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United States Government Accountability Office: 
GAO: 

Report to Congressional Requesters: 

May 2011: 

International Food Assistance: 

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

GAO-11-491: 

GAO Highlights: 

Highlights of GAO-11-491, a report to congressional requesters. 

Why GAO Did This Study: 

For more than 50 years, the United States—which accounts for about 
half of global food aid supplies—has played an important role in 
alleviating malnutrition and hunger, especially during emergencies. In 
fiscal year 2010, the United States spent about $1.5 billion on 
emergency food aid that reached about 46.5 million beneficiaries. To 
preserve the nutritional value of food aid, quality controls are in 
place throughout the supply chain. GAO was asked to assess U.S. 
efforts to (1) meet the nutritional needs of intended recipients and 
(2) maintain the quality of commodities throughout the food aid supply 
chain. GAO analyzed program data, interviewed agency officials and 
their implementing partners, and conducted fieldwork in the United 
States and four countries in Africa. 

What GAO Found: 

U.S. food aid provides crucial life-saving calories and nutrients to 
vulnerable populations during short-term emergencies, but food rations 
designed to address short-term food insecurity may not provide 
adequate nutrition during long-term food emergencies if the recipients 
rely solely on food aid. Furthermore, specialized food products 
designed for the most vulnerable groups are costly and difficult to 
target to the intended recipients. U.S. food aid provides essential 
calories and nutrients during short-term emergencies, but many food 
emergencies extend beyond 1 year, with multiyear feeding programs now 
accounting for more than half of U.S emergency food aid funding. To 
address the nutritional needs of vulnerable groups, including young 
children and pregnant and lactating women, specialized food products 
can be used in addition to the commodities normally used for general 
distribution. However, these products are also more costly than the 
commodities used for general distribution. As a result, U.S. agencies 
and implementing partners face challenges with the costliness of 
specialized food products and the trade-off between reaching more 
beneficiaries and improving nutritional outcomes for some. Within a 
fixed budget, distributing the more costly specialized products would 
reduce the overall number of beneficiaries served. The relatively 
higher cost of specialized food accentuates the importance of 
targeting efforts to ensure that the food reaches its intended 
recipients. However, USAID provided implementing partners with limited 
guidance on how to target the specialized food products to ensure they 
reach intended recipients. 

The quality of blended and fortified U.S. food aid procured has 
generally improved; however, problems still occasionally arise, and 
vulnerabilities in quality controls—such as data collection and food 
packaging—make it difficult to ensure that the quality of commodities 
is maintained throughout the supply chain. In 2007, GAO found long-
standing concerns about food aid quality, specifically with corn soy 
blend (CSB), a nutritionally enhanced product intended for vulnerable 
populations. To mitigate such quality problems, in September 2009, the 
U.S. Department of Agriculture (USDA) resumed quality assurance 
activities for CSB and wheat soy blend, including vendor facility 
inspections and commodity sampling and testing. According to FGIS 
officials, virtually all (approximately 99.5 percent) of CSB lots 
procured by KCCO in the first quarter of fiscal year 2011 met 
acceptable specifications and discount ranges. Even with testing, 
quality problems may still arise due to ineffective quality controls 
within the supply chain, particularly in data tracking and food 
packaging. U.S. agencies and implementing partners track data only on 
food aid damage and losses, even though they are an imperfect 
indicator for quality. Without systematically tracking key quality 
indicators, such as elapsed time between major points within the food 
aid supply chain, agencies and implementing partners may not be aware 
of the full extent of quality problems. Furthermore, quality problems 
and losses have resulted from food packaging that is not sufficiently 
durable for the rugged conditions encountered throughout the food aid 
supply chain. 

What GAO Recommends: 

GAO recommends that the Administrator of the U.S. Agency for 
International Development (USAID) and the Secretary of Agriculture 
issue guidance on how to address nutritional deficiencies that may 
emerge during protracted emergencies, evaluate the performance and 
cost-effectiveness of specialized food products, issue guidance on the 
use of these products, identify and systematically track key quality 
indicators, and evaluate food packaging specifications for durability. 
Both USAID and USDA generally concurred with our recommendations and 
provided examples of recent efforts to address them. 

View [hyperlink, http://www.gao.gov/products/GAO-11-491] or key 
components. For more information, contact Thomas Melito at (202) 512-
9601 or melitot@gao.gov. 

[End of section] 

Contents: 

Letter: 

Background: 

U.S. Food Aid Provides Essential Calories and Other Nutrition during 
Short-Term Emergencies, but May Not Meet the Nutritional Needs of 
Vulnerable Groups: 

The Quality of Blended and Fortified U.S. Food Aid Has Generally 
Improved, but Quality Control of the Supply Chain Has Vulnerabilities: 

Conclusions: 

Recommendations for Executive Action: 

Agency Comments and Our Evaluation: 

Appendix I: Objectives, Scope, and Methodology: 

Appendix II: International and U.S. Commitments and Actions to Address 
Food Security and Nutrition: 

Appendix III: Processes within Each Stage of the Food Aid Supply Chain: 

Appendix IV: Nutrition and Quality Control Guidance and Standards for 
U.S. Food Aid Programs: 

Appendix V: USAID Quality Incident Feedback Loop: 

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

Appendix VII: Comments from the U.S. Department of Agriculture: 

Appendix VIII: GAO Contact and Staff Acknowledgments: 

Related GAO Products: 

Tables: 

Table 1: Illustrative Emergency Food Rations Provided in General Food 
Distributions: 

Table 2: Number of GAO Survey Respondents Reporting Common 
Micronutrient Deficiencies among Their Beneficiaries: 

