with 
traditional food products. Furthermore, we conducted fieldwork in four 
countries--Ethiopia, Guatemala, Sri Lanka, and Zimbabwe--and met with 
officials from U.S. missions, implementing partners, and relevant host 
government agencies. Finally, we convened a roundtable of 10 experts 
and practitioners--including representatives from academia, research 
organizations, and implementing partners such as WFP and NGOs--to 
further delineate, on the basis of our initial work, in-country 
factors that affect targeting vulnerable groups and the process that 
USAID and its implementing partners use to target food assistance. 
Appendix I provides a detailed discussion of our objectives, scope, 
and methodology. 

We conducted this performance audit from October 2011 to September 
2012 in accordance with generally accepted government auditing 
standards. Those standards require that we plan and perform the audit 
to obtain sufficient, appropriate evidence to provide a reasonable 
basis for our findings and conclusions based on our audit objectives. 
We believe that the evidence obtained provides a reasonable basis for 
our findings and conclusions based on our audit objectives. 

Background: 

The United States Has Stated Its Commitment to Combating World Hunger 
and Malnutrition: 

Combating world hunger and malnutrition is a stated objective of the 
Food for Peace Act, which authorizes international food assistance for 
developing countries. The United States has also stated its commitment 
to the Millennium Development Goal to halve world hunger by 2015, and 
it supports the Scaling-Up Nutrition (SUN) movement to provide 
assistance to country-led efforts to address maternal and child 
malnutrition.[Footnote 11] To support SUN, the United States and 
others initiated the 1,000 Days public-private partnership, which aims 
to improve nutrition for pregnant and lactating mothers and children 
under 2. Adequate nutrition in this critical period in a child's life 
is widely recognized to have the greatest impact on saving lives, 
developing a child's cognitive and physical capacity, and mitigating 
the risk of chronic disease. According to the USAID Policy Framework 
2011-2015, USAID plans to ensure that the quality of U.S. government 
food aid is improved within 3 years to meet the nutritional 
requirements of vulnerable populations overseas, including by 
developing new blended products and formulations to support pregnant 
and lactating mothers and children under 2. 

In fiscal year 2011, USAID provided about $1.2 billion in Title II 
emergency funding to deliver about 1 million metric tons of food to 33 
countries, as shown in figure 1. Approximately 74 percent of the food 
commodities were delivered to 14 countries that received U.S. 
emergency food assistance every year from fiscal years 2006 through 
2011.[Footnote 12] Ten countries--eight of them in Africa--accounted 
for about 83 percent of Title II emergency funding.[Footnote 13] Seven 
of these 10 countries consistently received Title II emergency food 
assistance in the last 6 years. Also, among these 10 countries, the 
prevalence of stunting, a standard indicator for undernourishment in 
children under 5, ranged from 32 to 59 percent.[Footnote 14] Ethiopia, 
one of the four countries we visited, received about $207 million, 
which accounted for about 17 percent of total Title II emergency 
funding. A higher percentage of the total population in Ethiopia 
suffers from malnutrition than in most other recipient countries, with 
51 percent of children under 5 suffering from stunting. 

Figure 1: Prevalence of Stunting as an Indicator of Hunger and 
Malnutrition among the Countries That Received Title II-Funded 
Emergency Assistance in Fiscal Year 2011: 

[Refer to PDF for image: illustrated world map] 

Percentage of children under age 5 suffering from stunting[C]: 

25 percent or below: 
Algeria; 
Colombia; 
Sir Lanka. 

26-50 percent: 
Bangladesh; 
Burundi; 
Central African Republic; 
Chad; 
Cote d'Ivoire
Democratic Republic of Congo; 
Djibouti; 
Guatemala; 
Haiti; 
Kenya; 
Laos; 
Liberia; 
Madagascar; 
Nepal; 
Niger; 
Pakistan; 
Philippeans; 
Rwanda; 
Somalia; 
Sudan[B]; 
Tanzania; 
Uganda; 
Zimbabwe. 

51 percent or above: 
Afghanistan; 
Ethiopia; 
Yemen. 

Country requires external food assistance[D]: 
Afghanistan; 
Burundi; 
Central African Republic; 
Chad; 
Cote d'Ivoire; 
Democratic Republic of Congo; 
Djibouti; 
Ethiopia; 
Haiti; 
Kenya; 
Liberia; 
Madagascar; 
Niger; 
Somalia; 
Sudan[B]; 
Yemen; 
Zimbabwe. 

Country received food aid every year from fiscal years 2006-2011[E]: 
Burundi; 
Central African Republic; 
Chad; 
Colombia; 
Democratic Republic of Congo; 
Kenya; 
Rwanda; 
Somalia; 
Sudan[B]; 
Tanzania. 
      
Emergency food aid delivered in fiscal year 2011 to countries that 
received food aid between fiscal years 2006 and 2011[F]: 

6 years; 14 countries, 762,800 metric tons: 74%; 
3-5 years; 15 countries, 238,370 metric tons: 23%; 
1-2 years; 4 countries, 32,180 metric tons: 3%. 

Percentage of funding by region, fiscal year 2011[F]:    
Africa: 73%; 
South and Central Asia: 20%; 
Near East: 3%; 
Western Hemisphere: 3%; 
East Asia and Pacific; 1%. 

Country we visited: Ethiopia; 
FY 2011 funding: $207,450,100; 
Percentage of stunting: 51%. 

Country we visited: Guatemala; 
FY 2011 funding: $15,286,400;
Percentage of stunting: 48%. 

Country we visited: Sri Lanka; 
FY 2011 funding: $10,695,800;
Percentage of stunting: 17%. 

Country we visited: Zimbabwe; 
FY 2011 funding: $45,088,200;
Percentage of stunting: 32%. 

Source: GAO analysis based on various sources; Map Resources (map). 

[A] Stunting data are not available for Ecuador, Libya, and West 
Bank/Gaza. 

[B] South Sudan became independent from Sudan in 2011 and first 
received Title II-funded emergency assistance in fiscal year 2011. 
Stunting data reported include both Sudan and South Sudan. 

[C] The percentage of stunting among children under 5 is based on 
World Health Organization data for 2006-2010, as reported by UNICEF. 

[D] Countries requiring external food assistance as of June 2012, 
according to FAO. 

[E] Countries receiving Title II-funded emergency assistance from 
fiscal years 2006 through 2011, according to annual U.S. International 
Food Assistance Reports issued by USAID and USDA for 2006 through 2011. 

[F] Title II emergency food aid tonnage and funding levels for fiscal 
year 2011 are preliminary based on the U.S. International Food 
Assistance Report (draft) for 2011, to be issued by USAID and USDA. 

[End of figure] 

Traditional Food Products Account for the Vast Majority of Food 
Assistance, with the Use of Specialized Food Products Increasing: 

USAID uses traditional food products, such as grain, pulses, and 
vegetable oil, for the vast majority of its food assistance programs, 
but specialized food products are increasingly being used. For more 
than 40 years, USAID has been using fortified blended foods, such as 
CSB or WSB, as the primary food product to provide enhanced nutrition 
during emergencies. Figure 2 provides a breakdown of USAID Title II 
emergency program commodity value by product in fiscal year 2011, with 
traditional specialized food products accounting for 8 percent. Since 
fiscal year 2010, USAID has been purchasing small quantities of new 
specialized food products such as ready-to-use emergency rations, 
making a limited supply available in two of its prepositioning sites 
where food commodities are stocked for shipment as necessary.[Footnote 
15] 

Figure 2: Commodity Value of USAID Title II Emergency Program by 
Product, Fiscal Year 2011: 

[Refer to PDF for image: pie-chart] 

Traditional food products: $502 million; 92%; 
Traditional specialized food products: $42 million, 8%. 

Source: GAO analysis based on USAID data. 

Note: Traditional food products include grain, pulses, and vegetable 
oil. Traditional specialized food products include CSB and WSB. 

[End of figure] 

[Side bar: 

Example of a Food Ration Consisting of Traditional Food Products 

[Photograph: Source: GAO] 

The photo above, from a food assistance program we visited in Zimbabwe 
in 2012, shows food rations consisting of traditional food products, 
to be distributed to multiple recipient households. A household of 
five received a monthly ration of 50 kilograms of sorghum, 9 kilograms 
of yellow peas, and 3 kilograms of vegetable oil. 

Example of a Food Ration Consisting of Both Traditional and 
Specialized Food Products: 

[Photograph: Source: GAO] 

The photo above, from a food assistance program we visited in 
Guatemala in 2012, shows a monthly food ration consisting of both 
traditional and specialized food products. The ration was for a 
household of six and included 18 pounds of rice, 18 pounds of pinto 
beans, 18 pounds of CSB, and 2 liters of vegetable oil. 
End of side bar] 

In recent years, nutritionists have argued that traditional 
specialized food products may not be appropriate for children under 2 
to obtain sufficient nutrients.[Footnote 16] As a result, USAID and 
WFP have introduced new specialized food products, including enhanced 
versions of some of their traditional specialized food products, such 
as CSB+ or Supercereal+, to better meet the nutritional needs of 
vulnerable groups. Recently, USAID also has introduced a range of 
ready-to-use products, which are designed for recipients affected by 
emergencies such as natural disasters or conflicts.[Footnote 17] WFP 
is the largest provider of global food aid and implementing partner of 
USAID, accounting for 90 percent of U.S. emergency food assistance 
funding. WFP has increased the share of specialized food products in 
its procurement by 10 percentage points across a period of 2 years, 
reaching over 25 percent in its 2011 procurement. The countries that 
received the largest amounts of specialized food products from WFP 
were Ethiopia, Pakistan, Kenya, Niger, and Somalia. 

Specialized food products are designed to meet specific nutritional 
needs of vulnerable groups but are more costly than traditional food 
products. As a result, within a fixed budget, USAID and its 
implementing partners must decide whether to provide more nutritious 
but more costly food to fewer people, or less nutritious and less 
costly food to more people. In other words, they face a quality-
quantity trade-off.[Footnote 18] Table 1 provides illustrative 
examples of cost per ration for the three different types of food 
assistance. See appendix III for a more detailed comparison of cost 
differences between traditional food products and specialized food 
products. 

Table 1: Illustrative Examples of Cost Per Ration of Different Types 
of Food Products, for Children 6 Months to 2 Years of Age, Based on 
2012 Prices: 

Type of food product[A]: Traditional food product; 
Example of product: Grain; 
Cost per daily ration or dose: $0.02-$0.06. 

Type of food product[A]: Traditional specialized food product; 
Example of product: CSB; 
Cost per daily ration or dose: $0.09-$0.18. 

Type of food product[A]: New specialized food product; 
Example of product: Ready-to-use therapeutic food (RUTF); 
Cost per daily ration or dose: $0.42-$0.46. 

Source: GAO analysis based on various studies and USAID and WFP data. 

[A] The products listed in this table are used for different purposes. 
This table does not assess which products are more effective. We note 
that USAID does not provide RUTF as part of a general food 
distribution ration. 

