International Food Assistance: Better Nutrition and Quality Control Can Further Improve U.S. Food Aid

USAID and USDA generally agreed with this recommendation. In commenting on the report, both agencies provided examples of ongoing efforts to address this recommendation. USAID, for example, was in the process of field-testing new fortified blended foods, such as corn-soy-blend-plus (CSB+), and establishing guidance for implementing partners on how to address nutritional deficiencies with these new products. By April 2015, USAID updated its Food for Peace website with guidance for implementing partners about when and how to use CSB+ during emergencies. Although emergency programs are largely under the purview of USAID, USDA has been supporting USAID's efforts through changes in commodity procurement requirements. For example, through an Interagency Working Group, USDA worked with USAID to develop guidance for applicants seeking funding for nutritional commodities. This guidance, updated for CSB+ in September 2014, now requires a detailed explanation of how the requested commodity and ration size will help address nutritional and micronutrient deficiencies.

USDA generally agreed with this recommendation. In commenting on our report, USDA said it would review these new products' relative cost-effectiveness and evaluate the results of field testing in order to determine if they should be included in future programs. Since then, USDA has been reviewing the performance and cost-effectiveness of new products in a field setting through the Micronutrient-Fortified Food Aid Products Pilot (MFFAPP). Under MFFAPP, USDA implemented programs aimed at developing nutritious and high quality micronutrient-fortified food aid products to meet the energy and nutrient needs of certain populations. The testing of these products was aimed at enhancing the U.S. government's ability to respond to crises around the world, providing a means of delivering ready-to-eat products to populations that do not have immediate access to food or a means of cooking. USDA executed six grant agreements with five organizations to implement MFFAPP programs in five countries: Guatemala, Guinea-Bissau (where two grants were awarded), Haiti, Cambodia, and Tanzania. By October 2014, field-testing of the food aid products and final data collection was completed in five of the six pilots. Five organizations submitted final reports and third-party evaluations, while a sixth is expected to be available by June 2016. All five of the final reports submitted to USDA for MFFAPP discuss the costs or nutritional benefits of these new fortified food aid products.

USAID and USDA generally agreement with this recommendation. In September 2014, USAID completed field work on a feasibility trial in Malawi, testing whether enhanced nutritional messaging and reduced packaging size were necessary to improve targeted use of new specialized food products?corn-soy blend plus (CSB+) and modified fortified vegetable oil. In May 2015, the contractor's preliminary report findings were presented to USAID and its partners, resulting in a discussion about enhanced programming and modified guidance. By June 16, 2015, USAID updated its programming guidance on its commodity fact sheets for CSB+ and fortified vegetable oil. Though these specialized food aid products are provided largely through emergency food aid programs under the purview of USAID, USDA has continued to support USAID's efforts to develop new guidance for implementing partners on targeting and nutrition. USDA and USAID hold regular Interagency Working Group meetings to develop the guidance and to examine the cost-effectiveness and appropriateness of new commodities in food aid programs in both emergency and nonemergency situations. USDA has stated that it will continue to work with USAID to develop protocols designed to assess the feasibility of programming these new products in multiple settings targeting improved nutritional outcomes.

In September 2014, USAID completed field work on a feasibility trial in Malawi, testing whether enhanced nutritional messaging and reduced packaging size were necessary to improve targeted use of new specialized food products -- corn-soy blend plus (CSB+) and modified fortified vegetable oil. In May 2015, the contractor's preliminary report findings were presented to USAID and its partners, resulting in a discussion about enhanced programming and modified guidance. By June 16, 2015, USAID updated its programming guidance on its commodity fact sheets for CSB+ and fortified vegetable oil. Though these specialized food aid products are provided largely through emergency food aid programs under the purview of USAID, USDA has continued to support USAID's efforts to develop new guidance for implementing partners on targeting and nutrition. USDA and USAID hold regular Interagency Working Group meetings to develop the guidance and to examine the cost-effectiveness and appropriateness of new commodities in food aid programs in both emergency and nonemergency situations. USDA has stated that it will continue to work with USAID to develop protocols designed to assess the feasibility of programming these new products in multiple settings targeting improved nutritional outcomes.

USAID agreed with our recommendation. According to USAID, it has been actively engaged with suppliers and with the U.S. Department of Agriculture counterparts to improve commodity food safety and quality systems. In January 2014, USAID began asking suppliers to transition into a more comprehensive food safety and quality approach , which would: (a) shift the responsibility of food safety and quality monitoring to the suppliers themselves, thus eliminating the need for on-site USDA permanent inspections; and (b) require suppliers to implement a better defined environmental and pathogen monitoring program, in compliance with the Food and Drug Administration's Food Safety Modernization Act. According to USAID, these food safety and quality system changes not only resulted in safer and better quality foods, but also more affordable commodities, particularly for Ready-to-Use foods. These steps, coupled with USDA's 2012 warehouse licensing agreement, 2013 testing protocols, and 2015 pre-production audits, have helped USAID strengthen its monitoring of export food aid commodity quality.