Table 3: Cost Comparison of Commodities for General Food Distribution 
and Specialized Products for Vulnerable Groups as of 2009: 

Table 4: Processes within Each Stage of the Food Aid Supply Chain: 

Table 5: Nutrition and Quality Control Guidance and Standards: 

Table 6: Steps Required for USAID FFP Title II Food Aid Commodity 
Quality Feedback Loop: 

Figures: 

Figure 1: U.S. Funding for International Food Aid Programs, Fiscal 
Years 2006 through 2010, and Regions that Received Emergency Food Aid 
in Fiscal Year 2010: 

Figure 2: Food Distribution Activities to Target Different Recipients 
of Emergency Food Aid: 

Figure 3: Illustrative Example of the Three-Stage Food Aid Supply 
Chain, Including Processes within Each Stage and Estimated Time Range 
to Deliver Food from Vendor to Village: 

Figure 4: FFP Emergency Food Aid Commodity Purchases, Single-Year 
versus Multi-Year Programs, Fiscal Years 2006 through 2010: 

Figure 5: Percentage of CSB Samples Tested by FGIS that Failed 
Acceptable Product Specification and Discount Ranges, First Quarter of 
Fiscal Year 2010 through First Quarter of Fiscal Year 2011: 

Figure 6: Percentage of CSB Samples that Did Not Meet Microbial 
Specifications for Food Safety, First Quarter of Fiscal Year 2010 
through First Quarter of Fiscal Year 2011: 

Figure 7: Examples of Vegetable Oil and CSB Packaging Problems: 

Figure 8: Loading of U.S. Food Aid Commodities at Jacintoport, Texas: 

Figure 9: Reconstituting Damaged Bags and Cans: 

Figure 10: International and U.S. Commitments and Actions to Address 
Food Security and Nutrition, 1996 through 2015: 

Abbreviations: 

CSB: corn soy blend: 

FDA: Food and Drug Administration: 

FFP: Office of Food for Peace: 

FGIS: Federal Grain Inspection Service: 

KCCO: Kansas City Commodity Office: 

NGO: nongovernmental organization: 

USAID: U.S. Agency for International Development: 

USDA: U.S. Department of Agriculture: 

WBSCM: Web-Based Supply Chain Management System: 

WFP: World Food Program: 

WSB: wheat soy blend: 

View GAO Components: 

Videos of the three-stage food aid supply chain: 

[End of section] 

United States Government Accountability Office: 
Washington, DC 20548: 

May 12, 2011: 

Congressional Requesters: 

In 2010, the United Nations' Food and Agriculture Organization 
estimated that a total of 925 million people worldwide are 
undernourished, of whom 88 percent live in Asia and sub-Saharan 
Africa.[Footnote 1] Pregnant and lactating women and children under 
the age of 2 are among the most vulnerable groups at risk of 
undernourishment.[Footnote 2] Inadequate nutrition in the first few 
years of life can result in irreversible damage to a person's health, 
mental development, and future labor productivity. 

For more than 50 years, the United States has provided assistance to 
food insecure countries--serving as the largest food aid donor in the 
world and providing about half of all global food aid supplies. In 
fiscal year 2010, the United States spent almost $2.3 billion to 
provide a total of 2.5 million metric tons of food aid commodities to 
food-insecure countries. The majority of U.S. food aid, with funding 
authorized under the Food for Peace Act, is managed through the U.S. 
Agency for International Development's (USAID) Office of Food for 
Peace (FFP).[Footnote 3] In fiscal year 2010, funding for USAID's Food 
for Peace food aid programs amounted to $1.9 billion, or 83 percent of 
the total food aid budget. Of the $1.9 billion, $1.5 billion (79 
percent) represents USAID-administered emergency programs that reached 
about 46.5 million beneficiaries in fiscal year 2010. FFP uses 
indicators of food insecurity,[Footnote 4] such as levels of 
malnutrition in recipient countries, when prioritizing funding. FFP 
programs provide U.S.-grown agricultural commodities, such as wheat, 
corn, and sorghum, as well as other fortified products,[Footnote 5] 
such as corn soy blend (CSB) a nutritionally-enhanced product intended 
for vulnerable populations, including pregnant and lactating women and 
children under the age of 5. 

To preserve the nutritional value of food aid commodities and ensure 
that recipients realize their full nutritional benefit, food aid 
suppliers rely on quality controls[Footnote 6] throughout the entire 
food aid supply chain.[Footnote 7] U.S. and international entities 
have established quality standards and controls to assist food aid 
suppliers, transporters, ocean carriers, and distributors minimize 
losses and reduce quality problems during each phase of the supply 
chain. U.S. agencies rely on contractors, nongovernmental 
organizations (NGO),[Footnote 8] and the World Food Program (WFP) to 
adhere to these standards and to address quality control problems when 
they occur. However, in 2007, we found that U.S. agencies and their 
partners were not coordinating adequately to respond to quality 
control problems.[Footnote 9] 

As part of our work on international food assistance,[Footnote 10] you 
asked us to review the nutrition and quality control of U.S. food aid. 
In this report, we assessed U.S. efforts to (1) meet the nutritional 
needs of intended recipients and (2) maintain the quality of 
commodities throughout the food aid supply chain. 