[End of table] 

Targeting Is an Iterative Process: 

Targeting in food assistance programs is an iterative process that 
aims to ensure that food reaches and is consumed by people whose 
characteristics meet certain eligibility criteria, such as age, 
gender, income level, asset level, or nutritional status. Figure 3 
presents a simplified schematic of the overall targeting process and 
its key phases--design, implementation and monitoring, and evaluation--
and steps within each phase. As key stakeholders in the targeting 
process, USAID and its implementing partners, including WFP and NGOs, 
play an important role, as do host governments. In the design phase, 
implementing partners design food assistance programs and submit 
proposals to USAID. USAID reviews the proposals and decides whether to 
fund the programs.[Footnote 19] Feedback occurs within and across each 
of the phases--both in host countries and at USAID headquarters--and 
is crucial to maximizing targeting effectiveness, leading to steps 
within the process that may not be strictly sequential. For example, 
during the design phase, USAID and its implementing partners may 
conduct an assessment of needs to determine the basis for the design 
of a program; however, as needs may change or be clarified, they may 
retarget or make adjustments during the monitoring phase to address 
issues that may arise. 

Figure 3: Overview of the Food Assistance Targeting Process: 

[Refer to PDF for image: illustration] 

Assess and define needs: 
Needs can be defined on the basis of: 
* income, 
* vulnerability, or, 
* other variables. 

Set objectives:  
Who should get how much food assistance and why? 
* Determine ration size and targeting approach; 
* Establish program objectives (e.g., improve food security or 
nutrition, or save lives). 

Determine eligibility and identify recipients: 

Self-targeting: 
* Market; 
* Commodity choice; 
Individuals: 
* Nutritional status; 
* Health status; 
* Age; 
* Pregnancy; 
Households: 
* Socio-economic characteristics, including gender, asset holdings, or 
income level; 
* Health status of household members; 
* Nutritional status of household members. 

Key stakeholders: 
Host governments, U.S. agencies, nongovernmental organizations, World 
Food Program. 

Design: 
Monitoring: 
Distribute food[A] and monitor implementation: 
* Maximize coverage; 
* Minimize inclusion and exclusion errors; 
* Conduct food basket and post-distribution monitoring; 
* Conduct food usage and market surveys; 
Evaluation: 
Evaluate program impact. 

Source: GAO analysis based on data from various sources. 

[A] This figure illustrates a generalized targeting process for both 
Title II emergency and development in-kind food assistance programs, 
particularly those that directly distribute specialized food products 
to achieve nutritional goals. It does not necessarily reflect other 
types of development food assistance programs, such as those that do 
not directly distribute food or have any nutritional goals. 

[End of figure] 

Various In-Country Factors Affect USAID and Implementing Partners' 
Ability to Target Food Assistance Effectively to Vulnerable Groups: 

USAID and its implementing partners face a range of in-country factors 
that, to varying degrees, affect their ability to effectively target 
food assistance to vulnerable groups. These factors include (1) the 
quality of data used to identify and reach recipients, (2) host 
government policies, and (3) sharing of rations among recipients and 
community members. Targeting effectiveness is reduced when data 
quality is poor, host government policies cause distortions in program 
design and implementation, and sharing prevents food rations from 
being consumed by the intended recipients in the intended amounts. 
USAID and its implementing partners take steps to mitigate such 
challenges by, for example, employing technology to improve data 
quality, coordinating closely with government officials to foster 
better relationships, and educating recipients about proper food usage 
to reduce sharing. In some cases, host governments have facilitated 
targeting efforts by, for example, establishing national targeting 
guidelines that set a common standard, or national statistical offices 
that assist in collecting data. Nevertheless, ensuring that food 
assistance reaches intended recipients remains difficult.[Footnote 20] 

Poor Data Quality May Hinder Implementing Partners' Ability to 
Identify and Reach Intended Recipients: 

Lack of Reliable Population and Household Data May Hinder Targeting 
Effectiveness: 

Poor data quality--lack of timely and accurate information--may affect 
implementing partners' ability to effectively identify and reach 
recipients. For example, in Zimbabwe, USAID and three implementing 
partners noted that a lack of current and reliable population data 
made it difficult to determine the overall number and geographic 
distribution of households that are in need of food assistance. 
[Footnote 21] In Guatemala, an implementing partner told us that 
because it used inaccurate data on average household size to determine 
the initial ration size, people who were initially identified received 
more food than they would have received if the data had been accurate. 
Although the error was later corrected, if the data had been accurate, 
resources could have been used more optimally to reach people in need. 

Natural Disasters or Conflicts May Cause Population Movements and 
Raise Security Concerns, Hindering Ability to Reach Targeted 
Recipients: 

USAID and implementing partners we spoke with stated that sudden 
natural disasters or conflicts could raise security concerns for 
implementing partners, hindering their ability to reach the originally 
targeted recipients. Furthermore, gathering reliable data on transient 
populations is challenging. For example, USAID and an implementing 
partner in Ethiopia told us that in some areas of the country, it is 
difficult to determine the number and location of people in need of 
food assistance, particularly pastoralists, who move often as a 
traditional way of life and to cope with drought or natural disasters. 
As a result, it is difficult for implementing partners to accurately 
assess the needs in a particular geographic area and design an 
appropriate food assistance program. 

[Side bar: Pastoralists: 

{Photograph: Source: GAO] 

The term "pastoralists" refers to nomadic communities-—including an 
estimated 15 to 20 million people in East Africa—-who depend on 
raising and herding livestock for a living and who move with rainy and 
dry seasons in search of water and grazing land. In some instances, 
nomadic families become agropastoralists, with some family members 
raising agricultural crops to meet a portion of their household food 
needs and others moving with their herds of livestock in search of 
water and grazing land. The photo above shows a pastoralist we 
observed during our fieldwork in Ethiopia in 2012. End of side bar] 

In addition, natural disasters or conflicts may raise security 
concerns, hindering ability to reach targeted recipients. We recently 
reported that security concerns prevented WFP from conducting field 
monitoring of food distribution to determine whether the food rations 
reached the originally targeted recipients in some high-risk areas of 
Ethiopia, Kenya, and Somalia.[Footnote 22] For example, WFP noted that 
it has been unable to access six districts in the Somali region of 
Ethiopia since May 2011. As a result, WFP's ability to collect data to 
ensure that the intended recipients received their food assistance in 
these high-risk areas is limited. 

USAID and Its Implementing Partners Have Taken Some Measures to 
Address Data Quality Issues, but They Remain a Challenge: 

USAID and implementing partners have taken some measures to improve 
data quality by building capacity through technology, training, and 
other activities. For example, USAID funds the Famine Early Warning 
Systems Network (FEWS NET), which is used to monitor and prepare for 
changes in food assistance needs. FEWS NET monitors and analyzes 
vulnerability information, using multiple sources such as satellite 
imagery and field observations. Moreover, some countries, such as 
Ethiopia, have established national statistical offices that can 
assist in collecting data for targeting food assistance. In addition, 
a 2011 report on food assistance stated that implementing partners are 
working on increasing the speed, accuracy, accessibility, and 
comparability of information.[Footnote 23] Implementing partners in 
two countries we visited told us that they are using mobile devices, 
such as tablets and phones, to collect recipient and distribution 
data. The use of technology enables the implementing partners to 
better identify and track recipients throughout the program and 
identify needs. In the aforementioned example about excess ration size 
in a Guatemala program, the implementing partner used tablets to 
collect information on recipient consumption patterns. In this way, 
the implementing partner ultimately discovered the ration error and 
corrected the ration size for each household, freeing up resources to 
reach more recipients as a result. Also, implementing partners in 
Guatemala and Sri Lanka indicated that they train their staff and 
community volunteers on data collection, and work with the host 
governments to improve the governments' ability to collect data. In 
addition, some countries, such as Sri Lanka, have conducted repeated 
assessments of food assistance needs over several years, which can 
lead to improvements in the precision of the data collected. 

[Side bar: Using Technology to Improve Data Quality: 

[Photograph: Source: GAO] 

Implementing partners use technology such as laptops and fingerprint 
readers to register and verify recipients at food distribution sites, 
as we observed during our fieldwork in Guatemala in 2012 (see photo 
above). Implementing partners also use such technology to track 
recipients during monitoring. End of side bar] 

Even with efforts to improve the data used to identify and reach 
recipients, data quality remains a challenge in targeting food 
assistance. A 2011 food assistance report points out that implementing 
partners often lack disaggregated information, such as household-level 
data, that would help them design an effective targeted food 
assistance program.[Footnote 24] Similarly, implementing partners we 
spoke with stated that the detailed data necessary for effective 
targeting are often not available, while acknowledging that data 
quality differs across countries. An implementing partner in Guatemala 
stated that data need to be improved continuously to measure outcomes 
and impacts of targeting, particularly for programs with a nutritional 
objective. 

Host Government Policies May Cause Distortions, Limiting Targeting 
Effectiveness: 

Host government policies may lead to distortions, hampering targeting 
effectiveness, but implementing partners have made some efforts to 
reduce these adverse effects. We previously reported that one of the 
key challenges to accurately assessing the needs of vulnerable groups 
was a lack of coordination among key stakeholders--especially with 
host governments--on assessments of food assistance needs.[Footnote 
25] In addition, some host country governments have been criticized 
for underestimating actual needs or directing implementing partners to 
operate only in certain geographic areas, due to political or other 
reasons.[Footnote 26] As a result, implementing partners may not be 
able to reach recipients or locations most in need of food assistance. 
[Footnote 27] For example, an implementing partner in Ethiopia 
reported to USAID that the government of Ethiopia set an artificial 
quota for the number of people targeted in each household that in some 
cases did not reflect the actual needs, and severely hampered the 
partner's ability to reach vulnerable groups as a result. However, 
USAID and implementing partner officials in Ethiopia also told us that 
working with the government's distorted figures is less challenging 
now than in the past, due in part to recent efforts of local and 
regional government officials to improve the validity and 
documentation of needs assessments as well as better stakeholder 
coordination. 

In some instances, however, host government policies may facilitate 
targeting efforts. For example, the government of Sri Lanka has worked 
closely with WFP to identify vulnerable groups and has supported 
efforts to improve both data collection and the analysis of food 
needs, including by supporting the research organization that partners 
with WFP in conducting assessments of needs for food assistance. 
[Footnote 28] In another example, the government of Ethiopia has 
published National Targeting Guidelines that are intended to 
standardize and improve targeting efforts.[Footnote 29] This document 
helps all food assistance stakeholders in the country operate under a 
commonly understood set of targeting policies and practices. 

To address host government policies that cause distortions, 
implementing partners undertake efforts to coordinate with 
stakeholders and verify information on food assistance needs. 
Implementing partners we spoke with told us they work with each other 
and with host governments in the initial phase of the targeting 
process to increase transparency, in an effort to encourage more 
accurate government estimates of actual needs. For example, in 
Ethiopia, USAID officials told us that to increase transparency, 
donors are working with the government to introduce software tools and 
technology that facilitate access to information and increase public 
awareness and thereby discourage government authorities from 
manipulating data on food assistance needs. Moreover, to help 
facilitate distribution of food assistance to intended recipients in 
Guatemala, implementing partners stated that it is essential to 
closely coordinate with government authorities at the beginning of the 
targeting process to obtain approval for the use of new products and 
to set up the appropriate distribution channels and protocol. In 
addition, in Sri Lanka, an implementing partner told us that it plans 
to use local organizations to conduct independent verification of the 
potential recipient list, which is largely selected by the government. 
Doing so would help the implementing partner ensure that only 
recipients who qualify for food assistance are included on the list, 
increasing the likelihood that food assistance reaches the intended 
recipients. Despite these efforts, implementing partners have limited 
ability to influence host government policies. 