When commenting on our report, USDA agreed with our recommendation and noted that it would work with relevant agencies to minimize instances of quality problems and strive for greater accountability in food aid contracts. USDA has taken several steps to help maintain commodity quality. First, in April 2012, USDA implemented the U.S. Warehouse Act's Export Food Aid Commodities Licensing Agreement that required inspection and examination procedures of food aid quality at all domestic and foreign port facilities. Although the licensing agreement addressed poor warehouse conditions and inadequate fumigation, it did not address lack of compliance with product specifications. In February 2013, USDA reported continuing to work with USAID to establish testing protocols for suppliers of grain-based food aid products and blended and fortified commodities to ensure compliance with existing commodity specifications. In September 2014, USDA's commodity requirements for corn-soy-blend plus, a blended and fortified food, went into effect, requiring product testing and quality analysis of commodity specifications. By June 2015, USDA added more testing protocols, requiring start-up production phase inspections and pre-production audits , to its suppliers. These steps, coupled with USAID's 2014 transition to a more comprehensive food safety and quality approach, have helped USDA strengthen its monitoring efforts, thereby enhancing its ability to maintain the quality of commodities throughout the food aid supply chain.

USAID's implementing partners now have options to select more durable packaging for vegetable oil. In addition, in order to better withstand rigorous handling and transportation, in January 2013, USAID increased from 90 to 100 percent its use of high performance multi-layered 25 kilogram bags.

As of February 2012, USDA and USAID had begun working with FACG's Packaging Working Group to examine potential weaknesses and explore improvements for current standards of existing food aid packaging specifications. As a direct result of this collaboration, the containers used to ship vegetable oil were changed to improve the seal and durability of cans. Additional alterations in packaging include changes to markings describing how the contract and lot numbers were applied. For example, in response to revised USAID program requirements concerning overseas inventory issues, USDA also increased the utilization of "best if used by dates" on all packaging. In January 2013, the FACG recommended USDA and USAID switch to 100 percent high performance bags for all commodities packaged in 25 kilogram multiwall paper bags. Based on a study performed by the FACG Packaging Working Group, it was determined that the switch to these high performance bags would further reduce commodity losses and simplify inventory control procedures and costs for commodity and bag suppliers. These packaging changes became effective with the March 2013 purchase and could potentially result in reduced commodity costs.

USAID and USDA generally agreed with this recommendation. In commenting on the report, both agencies provided examples of ongoing efforts to address this recommendation. USAID, for example, was in the process of field-testing new fortified blended foods, such as corn-soy-blend-plus (CSB+), and establishing guidance for implementing partners on how to address nutritional deficiencies with these new products. By April 2015, USAID updated its Food for Peace website with guidance for implementing partners about when and how to use CSB+ during emergencies. Although emergency programs are largely under the purview of USAID, USDA has been supporting USAID's efforts through changes in commodity procurement requirements. For example, through an Interagency Working Group, USDA worked with USAID to develop guidance for applicants seeking funding for nutritional commodities. This guidance, updated for CSB+ in September 2014, now requires a detailed explanation of how the requested commodity and ration size will help address nutritional and micronutrient deficiencies.

USAID generally agreed with this recommendation. In commenting on our report, USAID said it would review these new products' relative cost-effectiveness and evaluate the results of field testing in order to determine if they should be included in future programs. In March 2013, USAID, in coordination with its partners, developed two field trials to examine the cost effectiveness of new food aid products: (1) for preventing malnutrition in Burkina Faso, and (2) for treating malnutrition in Sierra Leone. Since then, USAID obtained approval to carry out research with human subjects, issued a request for proposal for the procurement of the foods, procured and shipped them, and trained local partners and community health workers. Meanwhile, USAID worked with a costing specialist to develop the cost-effectiveness protocol, which is being field-tested with these studies. In Burkina Faso, food distribution began in March 2014 and enrollment of the first of 6,000 children began in June 2014 and was expected to be completed by the end of June 2015. Follow-up of these infants will take 24 months, so the final follow up measurement visits should be finished by July 2017, with results expected in calendar year 2018, including the cost-effectiveness data. In Sierra Leone, the treatment trials should have taken less time but was interrupted by the Ebola outbreak in June 2014. Field work was suspended in July, 2014. At that point only 1300 children (under age 5) of the expected 5,000 enrollees had actually been followed for the treatment period and this number was not large enough to show any difference in response to the treatment foods. Since then, USAID and its contractors have searched for a substitute country and intends to identify one by the end of fiscal year 2015.