To address these objectives, we analyzed emergency food aid program 
data provided by USAID, the U.S. Department of Agriculture (USDA), and 
WFP. Our review focuses on USAID emergency food aid programs because 
approximately 79 percent of FFP food aid funding was for emergency 
programs in fiscal year 2010 and a majority of food aid recipients 
receive rations through FFP emergency programs.[Footnote 11] However, 
since the United States provides many of the same commodities to both 
emergency and nonemergency food aid programs, and the commodities 
generally go through the same food aid supply chain, our findings may 
be applicable to both programs. We surveyed the 29 FFP country program 
offices that had active FFP emergency food aid programs in fiscal year 
2010 and received an 86 percent response rate. In Washington, D.C., we 
interviewed officials from the Departments of State, the Treasury, and 
Transportation; the Office of Management and Budget; USAID; and USDA. 
In Kansas City, Missouri, we met with officials at USDA's Kansas City 
Commodity Office (KCCO), which is the entity that procures commodities 
for U.S. food aid programs. We also met with officials representing 
NGOs that serve as implementing partners[Footnote 12] to USAID in 
carrying out U.S. food aid programs overseas; a freight forwarding 
company; nutrition experts; and international surveyors. In Rome, 
Italy, we met with officials from the U.S. Mission to the United 
Nations, the United Nations' Food and Agriculture Organization, and 
WFP. We also conducted fieldwork in three countries that receive 
emergency U.S. food aid--Djibouti, Ethiopia, and Zimbabwe--and met 
with officials from U.S. missions, implementing organizations, and 
relevant host government agencies. We visited a port in Jacintoport, 
Texas from which food is prepositioned and shipped; two food aid 
destination ports and prepositioning sites in Djibouti and South 
Africa; and several warehouses where U.S. food aid may be stocked 
prior to shipping, handling, or distributing to final recipients. 

We conducted this performance audit from April 2010 to May 2011 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. Appendix I 
provides a detailed discussion of our objectives, scope, and 
methodology. 

In this report, we are recommending that the Administrator of USAID 
and the Secretary of Agriculture work together to (1) provide clear 
guidance to implementing partners on how to address nutritional 
deficiencies that may emerge when U.S. food aid is provided through 
general distribution programs during emergencies that extend beyond a 
year; (2) evaluate the performance and relative cost-effectiveness of 
new specialized food products in meeting the nutritional needs of the 
most vulnerable groups within appropriate program settings before they 
are included in the agencies' approved list of commodities; (3) 
provide clear guidance on whether and how best to use new specialized 
food products, including guidance to the agencies' implementing 
partners on targeting strategies to ensure that the products reach 
their intended recipients; (4) strengthen agencies' monitoring of 
commodity quality by identifying and tracking key quality indicators 
to ensure that agencies and implementing partners are aware of the 
full extent of quality problems, including emerging concerns, 
throughout the supply chain; and (5) evaluate packaging specifications 
to ensure food packaging is sufficiently durable for the rugged 
conditions encountered throughout the supply chain. Both USAID and 
USDA concurred with our recommendations and provided examples of 
recent efforts to address them. 

Background: 

It is a stated policy of the United States, as promulgated in the Food 
for Peace Act,[Footnote 13] to enhance the food security of the 
developing world through the use of U.S.-grown agricultural 
commodities to combat world hunger and malnutrition and their causes. 
Thus, as one element of a broader global strategy to enhance food 
security in developing countries, U.S. food aid is utilized as both a 
humanitarian response to alleviate malnutrition and address acute 
hunger in emergencies in the short term and a development-focused 
response to address chronic hunger in the longer term. Similarly, the 
United Nations System High-Level Task Force on the Global Food 
Security Crisis, established in April 2008, also calls for a twin-
track approach that responds to the immediate needs of vulnerable 
populations and contributes to longer-term resilience.[Footnote 14] 

Numerous International and U.S. Commitments and Actions Aim to Address 
the Food and Nutrition Needs of Undernourished Populations: 

In 1996, the United States and about 180 world leaders pledged to 
address global food insecurity and nutrition, specifically making a 
commitment to halve the number of undernourished people in the world 
by 2015. In 2000, they reaffirmed this commitment with the 
establishment of the United Nations Millennium Development Goals and, 
more recently, at the World Summit on Food Security held in Rome, 
Italy, in November 2009. 

The global food price crisis in 2007 and 2008 spurred new initiatives 
to address the growing prevalence of hunger, and this year, high food 
prices are renewing concerns over their impact on food security and 
political stability in a number of developing countries around the 
world.[Footnote 15] Among the international initiatives were two key 
studies that estimated the costs of preventing malnutrition and the 
benefits from such interventions. In the first study, the Copenhagen 
Consensus Center estimated that the use of specific micronutrients as 
supplements or fortification in food could result in economic benefits 
much larger than their costs, concluding that combating malnutrition 
in the 140 million children who are undernourished was the best 
investment the world can make.[Footnote 16] In the second study, the 
World Bank estimated that $10.3 billion a year would be required to 
increase the delivery of a package of 13 proven nutrition 
interventions targeted to children up to 2 years of age--extending 
coverage from current levels to 100 percent of the target populations 
in 36 countries that carry 90 percent of the burden of stunting. 
[Footnote 17] 

As described in appendix II, U.S. agencies have also undertaken 
several initiatives to address global food insecurity and nutrition in 
recent years. For example, in 2007, USDA commissioned a nonprofit 
organization, the Sharing Science and Technology to Aid in the 
Improvement of Nutrition (SUSTAIN), to develop templates for food aid 
specifications, harmonize the specifications, and make recommendations 
on quality assurance.[Footnote 18] In 2009, the administration 
announced the U.S. Global Hunger and Food Security Initiative, 
subsequently renamed Feed the Future,[Footnote 19] which identified 
reducing undernutrition and increasing the impact of humanitarian food 
assistance among the areas of potential investment.[Footnote 20] Most 
recently, in April 2011, USAID released the Food Aid Quality Review, a 
2-year study conducted by Tufts University that recommended 35 changes 
to U.S. food aid products and programs to deliver improved nutrition. 
[Footnote 21] 