Sharing Reduces Targeting Effectiveness If Food Rations Are Not 
Consumed by the Intended Recipients in the Intended Amounts: 

Sharing within recipient households and among community members may 
result in food rations being consumed by unintended recipients or in 
unintended amounts, but implementing partners have taken some measures 
to reduce sharing. External assessments suggest that sharing of food 
rations is a widespread and established coping mechanism when 
insufficient food is available. The 2011 Food Aid Quality Review 
(FAQR) report[Footnote 30] and the 2011 WFP guidance on targeted food 
assistance programs acknowledge that sharing of specialized food 
products is a concern, and according to a 2011 USAID assessment of a 
food assistance program in the Somali region of Ethiopia, sharing of 
food rations is widespread. In addition, in countries we visited, 
USAID and its implementing partners told us that both CSB and 
traditional food products are routinely shared within and among 
households in some communities--a finding we previously reported in 
2011.[Footnote 31] The 2011 USAID assessment also notes that sharing 
is an established coping mechanism for the recipient community when 
not everyone in the community receives food rations. When food rations 
are shared, the intended recipients may not consume the intended food 
products in the desired amounts, which may reduce targeting 
effectiveness by limiting nutritional impact, particularly for 
specialized food products that are intended for vulnerable groups. 

[Side bar: Sharing of Food Rations: 

[Photograph: Source: GAO] 

Recipients commonly share their food rations with other households in 
the community. In the photo above, taken at a food distribution site 
in Dire Dawa, Ethiopia in 2010, women recipients are shown rebagging 
their food rations to share with nonrecipients. End of side bar] 

Implementing partners have made efforts to reduce the likelihood of 
sharing, especially of specialized food products. Specifically, 
implementing partners have employed various strategies to teach 
recipients how to use specialized food products and have monitored 
recipient food ration consumption. For example, one implementing 
partner in Guatemala requires pregnant or lactating women to attend 
education sessions, where they learn about the benefits of the 
specialized food products and how to properly prepare them, before 
they can receive rations. Implementing partners in Guatemala also 
print culturally relevant instructional images on the food packages or 
the canvas bags given to recipients to carry the rations. The images 
explain how to prepare the food products and depict the type of person 
for whom the products are intended--such as a pregnant woman or a 
child under 2 years of age. One of these implementing partners 
reported that it had seen an improvement in recipient participation in 
these education sessions and expected that these sessions would reduce 
sharing. 

[Side bar: Educating Recipients on Nutrition] 

[Photograph: Source: GAO] 

Implementing partners conduct educational sessions for pregnant or 
lactating women on nutrition and the use of specialized food products, 
as we observed at a food assistance program we visited in Guatemala in 
2012 (see photo above). 

Packaging Used As an Educational Tool: 

[Photograph: Source: GAO] 

An implementing partner uses canvas bags for food rations in a food 
assistance program we visited in Guatemala in 2012. The bags are used 
to educate recipients on nutrition and food preparation (see photo 
above). End of side bar] 

In addition, implementing partners use community volunteers to monitor 
effectiveness or consumption of food products. For example, in 
Guatemala, implementing partners train "mother leaders"--mothers who 
are also recipients--to provide training to other recipients on how to 
prepare food and monitor outcomes by, for example, observing 
improvement in a child's weight or overall health appearance. In Sri 
Lanka, another implementing partner uses health volunteers from the 
recipient community and coordinates with the host government to ensure 
that specialized food products are consumed by the children through 
monthly monitoring of their nutritional status at government-run 
clinics and weighing stations. The health volunteers also follow up 
with the mothers of these children, who are receiving specialized food 
products, if they do not bring their children to the monthly checkup. 
While implementing partners have taken these and other steps to 
address sharing, evidence of the impact of these steps has yet to be 
determined.[Footnote 32] 

Weaknesses in the Design, Monitoring, and Evaluation Phases of USAID's 
Targeting Process Hinder Targeting Effectiveness, Although Some 
Improvements Are Under Way: 

Weaknesses in the design, monitoring, and evaluation phases of USAID's 
targeting process hinder targeting effectiveness, although the agency 
is taking actions to make improvements. In the design phase of the 
targeting process, USAID does not provide sufficient guidance on 
whether and how to target specialized food products. Specifically, 
USAID's guidance on design for both emergency and development programs 
is neither up-to-date nor complete, and does not adequately address 
key benefits and risks that inform decisions on whether to target 
specialized food products. In both USAID's monitoring and evaluation 
phases, weaknesses limit targeting effectiveness and hinder decision 
making. USAID currently does not require monitoring of key indicators 
needed to determine the level of targeting effectiveness for either 
emergency or development programs. Furthermore, its evaluations do not 
systematically address targeting effectiveness.[Footnote 33] Without 
adequate guidance, monitoring, and evaluations, USAID cannot ensure 
targeting effectiveness in its food assistance programs. USAID is 
taking some steps to improve both guidance and monitoring. For 
example, USAID has a contract with Tufts University to develop updated 
guidance, and the agency is taking steps to improve monitoring by 
planning to track indicators such as detailed age breakdowns that are 
key to better understanding targeting effectiveness. However, these 
steps do not fully address the weaknesses in USAID's targeting process. 

USAID Does Not Provide Sufficient Guidance in the Design Phase on 
Whether and How to Target Specialized Food Products, Although the 
Agency Is Starting to Make Improvements: 

USAID's Guidance for Targeting Is Neither Up-to-Date Nor Complete, 
Hindering Decision Making: 

We found that USAID's guidance for targeting is neither up-to-date nor 
complete for both emergency and development programs, which reduces 
the ability of implementing partners to make informed decisions in the 
design phase. USAID currently provides its implementing partners with 
a range of guidance and tools. Of these, the Commodities Reference 
Guide[Footnote 34] is USAID's official standard reference for food 
assistance programs and is intended to be used by USAID and 
implementing partner staff in deciding how to plan, manage, control, 
evaluate, and use Title II-funded food products. It is available on 
USAID's public website and provides information on available food 
products, including nutritional values, physical properties, and 
storage and handling guidelines.[Footnote 35] However, USAID has not 
updated the Commodities Reference Guide since 2006 and has not 
included guidance in the Commodities Reference Guide on all of the 
products currently used in USAID food assistance programs. The 2011 
Food Aid Quality Review also noted that the Commodities Reference 
Guide and other USAID guidance relevant to targeting are neither up-to-
date nor complete and recommended, for example, that USAID improve its 
guidance to enable implementing partners to better determine whether 
to use certain products for programs. 

[Side bar: Design: Monitoring: Evaluation: 

[Illustration: Source: GAO] 

Selected Guidance Used in the Design Phase of the Targeting Process:  

* Annual Program Statement provides requirements for implementing 
partners to consider regarding program design in emergency program 
applications.  

* Needs assessments help USAID and implementing partners target 
vulnerable groups; decide where activities will occur; and identify 
the size, location, timing, and duration of needs.  

* Commodities Reference Guide helps USAID and implementing partners 
design food assistance packages, ration sizes, and product mixes.  

* Flow charts and decision trees help implementing partners determine 
aspects of program design, including types of food distribution 
activities. End of side bar] 

We found that the lack of updated and complete guidance has hindered 
implementing partners' ability to make better-informed targeting 
decisions. One participant at our roundtable, for example, told us 
that his organization was unable to find all of the products it was 
using for a program in the outdated Commodities Reference Guide. As a 
result, it was not able to use these products in its program. 
Furthermore, USAID has recently deployed some limited quantities of 
various new specialized products without providing official standard 
guidance on how to use them. We recommended in 2011 that USAID provide 
clear guidance on whether and how best to use new specialized food 
products, including guidance to its implementing partners on targeting 
strategies to ensure that the products reach their intended 
recipients.[Footnote 36] USAID concurred with our recommendation and 
is taking steps to develop new guidance, but has deployed new 
specialized food products in the interim. USAID has purchased 
relatively small quantities of new specialized food products over the 
past 2 years, including those shown in table 2 below. For example, 
USAID purchased just over $6.5 million worth of these products in 
2011, as compared with $502 million of traditional food products and 
$42 million of traditional specialized food products purchased through 
Title II emergency program funding. 

Table 2: New Specialized Food Products Purchased with USAID Funding, 
Fiscal Years 2010 to 2012A: 

Fiscal year: 2010; 
Total cost of purchase: $1,965,484; 
Product type: Lipid nutritional supplement[B]; 
Cost of purchase: $1,965,484; 
Metric tons: 302. 

Fiscal year: 2011; 
Total cost of purchase: $6,565,820; 
Product type: Lipid nutritional supplement[B]; 
Cost of purchase: $1,998,920; 
Metric tons: 315. 

Product type: Ready-to-use therapeutic food (RUTF); 
Cost of purchase: $4,566,900; 
Metric tons: 990. 

Fiscal year: 2012; 
Total cost of purchase: $5,693,940; 
Product type: Ready-to-eat meal replacements; 
Cost of purchase: $660,000; 
Metric tons: 110. 

Product type: Ready-to-eat meal replacements; 
Cost of purchase: $715,000; 
Metric tons: 110. 

Product type: Ready-to-eat meal replacements; 
Cost of purchase: $649,000; 
Metric tons: 110. 

Product type: Ready-to-use therapeutic food (RUTF); 
Cost of purchase: $2,065,200; 
Metric tons: 500. 

Product type: CSB+; 
Cost of purchase: $819,040; 
Metric tons: 1,000. 

Product type: CSB+; 
Cost of purchase: $64,800; 
Metric tons: 80. 

Product type: CSB+; 
Cost of purchase: $720,900;
Metric tons: 890. 

Fiscal year: Total; 
Total cost of purchase: $14,225,244; 
Cost of purchase: $14,225,244; 
Metric tons: 4,407. 

Source: GAO analysis of USAID documents. 

[A] As of August 22, 2012. 

[B] These purchases were made with funding available through USAID's 
International Food Relief Partnership. This program enables USAID to 
award grant agreements to U.S. NGOs to produce and stockpile shelf-
stable, prepacked commodities for use in emergency food assistance 
programs. 

[End of table] 

In addition, USAID is planning to introduce nine new or reformulated 
products in the final part of 2012 and 2013, including new RUTFs and 
ready-to-use supplementary foods (RUSFs) (see appendix IV). USAID has 
not issued fully updated or complete guidance for all of these 
products. However, it has issued some guidance on their use. Moreover, 
USAID officials told us that they are providing the products only on a 
limited basis to organizations such as UNICEF that have experience 
using them in controlled environments, such as clinics, and have 
issued their own guidance on the use of these products. 

USAID's Guidance Inadequately Addresses Key Benefits and Risks That 
Inform Decisions on Whether to Target Specialized Food Products: 

USAID guidance inadequately addresses key benefits and risks of using 
specialized food products, according to USAID and implementing 
partners we spoke with during our field visits and our expert 
roundtable. This inadequate guidance hinders decision making on 
whether to use these products. As discussed earlier, the benefit of 
specialized food products is that, while more costly, they are also 
more nutritious, or of higher quality, than traditional food products. 
However, USAID has not quantified or clearly defined the degree of 
benefit that specialized food products may provide. In 2011, we 
reported that in recent years, nutritionists have debated the 
appropriateness of using fortified and blended foods to prevent and 
treat malnutrition in young children 6 to 24 months old, who have 
smaller stomachs, making it more difficult for them to eat enough of 
the product to obtain sufficient nutrients.[Footnote 37] As a result, 
the benefits of some traditional specialized food products are not 
clear. In addition, limited information on new specialized products is 
available. As we previously reported, USAID and implementing partners 
do not know how well new specialized food products perform in 
promoting nutritional health indicators, such as weight gain and 
growth, particularly in a program setting, or how well they perform in 
comparison to traditional food products.[Footnote 38] The efficacy of 
new specialized products, or the extent to which these products 
promote desired outcomes, is still being studied by USAID, WFP, 
nutritionists, and other researchers. As a result, while USAID is 
building knowledge about these products, it is not providing 
sufficient guidance on the benefits of specialized food products to 
implementing partners. 

USAID also lacks guidance on how to adequately address risks of using 
specialized food products, according to implementing partners we spoke 
with during our field visits and our expert roundtable. A key 
targeting risk is that various factors implementing partners face in-
country may reduce targeting effectiveness to such a degree that the 
additional cost of using specialized food products outweighs the 
potential benefit. This trade-off becomes more significant with the 
higher cost of new specialized food products, for which the cost per 
ration can be more than triple the cost of traditional food products. 
Poor data quality, host government policies, and sharing may reduce 
implementing partners' ability to identify and reach recipients, but 
USAID's existing guidance does not adequately inform decisions on 
whether the reduction in targeting effectiveness is of such a degree 
that the use of specialized food products is no longer justified. 
[Footnote 39] 

USAID Is Taking Steps to Improve Targeting Guidance: 

USAID is taking some steps to enhance guidance on whether and how to 
use new specialized food products, but fully up-to-date and complete 
guidance will not be completed until at least late 2013. In response 
to our 2011 recommendation on improved targeting guidance, USAID 
stated in its official agency response in July 2011 that it would work 
to address our recommendations through the second Food Aid Quality 
Review study now under way with Tufts University. This work is 
expected to include cost-effectiveness analyses on new specialized 
food products, adding information important to help determine whether 
and how to use them. In addition, according to USAID documents and 
officials, USAID is updating and improving the Commodities Reference 
Guide and other guidance related to targeting, including for new 
specialized food products. However, this work will not be completed 
until September 2013 at the earliest, according to USAID officials. 
USAID also plans to introduce other guidance before September 2013, 
including updated fact sheets for individual products. According to 
USAID officials, this interim guidance will be released on an as-
needed basis, beginning in October 2012. In addition, USAID has 
existing guidance that helps inform implementing partners' decision 
making, including its Annual Program Statement (APS), Food for Peace 
Information Bulletins, and some Food and Nutrition Technical 
Assistance (FANTA) guidance. 

Weaknesses in USAID's Monitoring and Evaluation Efforts Related to 
Targeting Could Limit Targeting Effectiveness and Hinder Decision 
Making, but the Agency Is Starting to Take Steps to Improve Monitoring: 

USAID Does Not Monitor Key Indicators of Targeting Effectiveness, but 
Is Initiating Improvements in This Area: 

USAID does not require monitoring of key indicators needed to 
determine the level of targeting effectiveness, although it is 
beginning to make improvements in this area.[Footnote 40] Information 
on indicators that are consistent with the goals of the program is 
critical to determining how effectively a program targets food 
assistance.[Footnote 41] Targeting effectiveness can be measured by 
the extent to which food assistance reaches correctly targeted 
recipients--that is, the percentage of intended recipients that 
actually receive food assistance in the intended amounts (see figure 
4).[Footnote 42] Effectively targeted programs reduce the magnitude of 
these errors. USAID guidance states that monitoring should be used to 
measure progress toward planned program results.[Footnote 43] 
Additionally, FANTA guidance states that monitoring efforts should 
allow USAID and its implementing partners to assess the extent to 
which targeted recipients received intended food assistance.[Footnote 
44] According to a USAID official, USAID field staff do consider 
targeting during their routine monitoring of food assistance programs. 
In addition, USAID requires its implementing partners to collect some 
data, such as the number of intended recipients for all food 
assistance programs, and requires other indicators to be monitored 
depending on the type of program--emergency or development. However, 
USAID does not currently require sufficient monitoring of key 
indicators consistent with program goals that would allow its 
implementing partners to report on levels of targeting effectiveness. 
For example, it cannot determine the effectiveness of a program 
targeting children under 2 because it does not monitor the age of the 
actual recipients in either emergency or development programs. 

[Side bar: Design: Monitoring: Evaluation: 

[Illustration: Source: GAO] 

Selected Guidance Used in the Implementation and Monitoring Phase of 
the Targeting Process: 

* USAID Automated Directives System (ADS) 203-Assessing and Learning 
provides USAID staff with guidance on monitoring and collecting 
program information. 

* Food and Nutrition Technical Assistance (FANTA) provides partners 
with technical support for implementation and monitoring. 

* Food for Peace (FFP) Standard Indicators Handbook provides partners 
with a list and description of monitoring indicators that must be used 
in programs. 

* FFP Information Bulletins provide periodic updates to guidance on 
monitoring and evaluation policies and procedures. End of side bar] 

USAID monitoring is inadequate for both emergency and development 
programs because it does not monitor key data on recipients that would 
allow USAID to measure whether food assistance is actually reaching 
the intended recipients. Specifically, for emergency programs, USAID 
collects the total number of intended recipients from its implementing 
partners, but does not collect the total number of actual recipients 
or indicators such as breakdowns of age and gender for intended or 
actual recipients. According to USAID, these types of more specific 
indicators may not be as important for some emergency programs that 
focus solely on rapid lifesaving. However, these indicators are 
important for emergency programs that do have specific targeting 
goals, such as reaching severely malnourished children. For 
development programs, USAID collects both the total number of intended 
and actual recipients from its implementing partners, but as with its 
monitoring of emergency programs, does not collect data on key 
indicators such as breakdowns of age and gender. Without monitoring 
full sets of data for both intended and actual recipients, including 
key indicators consistent with program goals, USAID has limited 
ability to learn about the magnitude of targeting errors or the degree 
to which its implementing partners are achieving their program goals. 

Figure 4: Targeting Effectiveness Is Measured by the Magnitude of 
Targeting Error: 

[Refer to PDF for image: illustration] 

Overlapping circles: 
Less overlap: less effective targeting; 
Total overlap: More effective targeting. 

Correctly targeted recipients: those without: 
Exclusion error: 
Intended recipients who are not reached by the food assistance program; 
Inclusion error: Actual recipients who are reached by the food 
assistance program but should not be, according to the targeting 
criteria. 

Source: GAO analysis based on USAID and other sources. 

[End of figure] 

According to USAID and implementing partner officials, it is 
particularly complex to gather monitoring information on indicators 
related to targeting effectiveness about actual recipients, due in 
part to cost and data quality issues. These challenges are heightened 
for programs using new specialized food products, which are designed 
to provide nutritional benefits to very specific vulnerable groups, 
such as malnourished children or pregnant or lactating women. 
Identifying and selecting recipients for such programs requires using 
indicators that are more complex than those used for programs designed 
for the general population. Some of the indicators, such as 
nutritional status, are costly to measure and prone to errors. For 
example, implementing partners we spoke with during our fieldwork in 
Guatemala and Sri Lanka told us that they have difficulty in 
collecting data for some indicators in other, non-USAID programs using 
new specialized food products due to resource constraints, lack of 
technical capacity by some local NGO staff, or problems with 
unreliable data. 

USAID is making improvements in monitoring of some nutrition-focused 
development programs, for example, by planning to require implementing 
partners to collect data on the age of young children, a common 
criterion for new specialized food products. However, as mentioned 
earlier, indicators key to measuring targeting effectiveness are not 
consistently monitored across all USAID food assistance programs. 
According to the Standards of Internal Control in the Federal 
Government, program managers need to compare actual performance to 
planned results and analyze significant differences.[Footnote 45] 
Without reporting targeting effectiveness, USAID cannot compare actual 
targeting effectiveness to planned results. As a result, USAID may not 
be able to make fully informed targeting decisions for both ongoing 
and future food assistance programs. For example, USAID may not be 
able to track the performance of food assistance programs' targeting 
over time or across programs and may therefore miss opportunities to 
identify improvements to the targeting effectiveness of these programs. 

USAID Evaluations Do Not Systematically Address Targeting 
Effectiveness, Which May Hinder Decision Making: 

USAID's evaluations of its food assistance programs do not 
systematically discuss targeting effectiveness. As a result, the 
agency may be missing opportunities to learn important lessons about 
targeting effectiveness and apply them to current and future 
programs.[Footnote 46] Specifically, the 17 development and 3 
emergency USAID evaluations going back to 2009 that we examined did 
not systematically discuss targeting in general and targeting 
effectiveness in particular. These evaluations addressed targeting 
effectiveness to varying degrees--ranging from an entire section on 
targeting that included a discussion of a targeting effectiveness 
indicator, to no mention of targeting at all. The evaluations that 
discussed targeting effectiveness included information on the 
magnitude of inclusion or exclusion errors and the level of community 
satisfaction with targeting. For example, USAID's evaluation of an 
emergency program in Zimbabwe discussed inclusion and exclusion error, 
a key measure of targeting effectiveness, within a section focused 
exclusively on targeting. Similarly, USAID's evaluation of an 
emergency program in Ethiopia mentioned the level of community 
satisfaction with targeting: almost 90 percent of the respondents to a 
survey of community members were generally satisfied with the fairness 
of the program's targeting. Some evaluations, however, contained only 
a brief mention of targeting in general, with no mention of targeting 
effectiveness. For example, an evaluation of a development program in 
Bolivia mentioned targeting and contained tables showing monitoring 
indicators for the baseline compared against the final evaluation, but 
did not explain how the recipients were originally targeted or how the 
final evaluation results were verified. Other evaluations, such as a 
2011 evaluation of a development program in Guatemala, did not discuss 
targeting or targeting effectiveness at all. 

[Side bar: Design: Monitoring: Evaluation: 

[Illustration: Source: GAO] 

Selected Guidance Used in the Implementation and Monitoring Phase of 
the Targeting Process: 

* USAID Automated Directives System (ADS) 203-Assessing and Learning 
provides USAID staff with guidance on monitoring and collecting 
program information. 

* Food and Nutrition Technical Assistance (FANTA) provides partners 
with technical support for implementation and monitoring. 

* Food for Peace (FFP) Standard Indicators Handbook provides partners 
with a list and description of monitoring indicators that must be used 
in programs. 

* FFP Information Bulletins provide periodic updates to guidance on 
monitoring and evaluation policies and procedures. End of side bar] 

USAID policy and guidance call on USAID and its implementing partners 
to use evaluations as opportunities to learn about past programs to 
inform decision making for new programs. USAID policy calls for 
evaluations to "systematically generate knowledge about the magnitude 
and determinants of program performance, permitting those who design 
and implement programs…to refine designs and introduce improvements to 
future efforts."[Footnote 47] USAID guidance states that evaluations 
should assess the extent to which the program is meeting its stated 
objectives.[Footnote 48] For example, if a program is providing food 
assistance to a vulnerable subpopulation, effective targeting is an 
important program objective. However, USAID's evaluations of its food 
assistance programs do not systematically address targeting 
effectiveness, and as a result, the agency's ability to assess the 
extent to which a program is meeting its stated objectives is 
hindered, and it may miss opportunities for learning lessons that 
could be useful when designing new programs or improving ongoing ones. 