Funding for U.S. Food Aid Has Generally Increased since 2006 Due to 
Emergencies, and the Majority of the Food Aid Went to Africa: 

Over the last several years, funding for U.S. food aid programs has 
generally increased, and USAID projects that the demand for food will 
increase by 50 percent over the next 20 years. In 2010, the Food and 
Agriculture Organization identified 22 countries in crisis requiring 
external assistance for food, with the highest proportion of 
undernourished people residing in sub-Saharan Africa. As shown in 
figure 1, funding for U.S. food aid programs totaled $2.2 billion in 
fiscal year 2006, peaked at almost $3 billion in fiscal year 2009, and 
dropped to about $2.3 billion in fiscal year 2010--of which FFP 
emergency food aid represented 66 percent.[Footnote 22] In fiscal year 
2010, USAID's FFP emergency program provided almost 1.7 million metric 
tons of food aid commodities to alleviate malnutrition and hunger in 
30 countries in response to two kinds of emergencies: (1) natural 
disasters, such as floods or droughts, and (2) complex emergencies, 
characterized by a combination of natural disaster, conflict, and 
insecurity. Approximately 75 percent of FFP emergency food aid funding 
was allocated to Africa, 14 percent to Asia and the Near East, and 11 
percent to Latin America and the Caribbean.[Footnote 23] Of the fiscal 
year 2010 emergency food aid funding for Africa, 34 percent went to 
Ethiopia, 24 percent to Sudan, and 9 percent to Kenya. WFP received 78 
percent of all emergency U.S. food aid, the rest went to NGOs and 
prepositioned warehouses in fiscal year 2010. 

Figure 1: U.S. Funding for International Food Aid Programs, Fiscal 
Years 2006 through 2010, and Regions that Received Emergency Food Aid 
in Fiscal Year 2010: 

[Refer to PDF for image: multiple line graph and pie-chart] 

U.S. funding for international food assistance, fiscal years 2006 
through 2010: 

Fiscal year: 2006; 
Food for Peace emergency funding: $1.2 billion; 
Food for Peace nonemergency funding: $0.3 billion; 
Other Food Aid Programs: $0.7 billion; 
Total food assistance funding: $2.2 billion. 

Fiscal year: 2007; 
Food for Peace emergency funding: $1.4 billion; 
Food for Peace nonemergency funding: $0.3 billion; 
Other Food Aid Programs: $0.3 billion; 
Total food assistance funding: $2.1 billion. 

Fiscal year: 2008; 
Food for Peace emergency funding: $2 billion; 
Food for Peace nonemergency funding: $0.4 billion; 
Other Food Aid Programs: $0.6 billion; 
Total food assistance funding: $2.9 billion. 

Fiscal year: 2009; 
Food for Peace emergency funding: $2.2 billion; 
Food for Peace nonemergency funding: $0.4 billion; 
Other Food Aid Programs: $0.4 billion; 
Total food assistance funding: $3 billion. 

Fiscal year: 2010; 
Food for Peace emergency funding: $1.5 billion; 
Food for Peace nonemergency funding: $0.4 billion; 
Other Food Aid Programs: $0.4 billion; 
Total food assistance funding: $2.3 billion. 

Distribution of Food for Peace emergency food aid funding by region,
fiscal year 2010: 

Africa: 75%; 
Asia/Near East: 14%; 
Latin America/Caribbean: 11%. 

Sources: GAO analysis based on USAID Title II data; Nova Development 
(map). 

[End of figure] 

U.S. Food Aid Commodities Target Different Groups of Recipients during 
Emergencies: 

USAID defines targeting as any method by which an intervention is 
designed or implemented so that benefits accrue selectively to only a 
portion of the overall population. Targeting can be by geographic 
concentration; eligibility requirements such as age, sex or health 
status; or by means tests that assess household income. To meet the 
requirements of targeted beneficiaries, implementing partners design 
and implement emergency food aid programs by relying on needs 
assessments that help determine the nature and scale of humanitarian 
crises and the type and scope of assistance required. These 
assessments inform the selection of geographic areas to be targeted 
with U.S. food aid as well as criteria for the selection of intended 
recipients. According to USAID's Food Aid Quality Review, targeting 
requires assumptions to be made regarding the quantity of product to 
be consumed daily by target beneficiaries, contribution of total 
nutrients consumed through that product in the overall diet, health 
status of the target consumer, and intrahousehold sharing of the 
products, among others. Figure 2 describes three types of food 
distribution activities with different target groups of recipients: 
(1) general food distribution, (2) supplementary feeding, and (3) 
therapeutic feeding programs. Supplementary feeding programs address 
moderate acute malnutrition rates, whereas therapeutic feeding 
programs address severe acute malnutrition. Therapeutic feeding 
programs are not implemented with FFP funding and are usually 
supervised by qualified medical professionals.[Footnote 24] 

Figure 2: Food Distribution Activities to Target Different Recipients 
of Emergency Food Aid: 

[Refer to PDF for image: illustrated table] 

Activity: General distribution; 
Description: Food provided to a population or group; 
Target group: Entire population in a predefined area; 
Examples: 
* Food provided to an entire population affected by a disaster; 
* Often, the food is provided dry and distributed in bulk, without 
cooking; 
* Generally, several days or weeks’ worth of supplies are provided and 
the food is shared by all family members. 