Conclusions: 

The use of specialized food products, especially some of those most 
recently introduced, offers the promise of providing better nutrition 
to the most vulnerable. However, the increased cost of these new 
specialized products means that their use may likely reduce the 
overall number of recipients receiving food assistance under a fixed 
program budget--a quality-quantity trade-off. Choosing more costly 
specialized food products over less costly traditional food products 
may be the optimal policy option in certain circumstances, including 
areas with a high percentage of children suffering from hunger and 
malnutrition. However, the achievement of this policy goal requires 
effective targeting of food assistance so that food ultimately reaches 
the intended recipients. If food assistance is not targeted 
effectively, the program may fail to achieve its nutritional goals 
while simultaneously feeding fewer people. 

USAID recognizes the need to update and broaden its guidance on the 
use of specialized food products, but this revision will not be 
completed until late 2013 at the earliest. Issuance of improved 
interim guidance related to food assistance targeting will help USAID 
and its implementing partners make better-informed decisions about 
whether and how to deploy the range of food products that are 
available, particularly new specialized products. Moreover, the 
monitoring and reporting of key indicators consistent with program 
objectives are necessary to ensure that specialized food products are, 
in fact, reaching intended recipients. Improved targeting--which takes 
an approach that is appropriate to the circumstances and conditions--
would better ensure that valuable food resources are put to their most 
optimal use and that vulnerable groups receive the most effective 
assistance available to them. 

Recommendations for Executive Action: 

To improve USAID's targeting of specialized food products to 
vulnerable groups, such as children under 2 and pregnant women, we 
recommend that the Administrator of USAID take the following two 
actions: 

* As USAID continues to purchase new specialized food products without 
updated guidance, it should issue, as appropriate, improved interim 
guidance to assist implementing partners in deciding whether and how 
to target specialized food products. 

* When USAID chooses to provide specialized food products to targeted 
vulnerable groups, it should establish and report program-specific 
indicators related to each targeted group to allow USAID to assess its 
programs' effectiveness in reaching these groups. 

Agency Comments and Our Evaluation: 

We provided a draft of this report to USAID, USDA, and State for 
comment. In its written comments, reproduced in appendix V, USAID 
concurred with our recommendations. USDA and State provided no written 
comments. We also provided relevant excerpts of this report to WFP for 
comment. USAID, USDA, and WFP provided technical comments that were 
incorporated, as appropriate. 

USAID strongly agreed with our recommendation on improving interim 
guidance to help implementing partners decide whether and how to 
target specialized food products. USAID provided examples of recent 
and ongoing efforts that are expected to contribute to improved 
guidance on new specialized food products. For example, USAID expects 
to publish on its website updated fact sheets on food products 
provided in its food assistance programs and will prioritize issuing 
those relating to specialized food products. Although USAID noted that 
some existing guidance is available for three of the new specialized 
food products it is introducing, such as CSB+, the agency also 
acknowledged that it expects to issue its own guidance on all new 
products and update the Commodities Reference Guide. 

USAID agreed with our recommendation on establishing and reporting 
program-specific indicators to allow USAID to assess its programs' 
effectiveness in reaching targeted groups. USAID agreed with us on the 
need to develop new, program-specific indicators to assess the 
nutrition goals of new specialized food products for its Title II 
emergency programs and indicated that it would engage with partners on 
demonstrating impact and results. To that end, USAID indicated that it 
is in the process of recruiting a nutritionist to ensure that products 
used match their intended purpose and high-value specialized products 
are properly targeted. 

We are sending copies of this report to appropriate congressional 
committees, the Administrator of USAID, the Secretaries of Agriculture 
and State, and relevant agency heads. The report is also available at 
no charge on the GAO website at [hyperlink, http://www.gao.gov]. 

If you or your staff have any questions about this report, please 
contact me at (202) 512-9601 or melitot@gao.gov. Contact points for 
our Offices of Congressional Relations and Public Affairs may be found 
on the last page of this report. GAO staff who made major 
contributions to this report are listed in appendix VI. 

Signed by: 

Thomas Melito: 
Director, International Affairs and Trade: 

[End of section] 

Appendix I: Objectives, Scope, and Methodology: 

Our objectives were to (1) describe in-country factors that the U.S. 
Agency for International Development (USAID) and its implementing 
partners face in targeting vulnerable groups, and (2) examine the 
extent to which USAID's targeting process supports effective targeting. 

To address these objectives, we met with officials at USAID and its 
implementing partners, including the World Food Program (WFP) and 
nongovernmental organizations (NGOs). In addition, we met with 
officials at the U.S. Department of Agriculture (USDA) and the U.S. 
Department of State. We also spoke with academics, experts, and 
practitioners associated with research institutes, universities, and 
NGOs. We examined USAID program documents, including guidance and 
tools, related to food assistance targeting processes. Furthermore, we 
conducted fieldwork in four countries--Ethiopia, Guatemala, Sri Lanka, 
and Zimbabwe--and met with officials from U.S. missions, implementing 
partners, and relevant host government agencies. We also convened a 
roundtable of 10 practitioners and experts--including representatives 
from implementing partners such as NGOs and WFP, academia, and 
research organizations--to discuss in-country factors that affect the 
ability of USAID and its partners to target vulnerable groups, as well 
as the guidance and monitoring and evaluation tools that USAID and its 
implementing partners use to target food assistance activities (see 
appendix II for the list of participating organizations in our 
roundtable). 

To provide context and background, we analyzed data from USAID and WFP 
to identify trends in U.S. funding for international food assistance 
and procurement data on the use of traditional and specialized food 
products. As these data were for background purposes, we did not 
assess their reliability. In addition, we reviewed data that we 
reported on in 2011 concerning cost information for specialized food 
products relative to traditional food products. We then reviewed 
similar data to obtain updates about the costs and relative length of 
feeding for these products and interviewed USAID, WFP, and Tufts 
University about the reliability of the updated data. We used this 
information to create an analysis comparing the amount of time various 
commodities could be provided for the cost of other commodities. We 
found that these updated data were sufficiently reliable for the 
purposes of this report, in that they demonstrated the order of 
magnitude of the relative cost of different types of food products 
used in food assistance programs. Although commodity prices may 
fluctuate and suggested feeding lengths may vary by program or 
individual recipient, the data were sufficiently reliable to 
demonstrate that there are large differences in the cost of feeding, 
depending on the products used. In addition, we reviewed various 
literature on the targeting process, as well as USAID guidance and 
tools to facilitate targeting decisions. 

To describe in-country factors USAID and its implementing partners 
face in targeting vulnerable groups, we reviewed literature on 
targeting and new specialized food products issued by academics, 
research institutes, implementing partners, USAID contractors, UN 
organizations involved in humanitarian assistance, and independent 
international organizations; spoke with in-country officials such as 
relevant host government officials and implementing partners; and 
obtained the input of our roundtable participants. 

To examine the extent to which USAID's targeting process supports 
effective targeting, we analyzed responses and information from the 
general methodologies listed above. To examine the extent to which 
USAID provides guidance to its implementing partners on targeting, we 
reviewed existing USAID guidance for targeting and USAID's contract 
with Tufts University and spoke with USAID and Tufts University 
officials about the scope of work for this contract, including the 
section on updating guidance. We reviewed information from USAID about 
the product types, costs, and tonnage of new specialized food products 
purchased since fiscal year 2010. We interviewed USAID about the 
sources of this information and also compared it to data about these 
products from other sources of information. These included the 
requests for applications that USAID provides to its implementing 
partners for new specialized food products, including ready-to-use 
therapeutic foods and lipid nutritional supplements; USAID's commodity 
price calculator; and relevant legislation authorizing the use of 
these products. We found that the data were sufficiently reliable for 
the purposes of this report, in that they showed the magnitude and 
trends of purchases of new specialized food products with USAID 
funding in recent years. To examine the extent to which USAID monitors 
and evaluates targeting effectiveness and other related information, 
we analyzed monitoring information provided to us by USAID about 
numbers of planned recipients and actual beneficiaries for Title II 
food assistance programs since 2009. We reviewed current USAID 
policies and procedures on monitoring and evaluation. We also reviewed 
guidance provided by Food and Nutrition Technical Assistance (FANTA), 
under a cooperative agreement with USAID. This guidance covers aspects 
of monitoring and evaluation, such as the performance measures to be 
used for food assistance programs. Through searches of USAID's website 
and discussions with cognizant officials, we identified a total of 30 
final evaluations of USAID programs going back to 2009. Final 
evaluations are conducted at the end of a program. However, USAID 
could not assure us that it had provided all of the evaluations 
conducted for its development programs, and also noted that it does 
not require evaluations of its emergency programs. We selected 20 of 
these final evaluations for review based on the following criteria: we 
included all 3 final evaluations for the single-year programs, and 
selected 17 final evaluations for the multi-year programs to ensure 
that we had coverage by year and geographic region. We reviewed these 
evaluations to examine the extent to which they had addressed 
targeting issues. Finally, we reviewed evaluations that WFP conducted 
of those of its programs that were implemented with USAID funding. 

We conducted this performance audit from October 2011 to September 
2012 in accordance with generally accepted government auditing 
standards. Those standards require that we plan and perform the audit 
to obtain sufficient, appropriate evidence to provide a reasonable 
basis for our findings and conclusions based on our audit objectives. 
We believe that the evidence obtained provides a reasonable basis for 
our findings and conclusions based on our audit objectives. 

[End of section] 

Appendix II: Organizations That Participated in GAO Roundtable: 

The following organizations participated in our roundtable of experts 
and practitioners held in May 2012: 

* CARE:
* Catholic Relief Services:
* Cornell University:
* FHI 360:
* International Food Policy Research Institute:
* Mercy Corps:
* Save the Children:
* World Food Program:
* World Vision: 

[End of section] 

Appendix III: Cost Differences between Traditional Food Products and 
Specialized Food Products: 

Table 3 provides a comparison of cost differences between traditional 
and selected specialized food products, which include both traditional 
specialized food products and new specialized food products. For 
example, to feed a child 6 to 23 months old, a traditional grain-based 
representative ration costs $0.02 to $0.06 per day, a CSB+ ration, 
$0.10 to $0.21 per day, and a ready-to-use therapeutic food (RUTF) 
ration, $0.42 to $0.46 per day. 

Table 3: Relative Costs of Traditional and Selected Specialized Food 
Products (in U.S. dollars): 

Traditional food product: 

Product[A]: Grain-based representative ration; 
Description: Grain, pulse, CSB, and vegetable oil; 
Cost per ration for child: $0.02 - 0.06; 
Overall cost for suggested length of use[B]: 90 - 120 days; 
$2.07 - $7.45. 

Traditional specialized food product: 

Product[A]: CSB fortified blended food; 
Description: Processed cornmeal, soy flour, soybean oil, vitamins, and 
minerals; 
Cost per ration for child: $0.09 - $0.18; 
Overall cost for suggested length of use[B]: 90 - 120 days; 
$8.41 - $22.07. 

New specialized food products: 

Product[A]: CSB+ (WFP Supercereal); 
Description: WFP formulation for children over 6 months old; 
Cost per ration for child: $0.10 - $0.21; 
Overall cost for suggested length of use[B]: 90 - 120 days; 
$9.22 - $25.58. 

Product[A]: Ready-to-use therapeutic food (RUTF); 
Description: Nutritionally dense food for community-based treatment of 
severe acute malnutrition; 
Cost per ration for child: $0.42 - $0.46; 
Overall cost for suggested length of use[B]: 42 - 90 days; 
$17.77 - $41.40. 

Product[A]: Lipid nutritional supplement (LNS); 
Description: Supplementary complementary food for children 6 to 24 
months old to prevent stunting; 
Cost per ration for child: $0.10 - 0.13; 
Overall cost for suggested length of use[B]: 180 - 545 days; 
$17.06 - $71.90. 

Product[A]: Emergency food bars; 
(A-28 rice & A-29 wheat); 
Description: Meal replacement used during onset of emergencies; 
Cost per ration for child: $0.32 - $0.33; 
Overall cost for suggested length of use[B]: 3 - 15 days; 
$0.97 - $5.00. 

Product[A]: Emergency food paste (A-20); 
Description: Meal replacement used during onset of emergencies; 
Cost per ration for child: $0.29; 
Overall cost for suggested length of use[B]: 3 - 15 days; 
$0.86 - $4.28. 

Source: GAO analysis based on various studies and USAID and WFP data. 

Note: Costs per ration are for a child 6 to 23 months old, in 2012. 

[A] The products listed in this table are used for different purposes. 
This table does not assess the relative effectiveness of each product. 
We note that USAID does not provide RUTF as part of a general food 
distribution ration. 

[B] The suggested lengths of use in this table are fairly wide ranges 
of time (for example, 180-545 days) that reflect uncertainty, in part 
because limited data from actual application are currently available. 
The suggested lengths of use could change as more data become 
available for more precise estimates. 

[End of table] 

The cost per ration is one aspect of the relative cost of food 
assistance products; the length of time a product is used in a food 
assistance program also affects its overall relative cost. Some 
experts suggest that, although an individual daily ration of a new 
specialized food product may be relatively expensive, it may 
ultimately be less costly overall because it may be fed for a shorter 
period of time based on its suggested length of use. However, we found 
that some new specialized food products with a relatively shorter 
suggested length of use may still cost relatively more overall. For 
example, as shown in the table, although an RUTF's suggested length of 
use (42 to 90 days) for a child 6 to 23 months old is shorter than 
that of a traditional grain-based ration (90 to 120 days), the RUTF 
may still cost more overall ($17.77 to $41.40) than the grain-based 
ration ($2.07 to $7.45). Despite their higher overall costs, RUTFs may 
be the optimal choice in certain circumstances, such as for 
emergencies in areas with a high percentage of children suffering from 
severe acute malnutrition. 

Table 4 illustrates the number of days that traditional food products 
(grain-based rations) or traditional specialized food products (CSB) 
can be provided for the cost of providing a new specialized food 
product based on its suggested length of use. For example, for the 
cost of providing a nutritional supplementary paste fortified ration 
for 180 to 545 days, a grain-based ration could be provided for 741 to 
3,121 days and a CSB ration could be provided for 183 to 769 days. 

Table 4: Number of Days Grain-Based or Corn Soy Blend Ration Could Be 
Provided for the Cost of Providing Selected New Specialized Food 
Products: 

New specialized food product[A]: Nutritional supplementary paste; 
Suggested length of use of a specialized food product (number of 
days)[B]: 180 - 545; 
Number of days a grain-based ration could be provided for the same 
cost[C]: 741 - 3,121; 
Number of days a CSB ration could be provided for the same cost[C]: 
183 - 769. 

New specialized food product[A]: Ready-to-use therapeutic food 
(spread); 
Suggested length of use of a specialized food product (number of 
days)[B]: 42 - 90; 
Number of days a grain-based ration could be provided for the same 
cost[C]: 772 - 1,797; 
Number of days a CSB ration could be provided for the same cost[C]: 
190 - 443. 

New specialized food product[A]: A-20 paste (ready-to-eat meal 
replacement); 
Suggested length of use of a specialized food product (number of 
days)[B]: 3 - 15; 
Number of days a grain-based ration could be provided for the same 
cost[C]: 37 - 186; 
Number of days a CSB ration could be provided for the same cost[C]: 
9 - 46. 

New specialized food product[A]: A-29 wheat bar (ready-to-eat meal 
replacement); 
Suggested length of use of a specialized food product (number of 
days)[B]: 3 - 15; 
Number of days a grain-based ration could be provided for the same 
cost[C]: 42 - 211; 
Number of days a CSB ration could be provided for the same cost[C]: 
10 - 52. 

New specialized food product[A]: A-28 rice bar (ready-to-eat meal 
replacement); 
Suggested length of use of a specialized food product (number of 
days)[B]: 3 -15; 
Number of days a grain-based ration could be provided for the same 
cost[C]: 43 - 217; 
Number of days a CSB ration could be provided for the same cost[C]: 
11 - 53. 

New specialized food product[A]: CSB+ (WFP Supercereal); 
Suggested length of use of a specialized food product (number of 
days)[B]: 90 - 120; 
Number of days a grain-based ration could be provided for the same 
cost[C]: 400 - 1,110; 
Number of days a CSB ration could be provided for the same cost[C]: 
99 - 274. 

Source: GAO analysis based on various studies and USAID and WFP data. 

[A] The products listed in this table are used for different purposes. 
This table does not assess which products are more effective. We note 
that USAID does not provide RUTF as part of a general food 
distribution ration. 

[B] The suggested lengths of use in this table are fairly wide ranges 
of time (for example, 180-545 days) that reflect uncertainty, in part 
because limited data from actual application are currently available. 
The suggested lengths of use could change as more data become 
available for more precise estimates. 

[C] Cost of a grain-based ration for a child 6 months old. 

[End of table] 

[End of section] 

Appendix IV: USAID New Specialized Food Products Pending Introduction: 

USAID has thus far deployed a relatively limited quantity of new 
specialized food products but plans to introduce the following 
products to address various needs: 

* Ready-to-use supplementary food (RUSF) - Nutritionally dense and 
highly fortified for management of moderate acute malnutrition. 

* Fortified vegetable oil - Fortified with vitamins A and D. 

* Fortified milled cereals - Reformulated and standardized to improve 
general rations. 

* CSB++ (WFP Supercereal+) - Formulated by WFP for children 6 to 24 
months of age. 

* CSB-14 - Reformulated CSB to be prepared with vegetable oil. 

[End of section] 

Appendix V: Comments from the U.S. Agency for International 
Development: 

USAID: 
From The American People: 

Thomas Melito: 
Director, International Affairs & Trade: 
U.S. Government Accountability Office: 
Washington, DC 20548:  

Dear Mr. Melito:  

I am pleased to provide a formal response to the Government 
Accountability Office (GAO) draft report entitled "International Food 
Assistance: Improved Targeting Would Help Enable USAID to Reach 
Vulnerable Groups" (GAO-12-862) for the U. S. Agency for International 
Development (USAID).  

The enclosed USAID comments are provided for incorporation with this 
letter as an appendix to the final report. Thank you for the 
opportunity to respond to the GAO draft report and for the courtesies 
extended by your staff in the conduct of this audit review.  

Sincerely,  

Signed by: 

Angelique M. Crumbly: 
Acting Assistant to the Administrator:  
Bureau for Management: 
U.S. Agency for International Development: 
 
Enclosure: a/s: 
 
USAID Comments on GAO Report on "International Food Assistance: Improved
Targeting Would Help Enable USAID to Reach Vulnerable Groups" (GAO-12-
862): 

USAID appreciates the GAO's interest in USAID's new specialized food 
products. This is an exciting and interesting phase in USAID's food 
aid programming. For the first time in our history, USAID is procuring 
certain, specialized food products here in the U.S and donating them, 
in-kind, around the world. To date, four of the nine planned new or 
improved products are available through USAID. Of these, three of the 
products have been provided to an implementing partner. 

Lipid Nutritional Supplement (LNS): The LNS products currently 
distributed by USAID are part of the Congressionally-mandated 
International Food Relief Program (IFRP). At this time, Edesia's 
Nutributter, a supplemental, complementary food product, is being 
distributed under IFRP. Guidance on the use of this product is 
available at the Edesia website and in the IFRP Request for 
Application. USAID is not yet using LNS products in any other programs. 

Ready-To-Use Therapeutic Food (RUFF): RUTFs are nutritionally dense, 
highly fortified products used in the treatment of severe acute 
malnutrition. USAID has procured RUTFs using Title 11 funds and has 
donated a portion of these to the United Nations Children's Fund 
(UNICEF) for use in ongoing programs. This donation was based on an 
application from UNICEF that included detailed targeting information. 
In addition, UNICEF has a long history of programming RUTFs and 
explicit guidance on these products. The balance of RUTFs has not yet 
been donated to an implementing partner. 

Corn Soya Blend Plus (CSB+): USAID has procured and donated CSB F to 
three partners for pilot use. CSB+ is a more nutritious version of 
traditional CSB, which USAID and its partners have used for many 
years, and the guidance on its use is the same. This guidance is 
available to the public on the USAID website in the current Commodity 
Reference Guide. 

Emergency bars and pastes: USAID has procured emergency bars and 
pastes which are meal replacements for use in sudden onset emergencies 
when disaster-affected populations are displaced and do not have 
access to cooking supplies or facilities. To date, these products have 
not been disbursed to any partner. USAID anticipates using these 
products in conjunction with other emergency response items, such as 
water and plastic sheeting. 

USAID appreciates GAO's recognition of its efforts to improve design, 
monitoring and evaluation elements in ways that improve targeting 
effectiveness. FFP's Country Specific Guidance, which expressly states 
targeting objectives for new development food aid interventions, and 
FFP's placement of additional monitors to oversee programs in the 
field are examples of such improvements. FFP is refining its 
evaluation policy now and reforms will be in line with the Agency's 
new evaluation policy objectives to assure high quality, independent 
evaluation of USAID's work. 

Recommendation 1: We recommend that the Administrator of USAID take 
action as USAID continues to purchase new specialized food products 
without updated guidance, it should issue, as appropriate, improved 
interim guidance to assist implementing partners in deciding whether 
and how to target specialized food products. 

Management Comments: USAID strongly agrees with the GAO that the 
advent of new and improved specialized food products requires 
pertinent study and guidance in order to program them smartly. As a 
result. USAID has undertaken, and continues to support, important 
research programs relevant to improved food aid targeting. In 2009, as 
part of its ongoing efforts to improve the quality and efficiency of 
U.S. food aid operations, the USAID Office of Food for Peace (UP) 
awarded a contract to the Friedman School of Nutrition Science and 
Policy of Tufts University to review the state of science on nutrition-
related needs of traditionally vulnerable groups. The subsequent 
report was widely lauded and contained a wide range of 
recommendations, many of which USAID has prioritized and is in the 
process of implementing. As follow-on to Tufts' initial review and 
recommendations, USAID has extended Tufts' contract to include 
research and testing of new and existing food products including 
packaging and delivery methodologies, and inter-agency coordination 
around the application of new and improved food products. 

The development of new specialized products for use in USAID's Title 
II programs is a relatively new initiative but these products are not 
new to the nutrition community and its practitioners. There is a 
wealth of public information, guidance, and research on all of these 
products. The international community and organizations such as World 
Health Organization, the United Nations World Food Program, the United 
Nations Children's Fund and The Codex Alimentarius Commission set 
standards on the use of specialized food products. 

However, USAID fully expects to issue its own guidance on all new 
products, drawing on these international standards and on USAID-funded 
research results as they become available. Guidance on these new 
products may be issued through Food for Peace Information Bulletins, 
the Annual Program Statement or Request for applications and of 
course, incorporated into the USAID Commodity Reference Guide (CRG). 
As noted by GAO the CRG is currently being updated and although the 
complete revision of the CRG is expected in September 2013, USAID is 
currently updating and creating commodity fact sheets on a roiling 
basis. These updated fact sheets will be available on USAID's website 
as of October 2012 and USAID will prioritize those fact sheets which 
relate to specialized food products. 