Activity: Supplementary feeding; 
Description: Food provided to meet additional nutritional needs or 
caloric requirements of certain groups; 
Target group: Children under age 5; Women who are pregnant or 
lactating; People living with HIV/AIDS; 
Examples: 
* Food provided to mildly or moderately malnourished children at 
community feeding centers; 
* Food provided at health facilities to pregnant and lactating women; 
* Food provided as part of home-based care for people with HIV/AIDS. 

Activity: Therapeutic feeding; 
Description: Food provided to severely malnourished population groups; 
Target group: Malnourished adults and children; 
Examples: Food programs that are part of intensive care for severely
malnourished persons during emergencies. 

Source: GAO. 

[End of figure] 

Over the past decade, wheat, corn, sorghum, rice, soy, vegetable oil, 
peas, beans, and lentils have made up the vast majority of U.S. food 
aid commodities. Wheat, corn, sorghum, rice, and soy are often 
processed, fortified, or enriched into products such as CSB, wheat soy 
blend (WSB), fortified wheat flour, fortified cornmeal, and vitamin-A 
fortified vegetable oil. CSB is often used to treat moderate 
malnutrition and micronutrient deficiencies in underweight children. 
CSB is the most commonly programmed specialized product in 
supplementary feeding programs. According to USAID data, from 25 to 33 
percent of U.S. food aid commodities are enriched, blended, or 
fortified with micronutrients annually, and these products comprise a 
minimum of 25 percent of the total tonnage of food aid commodities 
procured for emergencies. Macronutrients, such as fat and protein, are 
important for a well-balanced diet, but micronutrients, such as iron 
or vitamin A, address specific nutritional deficiencies of vulnerable 
and food-insecure populations. 

Multiple Entities Are Responsible for Different Stages in the U.S. 
Food Aid Supply Chain: 

USAID and USDA share in the administration of all U.S. food aid 
programs. USAID's FFP is responsible for the administration of 
emergency and nonemergency food aid programs. USDA's Foreign 
Agricultural Service also administers two active food aid programs-- 
Food for Progress and McGovern-Dole Food for Education and Child 
Nutrition Program--among others.[Footnote 25] Under USDA's Farm 
Service Agency, KCCO manages the product standards, purchases, and 
delivery of all food aid commodities to domestic transfer points. FFP 
and the Foreign Agricultural Service direct KCCO to procure 
commodities for their implementing partners that are responsible for 
the distribution of food aid to intended recipients. KCCO procures a 
variety of commodities and products from several different vendors 
across the United States and enters into commodity contracts with 
vendors. When requested by KCCO contracting officers, USDA's Farm 
Service Agency conducts quality assurance surveillance, or 
verification of the vendor's quality control system's effectiveness 
and ability to deliver products that meet contract requirements. One 
branch of USDA--the Federal Grain Inspection Service--conducts quality 
reviews and certification of food aid products. An agency within USDA, 
the Commodity Credit Corporation pays for the commodities and 
transfers allocated funds to FFP to fund the movement of food aid from 
the United States to overseas locations. FFP then awards grants to 
implementing partners who enter into direct contracts with ocean 
carriers. The U.S. Department of Transportation's Maritime 
Administration is also involved in supporting the ocean transportation 
of food aid through a reimbursement process based on a percentage 
calculation of commodity and freight ratios. 

These U.S. agencies and other entities play a role in three different 
stages of the food aid supply chain: domestic, shipping, and foreign 
stages. Figure 3 is an example of the processes involved in the three-
stage food aid supply chain with an estimated time range of 4 to 6 
months[Footnote 26] to deliver food aid from vendor to village. 
[Footnote 27] The interactive map features videos based on our field 
work that we developed for illustrative purposes. (See appendix III 
for the processes within each stage of the supply chain). 

Figure 3: Illustrative Example of the Three-Stage Food Aid Supply 
Chain, Including Processes within Each Stage and Estimated Time Range 
to Deliver Food from Vendor to Village[A]: 

[Refer to PDF for image: illustrated map and associated data] 

Stage 1: Domestic: 
Planning; 
Procurement; 
Decisions; 
Production; 
Delivery. 
Up to 2 months: 
United States: Jacintoport, Texas. 

Stage 1A video: Domestic food production; 
Stage 1B video: Domestic delivery: load food at Jacintoport. 

Stage 2: Shipping: 
Ocean transport. 
Up to 1 month. 

Stage 2 video: 
Offloading food at Durban, South Africa. 

Stage 3: Foreign: 
Discharge; 
Inland transport; 
Distribution. 
Up to 3 months. 
Stage 3A video: Foreign discharge, inland transport, Djibouti; 
Stage 3B video: Foreign distribution, Dire Dawa, Ethiopia. 

Sources: GAO based on information provided by USDA-KCCO, USAID, and 
Tufts University’s Food Aid Quality Review: Report to USAID; video 3A 
courtesy of SDV, Inc., © 2011; and Map Resources (map). 

[End of figure] 

U.S. Food Aid Provides Essential Calories and Other Nutrition during 
Short-Term Emergencies, but May Not Meet the Nutritional Needs of 
Vulnerable Groups: 

U.S. food aid provides crucial life-saving calories and nutrients, but 
food aid rations[Footnote 28] designed to address short term food 
insecurity may not provide adequate nutrients in long-term food 
emergencies if the recipients rely solely on food aid. Pipeline breaks 
[Footnote 29] can further impede implementing partners' ability to 
meet the nutritional needs of recipients in protracted emergencies. 
Newly developed specialized foods have the potential to better meet 
the nutritional needs of vulnerable groups,[Footnote 30] but those 
foods are more costly than food aid commodities normally included in 
the general food distribution. As a result, U.S. agencies and their 
implementing partners may face challenges with the costliness of 
specialized food products and the trade-off between reaching more 
beneficiaries and improving nutritional outcomes for some. In 
addition, implementing partners may face difficulties in directing 
specialized foods to the targeted vulnerable populations. 