Recommendation 2: We recommend that the Administrator of USAID take 
action when USAID chooses to provide specialized food products to 
targeted vulnerable groups, it should establish and report program-
specific indicators related to each targeted group to allow USAID to 
assess its programs' effectiveness in reaching these groups. 

Management Comments: USAID appreciates GAO's highlighting of the 
various difficult aspects of targeting in food assistance; this is a 
constantly evolving field with a variety of challenges. 

USAID agrees with GAO that knowing the effectiveness of food aid 
programming requires targeting-related indicators. USAID Food for 
Peace indicators have evolved significantly in recent years and are 
increasingly refined to capture results, including in the area of 
improved nutrition. USAID Food for Peace has an extensive list of 
established impact, outcome, and output level program-specific 
indicators including on nutrition impacts for children under 2 and 
pregnant and lactating women. All USA1D FFP indicators are 
disaggregated by sex. These standard indicators are detailed 
extensively in the publicly available Food for Peace Information 
Bulletin 11-03 which was issued in November 2011. 

USAID FFP emergency programs, on the other hand, are required to 
report on number of persons reached, disaggregated by sex. Given that 
the objective of most emergency programs is to save lives, this is the 
most relevant indicator for these responses. However, with the advent 
of new specialized products, USAID recognizes the potential need for 
new, specific indicators that speak to the nutrition goals of these 
products. Therefore, USAID will engage Title 11 partners to discuss 
best steps forward on demonstrating impact and results in these types 
of programs. To that end, USAID FFP has recently solicited for a 
nutritionist to work specifically on these issues. This technical 
expert will review the nutritional appropriateness of commodities 
called forward for emergency programs to ensure that the product 
matches the intended purpose and to ensure that high value specialized 
products are properly targeted and programmed. This position will also 
collaborate with other USG partners, bilateral donors, multilateral 
organizations, foundations, universities, and non-governmental 
organizations on nutrition policy and programming to ensure that USAID 
Title H new specialized products are in fact reaching the right people 
at the right time for the right reasons. 

[End of section] 

Appendix VI: GAO Contact and Staff Acknowledgments: 

GAO Contact: 

Thomas Melito, (202) 512-9601 or melitot@gao.gov: 

Staff Acknowledgment: 

In addition to the person named above, Joy Labez (Assistant Director), 
Carol Bray, Marc Castellano, Ming Chen, Anna Chung, Debbie Chung, 
Martin De Alteriis, Mark Dowling, Etana Finkler, David Schneider, and 
Jeremy Sebest made key contributions to this report. Sada Aksartova, 
Vida Awumey, Teresa Heger, Erin McLaughlin, Michael Maslowski, Julia 
Ann Roberts, Barbara Shields, and Phillip Thomas also contributed to 
this report. 

[End of section] 

Related GAO Products: 

World Food Program: Stronger Controls Needed in High-Risk Areas. 
[hyperlink, http://www.gao.gov/products/GAO-12-790]. Washington, D.C.: 
September 13, 2012. 

Farm Bill: Issues to Consider for Reauthorization. [hyperlink, 
http://www.gao.gov/products/GAO-12-338SP]. Washington, D.C.: April 24, 
2012. 

International Food Assistance: Funding Development Projects through 
the Purchase, Shipment, and Sale of U.S. Commodities Is Inefficient 
and Can Cause Adverse Market Impacts. [hyperlink, 
http://www.gao.gov/products/GAO-11-636]. Washington, D.C.: June 23, 
2011. 

International Food Assistance: Better Nutrition and Quality Control 
Can Further Improve U.S. Food Aid. [hyperlink, 
http://www.gao.gov/products/GAO-11-491]. Washington, D.C.: May 12, 
2011. 

International School Feeding: USDA's Oversight of the McGovern-Dole 
Food for Education Program Needs Improvement. [hyperlink, 
http://www.gao.gov/products/GAO-11-544]. Washington, D.C.: May 19, 
2011. 

International Food Assistance: A U.S. Governmentwide Strategy Could 
Accelerate Progress toward Global Food Security. [hyperlink, 
http://www.gao.gov/products/GAO-10-212T]. Washington, D.C.: October 
29, 2009. 

International Food Assistance: Key Issues for Congressional Oversight. 
[hyperlink, http://www.gao.gov/products/GAO-09-977SP]. Washington, 
D.C.: September 30, 2009. 

International Food Assistance: USAID Is Taking Actions to Improve 
Monitoring and Evaluation of Nonemergency Food Aid, but Weaknesses in 
Planning Could Impede Efforts. [hyperlink, 
http://www.gao.gov/products/GAO-09-980]. Washington, D.C.: September 
28, 2009. 

International Food Assistance: Local and Regional Procurement Provides 
Opportunities to Enhance U.S. Food Aid, but Challenges May Constrain 
Its Implementation. [hyperlink, 
http://www.gao.gov/products/GAO-09-757T]. Washington, D.C.: June 4, 
2009. 

International Food Assistance: Local and Regional Procurement Can 
Enhance the Efficiency of U.S. Food Aid, but Challenges May Constrain 
Its Implementation. [hyperlink, 
http://www.gao.gov/products/GAO-09-570]. Washington, D.C.: May 29, 
2009. 

International Food Security: Insufficient Efforts by Host Governments 
and Donors Threaten Progress to Halve Hunger in Sub-Saharan Africa by 
2015. [hyperlink, http://www.gao.gov/products/GAO-08-680]. Washington, 
D.C.: May 29, 2008. 

Somalia: Several Challenges Limit U.S. International Stabilization, 
Humanitarian, and Development Efforts. [hyperlink, 
http://www.gao.gov/products/GAO-08-351]. Washington, D.C.: February 
19, 2008. 

Foreign Assistance: Various Challenges Limit the Efficiency and 
Effectiveness of U.S. Food Aid. [hyperlink, 
http://www.gao.gov/products/GAO-07-905T]. Washington, D.C.: May 24, 
2007. 

Foreign Assistance: Various Challenges Impede the Efficiency and 
Effectiveness of U.S. Food Aid. [hyperlink, 
http://www.gao.gov/products/GAO-07-560]. Washington, D.C.: April 13, 
2007. 

Foreign Assistance: U.S. Agencies Face Challenges to Improving the 
Efficiency and Effectiveness of Food Aid. [hyperlink, 
http://www.gao.gov/products/GAO-07-616T]. Washington, D.C.: March 21, 
2007. 

[End of section] 

Footnotes: 

[1] Vulnerable groups may include pregnant and lactating women; 
children under 2; and individuals who are elderly, handicapped, or 
afflicted with chronic diseases such as HIV/AIDS. 

[2] United Nations (UN) Food and Agriculture Organization (FAO), The 
State of Food Insecurity in the World (Rome, Italy: 2010); and UN 
Children's Fund (UNICEF), Tracking Progress on Child and Maternal 
Nutrition: A Survival and Development Priority (New York, NY: 2009). 

[3] Section 3001 of Pub. L. No. 110-246, the Food, Conservation, and 
Energy Act of 2008, changed the title of the underlying legislation 
from the Agricultural Trade Development Assistance Act of 1954, also 
known as P.L. 480, to the Food for Peace Act. Title II of the Food for 
Peace Act, administered by USAID, addresses donation of agricultural 
commodities for humanitarian purposes. Other U.S. food assistance 
programs are administered through the U.S. Department of Agriculture, 
including Food for Peace Title I, Food for Progress, and the McGovern-
Dole International Food for Education and Child Nutrition programs. In 
this report, we refer to the Food for Peace Act as Title II. 

[4] Fiscal year 2011 data reported by USAID were preliminary data at 
the time of this report. 

[5] USAID spent approximately $426 million on development programs and 
the remainder on other related efforts. USAID previously referred to 
these development programs as nonemergency programs. Development 
programs typically include a range of objectives, such as agricultural 
development, health and nutrition, or community development. Emergency 
programs may have some of these same objectives, but as noted above 
they are generally focused on alleviating hunger and malnutrition in 
countries affected by disaster. In this report, we focus on both Title 
II emergency and development in-kind food assistance programs, 
particularly those that have nutritional goals and include the use of 
specialized food products. We do not focus on other types of food 
assistance program activities, such as food-for-work or food-for-
assets. 

[6] For the purposes of this report, we use the following terms in 
reference to food products: (1) traditional food products, which 
include grain, pulses (dried beans, peas, and lentils), and vegetable 
oil; (2) traditional specialized food products, which include 
fortified and blended food, such as corn soy blend (CSB) and wheat soy 
blend (WSB); and (3) new specialized food products, which include 
reformulated fortified and blended food, such as Supercereal and 
Supercereal+; ready-to-use supplementary food (RUSF), such as 
Nutributter and Plumpy'Doz; ready-to-use therapeutic food (RUTF), such 
as Plumpy'Nut; and ready-to-use emergency rations, such as A-20. 
Traditional and new specialized food products are collectively 
referred to as specialized food products. Not all of the products 
defined in each food product category are currently used in Title II-
funded food assistance programs. 

[7] For the purposes of this report, we use the term "implementing 
partners" to refer to the UN World Food Program (WFP) and 
nongovernmental organizations (NGOs) that are awarded U.S. government 
grants to carry out food assistance programs. 

[8] These indicators are known as exclusion errors, which occur when 
people who are eligible for assistance do not receive it, and 
inclusion errors, which occur when people who are not eligible for 
assistance receive it. Together, these two measures can be referred to 
as targeting errors. 

[9] GAO, International Food Assistance: Better Nutrition and Quality 
Control Can Further Improve U.S. Food Aid, [hyperlink, 
http://www.gao.gov/products/GAO-11-491] (Washington, D.C.: May 12, 
2011). 

[10] Our current work on international food assistance includes a 
recently issued report, GAO, World Food Program: Stronger Controls 
Needed in High-Risk Areas, [hyperlink, 
http://www.gao.gov/products/GAO-12-790] (Washington, D.C.: Sept. 13, 
2012). In addition, we are conducting a review of the Feed the Future 
initiative, the U.S. governmentwide strategy to address global hunger 
and food security. The strategy was developed pursuant to a U.S. 
pledge made at the G-8 Summit in L'Aquila, Italy, to provide at least 
$3.5 billion for agricultural development and global food security 
over 3 years. 

[11] SUN promotes the implementation of nutrition interventions, 
proliferation of successful practices, and integration of nutrition 
goals into sectors such as public health, social protection, and 
agricultural development. The SUN movement currently comprises 27 
member countries, as well as civil society groups, donors, businesses, 
and international organizations. 

[12] We previously reported that, although Title II emergency funding 
is intended to address short-term food needs, more than half of the 
funding in fiscal year 2010 was spent on multiyear emergency programs. 
See [hyperlink, http://www.gao.gov/products/GAO-11-491]. In 2011, the 
14 countries that received U.S. emergency food assistance every year 
from fiscal years 2006 through 2011 were Afghanistan, Burundi, Central 
African Republic, Chad, Colombia, Democratic Republic of the Congo, 
Ethiopia, Kenya, Nepal, Rwanda, Somalia, Sudan, Tanzania, and Uganda. 
In addition, 23 percent of the emergency food commodities were 
delivered to 15 countries that received U.S. food assistance for 3 to 
5 years from fiscal years 2006 through 2011. Three percent was 
delivered to four countries that received emergency U.S. food aid for 
1 to 2 years. 

[13] The 10 countries were Afghanistan, Chad, Democratic Republic of 
the Congo, Ethiopia, Kenya, Pakistan, Somalia, South Sudan, Sudan, and 
Zimbabwe. 

[14] As defined by UNICEF, undernourishment includes stunting (being 
too short for one's age), a key indicator of hunger and malnutrition. 
USAID uses wasting as an indicator of acute malnutrition in Title II 
emergency and development programs and stunting as an indicator of 
chronic malnutrition in Title II development programs. 

[15] In addition, USDA's Foreign Agriculture Service has a 
Micronutrient-Fortified Food Aid Products Pilot (MFFAPP) that received 
$10 million in fiscal year 2010 to support the development and field 
testing of new ready-to-use foods, fortified blended foods, high-
energy foods, and micronutrient powders to address the micronutrient 
deficiencies of a population or group. The first MFFAPP project was 
under way in fiscal year 2011, with additional pilot projects 
continuing in fiscal year 2012. 

[16] [hyperlink, http://www.gao.gov/products/GAO-11-491]. 

[17] According to USAID officials, these ready-to-use products also 
include products that are aimed at reducing malnutrition, which can 
occur even outside of emergencies. 

[18] For the purposes of this report, we define the "quality" of a 
given food product as the degree to which it meets specific 
nutritional needs of vulnerable groups, not the degree to which it 
adheres to specifications designed to ensure that it is safe for 
consumption, which all USAID food products must meet at a minimum. 

[19] According to USAID and WFP officials, this process functions 
differently for WFP programs. After WFP submits its program design 
documents, USAID decides whether to fund the program in part or in its 
entirety. 

[20] These in-country factors and mitigating measures apply to both 
emergency and development programs. 

[21] WFP reported that the last census in Zimbabwe was conducted in 
2002. Since then, uncertainties about the volume of emigration due to 
economic and other reasons and the mortality rate due to HIV/AIDS have 
led some UN organizations to raise questions about official statistics. 

[22] See [hyperlink, http://www.gao.gov/products/GAO-12-790]. In the 
countries where WFP operates, the United Nations Department of Safety 
and Security (UNDSS) assesses the general security environment in 
specific geographic areas using five categories of threats: armed 
conflict, terrorism, crime, civil unrest, and hazards. UNDSS rates 
each area at one of six security levels, with level 6 indicating the 
most dangerous environment. The UN Security Management System uses 
these ratings to assess security risks to UN agencies, funds, and 
programs; on the basis of these assessments, WFP determines 
appropriate risk mitigation measures to protect its staff and 
operations. 

[23] Christopher B. Barrett, Andrea Binder, and Julia Steets, Uniting 
Food Assistance: The Case for Transatlantic Cooperation, 1ST ed. 
(Oxford, UK; and New York City: 2011), 55. 

[24] Barrett, et al., 67. 

[25] GAO, Foreign Assistance: Various Challenges Impede the Efficiency 
and Effectiveness of U.S. Food Aid, [hyperlink, 
http://www.gao.gov/products/GAO-07-560] (Washington, D.C.: Apr. 13, 
2007). 

[26] [hyperlink, http://www.gao.gov/products/GAO-07-560]; and Barrett, 
et al., 65. 

[27] For example, a 2001 study found evidence that the government of 
Ethiopia, which plays an important role in deciding where food 
assistance programs may operate, has at times transferred food 
assistance to favored regions. T.S. Jayne, J. Strauss, T. Yamano, and 
D. Molla, "Targeting of food aid in rural Ethiopia: chronic need or 
inertia?" World Development, Vol. 29, No. 5, pp. 887-910 (2001). 

[28] The Hector Kobbekaduwa Agrarian Research and Training Institute 
(HARTI), an entity that is funded in part by the government of Sri 
Lanka, partners with WFP to conduct the food security assessments. 

[29] Federal Democratic Republic of Ethiopia, Ministry of Agriculture, 
National Guidelines on Targeting Relief Food Assistance (Addis Ababa, 
Ethiopia: Aug. 2011). 

[30] The 2011 Food Aid Quality Review was a 2-year study conducted by 
Tufts University that recommended 35 changes to U.S. food aid products 
and programs to deliver improved nutrition. Food Aid Quality Review: 
Delivering Improved Nutrition: Recommendations for Changes to U.S. 
Food Aid Products and Programs (April 2011). 

[31] Both USAID and implementing partners recognized that food rations 
are shared within and among recipient households. For example, 26 of 
the 30 programs we surveyed in 2010 reported at least some sharing of 
CSB by recipients. See [hyperlink, 
http://www.gao.gov/products/GAO-11-491]. 

[32] [hyperlink, http://www.gao.gov/products/GAO-11-491]; Food Aid 
Quality Review (April 2011). 

[33] We selected 20 of USAID's final evaluations for review. Our 
sample included final evaluations for both emergency and development 
programs and provided coverage of all years going back to 2009 and all 
geographic regions to which USAID provides food assistance. For the 
purposes of this report, we refer to these final evaluations as 
evaluations. 

[34] USAID, Commodities Reference Guide (Washington, D.C.: 2006). 

[35] USAID also provides other forms of guidance to its implementing 
partners, including a commodities price calculator, which is used to 
estimate the cost of food aid commodities. According to USAID 
officials, the calculator is updated quarterly and available on 
USAID's public website. 

[36] [hyperlink, http://www.gao.gov/products/GAO-11-491]. 

[37] [hyperlink, http://www.gao.gov/products/GAO-11-491]. 

[38] [hyperlink, http://www.gao.gov/products/GAO-11-491]. 

[39] We previously reported that USAID officials acknowledged that 
more research is needed to better understand sharing of CSB, so that 
the agency can provide partners with more guidance on this issue. See 
[hyperlink, http://www.gao.gov/products/GAO-11-491]. 

[40] In 2009 we reported on the overall monitoring and evaluation 
efforts of USAID's Office of Food for Peace development programs. At 
that time, we acknowledged that USAID monitors a wide range of 
indicators related to assessing the extent to which development 
programs are achieving their goals. For example, we noted that USAID 
has monitored indicators on height-and-weight for age, maternal and 
child health practices, and household food security. We also reported 
that USAID's monitoring and evaluation practices for development 
programs were consistent, to varying degrees, with good practices set 
by the American Evaluation Association. See GAO, International Food 
Assistance: USAID Is Taking Actions to Improve Monitoring and 
Evaluation of Nonemergency Food Aid, but Weaknesses in Planning Could 
Impede Efforts, [hyperlink, http://www.gao.gov/products/GAO-09-980] 
(Washington, D.C.: Sept. 28, 2009). 

[41] In its efforts to monitor in-kind food assistance, USAID collects 
data on both recipients and beneficiaries. Recipients and 
beneficiaries are related but different, and the differences between 
them are important to understanding the extent to which USAID can 
measure targeting effectiveness. According to USAID definitions, 
recipients are individuals who receive food assistance rations, while 
beneficiaries are individuals who benefit from food assistance 
rations. Specifically, beneficiaries include all recipients and any 
other individuals who may benefit from the food assistance. For 
example, in a food-for-work program, only one person--the recipient--
actually receives targeted food assistance, but other members of the 
recipient's family or community may benefit from that individual's 
participation in the program, making them all beneficiaries. 
Therefore, while beneficiary data are useful to USAID in its efforts 
to monitor overall program effectiveness, they are of limited use in 
measuring targeting effectiveness. Recipient data are better suited to 
that purpose. As noted above, USAID collects a wide range of 
beneficiary data that are useful for many program purposes. For the 
purposes of this report, we refer to USAID indicators that are 
specifically about recipients and are directly related to measuring 
targeting and targeting effectiveness, such as the degree of targeting 
error. 

[42] As noted above, for the purposes of this report we define 
targeting effectiveness as the degree to which USAID and its 
implementing partners are able to (1) accurately assess needs and 
identify recipients using appropriate eligibility criteria, and (2) 
ensure that food assistance provided reaches and is consumed by the 
targeted recipients as defined by the eligibility criteria. 

[43] USAID Food for Peace Information Bulletin 09-06 (Washington, 
D.C.: July 2009). 

[44] FANTA, Food Security Indicators Framework for Use in the 
Monitoring and Evaluation of Food Aid Programs (Washington, D.C.: Jan. 
1999). 

[45] GAO, Standards for Internal Control in the Federal Government, 
[hyperlink, http://www.gao.gov/products/GAO/AIMD-00-21.3.1] 
(Washington, D.C.: Nov. 1999). 

[46] USAID's targeting evaluations are not systematic, in part, 
because they are not routinely conducted. USAID requires evaluations 
to be completed for all of its development programs but does not 
require them for its emergency programs. Instead, emergency programs 
are required to submit Annual Results Reports, which contain many of 
the same types of information as evaluations, but for which no 
baseline assessment is conducted. According to USAID officials, the 
difference between these requirements is due to the fact that 
emergency programs are by nature typically in places where there may 
not be the time or resources available to do a proper baseline 
assessment. 

[47] USAID Evaluation Policy (Washington, D.C.: Jan. 2011). 

[48] USAID Food for Peace Information Bulletin 09-07 (Washington, 
D.C.: July 2009). 

[End of section] 

GAO’s Mission: 

The Government Accountability Office, the audit, evaluation, and 
investigative arm of Congress, exists to support Congress in meeting 
its constitutional responsibilities and to help improve the 
performance and accountability of the federal government for the 
American people. GAO examines the use of public funds; evaluates 
federal programs and policies; and provides analyses, recommendations, 
and other assistance to help Congress make informed oversight, policy, 
and funding decisions. GAO’s commitment to good government is 
reflected in its core values of accountability, integrity, and 
reliability. 

Obtaining Copies of GAO Reports and Testimony: 

The fastest and easiest way to obtain copies of GAO documents at no 
cost is through GAO’s website [hyperlink, http://www.gao.gov]. Each 
weekday afternoon, GAO posts on its website newly released reports, 
testimony, and correspondence. To have GAO e-mail you a list of newly 
posted products, go to [hyperlink, http://www.gao.gov] and select 
“E-mail Updates.” 

Order by Phone: 

The price of each GAO publication reflects GAO’s actual cost of 
production and distribution and depends on the number of pages in the 
publication and whether the publication is printed in color or black 
and white. Pricing and ordering information is posted on GAO’s 
website, [hyperlink, http://www.gao.gov/ordering.htm]. 

Place orders by calling (202) 512-6000, toll free (866) 801-7077, or 
TDD (202) 512-2537. 

Orders may be paid for using American Express, Discover Card, 
MasterCard, Visa, check, or money order. Call for additional 
information. 

Connect with GAO: 

Connect with GAO on facebook, flickr, twitter, and YouTube.
Subscribe to our RSS Feeds or E mail Updates. Listen to our Podcasts.
Visit GAO on the web at [hyperlink, http://www.gao.gov]. 

To Report Fraud, Waste, and Abuse in Federal Programs: 

Contact: 
Website: [hyperlink, http://www.gao.gov/fraudnet/fraudnet.htm]; 
E-mail: fraudnet@gao.gov; 
Automated answering system: (800) 424-5454 or (202) 512-7470. 

[End of document] 

Congressional Relations: 

Katherine Siggerud, Managing Director, siggerudk@gao.gov, (202) 512-4400
U.S. Government Accountability Office, 441 G Street NW, Room 7125
Washington, DC 20548. 

Public Affairs: 
Chuck Young, Managing Director, youngc1@gao.gov, (202) 512-4800
U.S. Government Accountability Office, 441 G Street NW, Room 7149 
Washington, DC 20548.