U.S. Food Aid for Short-Term Emergencies May Not Be Adequate for 
Protracted Crises, and Various Factors Can Reduce Its Effectiveness: 

U.S. Food Aid for General Distribution Provides Essential Life-Saving 
Calories and Nutrients: 

U.S. food aid plays an important role in saving lives in emergencies 
by preventing starvation and addressing short-term food insecurity. 
Food aid emergency programs provide a general food distribution to 
affected populations with the primary goal of preventing food 
shortfalls that would contribute to mortality due to malnutrition. 
Access to food and the maintenance of adequate nutritional status are 
critical determinants of people's survival in a disaster. 

USAID's Commodities Reference Guide provides guidelines for 
implementing partners on how to develop rations and has set 
recommended levels of calorie and macronutrient requirements, such as 
fat and protein, to ensure nutrition in emergency feeding, based on 
international standards. (Appendix IV lists key documents that provide 
nutrition guidance and standards for U.S. food aid programs.) To 
enable planning for quick response at the onset of an emergency, 
international humanitarian aid organizations recommend setting a 
default energy requirement of 2,100 calories per person per 
day[Footnote 31] for populations entirely dependent on food aid. USAID 
provides implementing partners with similar guidelines on calorie and 
macronutrient requirements.[Footnote 32] Rations developed for general 
food distributions generally consist of grains (milled cereals or bulk 
grains); pulses; fortified blended foods, such as CSB; and oil. 
[Footnote 33] Specifically, a ration should include a mixture of 
cereals, oil, and pulses that provides a minimum of 46 grams of 
protein daily per person. To cover the requirements for certain 
essential fatty acids, 17 to 20 percent of the ration's energy should 
be provided in the form of fats or oil. Implementing partners are 
recommended to take into consideration local dietary preferences and 
needs assessments to develop various acceptable rations using several 
different combinations and varying amounts of commodities, as shown in 
table 1. USAID officials told us that when they approve feeding 
programs, they monitor the proposed ration sizes and compositions to 
make sure the rations meet nutritional guidelines and are consistent 
with the needs assessments. 

Table 1: Illustrative Emergency Food Rations Provided in General Food 
Distributions: 

Rations: Example 1: 
Item: 
Cereal (grams): 400; 
Pulse (grams): 60; 
Vegetable oil (grams): 25; 
Fortified blended food (grams): 60; 
Total (grams): 545; 
Total (calories): 2,104; 
Protein (grams): 49; 
Percentage of energy from fat: 14%. 

Rations: Example 2: 
Item: 
Cereal (grams): 420; 
Pulse (grams): 50; 
Vegetable oil (grams): 30; 
Fortified blended food (grams): 50; 
Total (grams): 550; 
Total (calories): 2,100; 
Protein (grams): 49; 
Percentage of energy from fat: 14%. 

Rations: Example 3: 
Item: 
Cereal (grams): 400; 
Pulse (grams): 100; 
Vegetable oil (grams): 30; 
Fortified blended food (grams): 0; 
Total (grams): 530; 
Total (calories): 2,100; 
Protein (grams): 49; 
Percentage of energy from fat: 18%. 

Sources: Based on WFP Emergency Operations rations, and Camilla 
Chaparro and Kathryn G. Dewey, Use of Lipid-Based Nutrient Supplements 
(LNS) to Improve the Nutrient Adequacy of General Food Distribution 
Rations for Vulnerable Subgroups In Emergency Situations (2009). 

Notes: The cereal in examples 1 and 3 is rice. In example 2, the 
cereal is cornmeal. These examples illustrate rations containing 
varying quantities of food aid commodities. All three meet the minimum 
requirements for calories and protein, but only example 3 meets the 
minimum requirement for fat. 

[End of table] 

In practice, ration sizes can vary from the norm of 2,100 calories per 
person per day. Ration sizes could be adjusted as a result of a needs 
assessment, which was the case for 20 of the 45 programs that 
responded to our survey. For example, during our fieldwork in Zimbabwe 
USAID officials noted that recipients had access to other sources of 
food and thus received monthly food aid rations of about 1,550 
calories a day. Additionally, respondents to our survey noted that 
logistical and other constraints, such as delays in food aid 
shipments, can reduce the quantity of food delivered, thereby lowering 
ration sizes. For example, WFP intended to provide 100 percent of the 
food needs in a program in the Democratic Republic of Congo, but 
logistical constraints to delivering food in vast and sparsely 
populated areas forced WFP to reduce the ration size to meet 76 to 99 
percent of the daily needs of the recipients. 

U.S. Food Aid for General Distribution Is Not Always Adequate during 
Protracted Crises: 

Even with the guidelines on nutrition, food aid rations for general 
distribution, which are meant to address short-term food insecurity, 
may not always meet the nutritional needs of the recipients in chronic 
emergencies when food aid is their sole source of nutrition for more 
than a year. Although FFP emergency funding is to address short-term 
food insecurity, we found that more than half of FFP food aid 
emergency funding was spent on multi-year emergency programs. 
Approximately 96 percent of the food aid in fiscal year 2010,[Footnote 
34] or nearly 1.6 million metric tons, was delivered to 21 countries 
that have received U.S. food aid for 4 years or more during fiscal 
years 2006 through 2010 (see figure 4).[Footnote 35] 

Figure 4: FFP Emergency Food Aid Commodity Purchases, Single-Year 
versus Multi-Year Programs, Fiscal Years 2006 through 2010: 

[Refer to PDF for image: stacked vertical bar graph and pie-chart] 

Emergency food aid commodity purchases, multi-year and single-year 
assistance programs, fiscal years 2006 through 2010: 

Fiscal year: 2006; 
Single-year programs: $126.9 million; 
Multi-year programs: $193.8 million. 

Fiscal year: 2007; 
Single-year programs: $130.9 million; 
Multi-year programs: $291.2 million. 

Fiscal year: 2008; 
Single-year programs: $290.9 million; 
Multi-year programs: $569.7 million. 

Fiscal year: 2009; 
Single-year programs: $279.7 million; 
Multi-year programs: $457.0 million. 

Fiscal year: 2010; 
Single-year programs: $292.2 million; 
Multi-year programs: $381.2 million. 

Emergency food aid delivered in 2010 to countries that received food 
aid for 4 or more years, between fiscal years 2006 to 2010[A]: 

4 or more years: 96.1%; 
2 to 3 years: 3.7%. 

Source: GAO presentation of USAID data. 

[A] Percentages in the pie chart are based on the amount (in metric 
tons) of food aid delivered in 2010 to countries that have received 
food aid for multiple years since 2006. The percentages do not add up 
to 100 percent in the pie chart because one country, which received 
food aid for 1 year and represented 0.2 percent of total emergency 
food aid in 2010, was not included in the pie. 

[End of figure] 

When the food provided is not nutritionally varied, recipients can 
develop serious micronutrient deficiencies, especially during 
prolonged emergencies. This is particularly detrimental when 
recipients' nutritional status was already poor before the emergency 
started. For example, vitamin-A and iron deficiencies are widely 
endemic public health nutrition problems in many poor countries, and 
the problem can be exacerbated by food emergencies. All respondents to 
our survey noted at least one common micronutrient deficiency in their 
program's beneficiaries, including iron, vitamin-A and iodine 
deficiencies, most of which were in countries receiving food aid for 
more than 1 year (see table 2). 

Table 2: Number of GAO Survey Respondents Reporting Common 
Micronutrient Deficiencies among Their Beneficiaries: 

Micronutrients: Iron; 
Number of respondents reporting this was a common deficiency among 
their beneficiaries, out of a total of 34 respondents: 34. 

Micronutrients: Vitamin A; 
Number of respondents reporting this was a common deficiency among 
their beneficiaries, out of a total of 34 respondents: 28. 

Micronutrients: Iodine; 
Number of respondents reporting this was a common deficiency among 
their beneficiaries, out of a total of 34 respondents: 19. 

Micronutrients: Vitamin C; 
Number of respondents reporting this was a common deficiency among 
their beneficiaries, out of a total of 34 respondents: 6. 

Micronutrients: Niacin; 
Number of respondents reporting this was a common deficiency among 
their beneficiaries, out of a total of 34 respondents: 3. 

Micronutrients: Thiamine; 
Number of respondents reporting this was a common deficiency among 
their beneficiaries, out of a total of 34 respondents: 3. 

Source: GAO analysis of FFP officers' responses to GAO survey. 

[End of table] 

Displaced populations in closed refugee camps that rely entirely on 
food aid for long periods of time are at a particularly high risk of 
developing micronutrient deficiencies. Epidemics of pellagra and 
beriberi as well as scurvy have broken out among food aid 
beneficiaries who were totally dependent on food aid.[Footnote 36] For 
example, in an Angolan refugee camp in 1999, an outbreak of pellagra 
affected more than 900 individuals, most of whom were dependent on WFP 
food distribution. Large-scale outbreaks have become rare as 
humanitarian organizations pay closer attention to the recipients' 
micronutrient needs. However, USAID officials noted that it is 
important that emergency food aid continues to be able to provide 
adequately formulated micronutrient-rich foods to ensure that this 
risk has not increased. 

Difficulties in designing precise rations and delays in food 
distribution can reduce the programs' effectiveness and negatively 
impact recipients' nutritional status during protracted crises. To 
simplify operations in the absence of an accurate assessment, 
implementing partners sometimes distribute household rations instead 
of individual rations, which may result in members of larger 
households receiving less than what they need. USAID told us that they 
have revised their instructions to implementing partners to better 
define the numbers of people who benefit from a household ration. In 
the past, USAID did not always know the number of people who benefited 
from a household ration. In addition, pipeline breaks can disrupt food 
distribution and negatively impact the recipients' nutritional status. 
Of the FFP feeding programs we surveyed, we found 32 of the 45 
implementing partners experienced a pipeline break at least once a 
year. When a pipeline break occurs, food aid rations are reduced or 
completely stopped, and the recipients have to cope with the reduction 
in rations by skipping meals or eating less. 

Side bar: 
Supplemental feeding programs through maternal and child health and 
nutrition activities: 

[Refer to PDF for image: photograph] 

Source: GAO. 

[End of figure] 

Beyond the general food distribution, the needs of vulnerable groups 
are often met through selected feeding programs, which provide 
specific foods to only a segment of the population to meet the 
particular needs of the most nutritionally vulnerable households or 
individuals. Implementing partners typically carry out supplemental 
feeding programs through maternal and child health and nutrition 
activities that are intended to improve the nutritional status of young
children and women. 

[End of side bar] 

Specialized Food Products Are Being Formulated to Meet Nutritional 
Needs of the Most Vulnerable Groups, but Are Costly and Difficult to 
Direct to Intended Recipients: 

New Products Are Specially Formulated to Meet the Nutritional Needs of 
the Most Vulnerable Groups and Their Effectiveness Is Under Study: 

Food for Peace is supporting efforts to introduce new, nutrient-dense 
products specially formulated to meet the nutritional needs of 
vulnerable groups[Footnote 37] and study how well these products 
achieve their desired outcomes. The ration for a general food 
distribution is tailored to meet the nutritional requirements of an 
entire population and thus does not meet the nutritional needs of 
certain individuals in vulnerable populations, especially very young 
children from 6 to 24 months old. 

Malnutrition is of particular concern for very young children because 
as research has shown, children are at the greatest risk of 
irreversible long-term physical and mental damage in the first 2 years 
of life, the period of time that provides the best window of 
opportunity in which a child may benefit from nutritional 
interventions. For more than 30 years, fortified blended foods, such 
as CSB, have been utilized as the primary vehicle by which FFP 
programs have provided enhanced nutrition during emergencies.[Footnote 
38] In recent years, nutritionists have debated the appropriateness of 
using fortified 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. The food has antinutrient properties that 
inhibit the uptake of certain vitamins and minerals. As a result, U.S. 
agencies, implementing partners, and private industry have developed 
several new products that aim to address the shortcomings of fortified 
blended foods and thus the specific nutritional needs of young 
children and other vulnerable groups.[Footnote 39] Some of the new 
specialized products provide additional vitamins and minerals or 
alternative forms of these micronutrients that can be more easily 
absorbed than standard fortified blended foods. They include enhanced 
versions of CSB, micronutrient powders, lipid-based nutrient 
supplements,[Footnote 40] and ready-to-eat food in emergencies. 

USAID plans to make specially-formulated products available to 
implementing partners to provide a more diverse selection of products 
aimed at enhancing nutrition but USAID and its implementing partners 
lack all the information necessary to choose the most appropriate 
product to achieve the desired nutritional outcome for their programs. 
In order to make such a choices, they need to know how well the 
product performs in promoting nutritional health indicators, such as 
weight gain and growth, particularly in a program setting, and how 
well they perform in comparison to the existing products. The efficacy 
of the newly developed specialized products, such as CSB++ and lipid 
based products, or the extent to which these products promote desired 
outcomes, is still being studied by USAID, WFP, nutritionists, and 
other researchers.[Footnote 41] Testing of several products has 
indicated potential effectiveness in treating severe malnutrition in a 
therapeutic setting. One NGO told us that it has successfully used 
some of these new products to treat severely malnourished children, as 
demonstrated by weight gain and other measures. Some studies on lipid- 
based products have also shown that the products are effective in 
preventing malnutrition in achieving some nutritional outcomes such as 
weight gain, but they do not demonstrate increases in height, which is 
another important measure of a child's nutritional health. In 
addition, our literature review found few studies that compared the 
new products to CSB to determine whether they perform better in 
achieving nutritional outcomes and according to a nutrition expert we 
interviewed, more research is needed in this area. 

Specialized Products to Meet the Nutritional Needs of the Most 
Vulnerable Groups Are Costly: 

Specialized food products are generally more costly than food rations 
used in general distribution. Within a fixed program budget, providing 
more costly products would result in fewer numbers of beneficiaries 
served. As a result, implementing partners may be faced with a choice 
between the nutritional quality and quantity of the food provided. For 
example, a general food distribution ration comprised mostly of grain 
such as rice, cornmeal, wheat, or sorghum can range from $0.02 per day 
for a 6-month-old child to $0.09 per day for a 2-year-old child. 
[Footnote 42] The more nutrients and energy a ration contains, the 
more expensive it becomes. Micronutrient powders are low-cost but 
contain no calories, so they would be used in addition to a daily 
ration, adding to the cost. A daily ration consisting primarily of CSB 
includes additional fortification and can cost between $0.06 and 
$0.12, depending on the size of the ration. Making improvements to the 
current CSB formulation results in higher costs as well. For example, 
WFP's new formulations for CSB+ at the upper end of the range cost 
more than CSB; and CSB++, at $0.24 per daily ration, is about two or 
three times the cost of CSB. Adding newly developed supplemental food 
products, such as Nutributter®, to enhance the nutritional value of 
the feeding can increase the total cost of the ration by several 
times, as shown in table 3. The cost of a recommended dose of ready-to-
use supplementary food, such as Plumpy'Doz® ($0.20) and 
Supplementary'Plumpy® ($0.33), is two to three times more than the 
recommended ration for CSB ($0.06 to $0.12). 

Table 3: Cost Comparison of Commodities for General Food Distribution 
and Specialized Products for Vulnerable Groups as of 2009: 

Type of product: Grain-based representative rations; 
Product[A]: Representative complementary ration; 
Product description: Ration of grain, pulse, CSB, and vegetable oil; 
Vulnerable population targeted: Children 6-8 months and 12-23 months 
old; 
Calories recommended daily ration: 202 and 548; 
Recommended ration or dose (in grams): 51 and 139; 
Cost of product per daily ration or dose: $0.019 and $0.05. 

Type of product: CSB-based rations[B]; 
Product[A]: CSB; 
Product description: Fortified blended foods made of processed 
cornmeal, soy flour, soybean oil, vitamins, and minerals; 
Vulnerable population targeted: Small children and pregnant and 
lactating women; 
Calories recommended daily ration: 502-985; 
Recommended ration or dose (in grams): 120-235; 
Cost of product per daily ration or dose: $0.06-$0.12. 

Type of product: CSB-based rations[B]; 
Product[A]: CSB+; 
Product description: Similar to CSB but formulated with improved 
micronutrient profile; 
Vulnerable population targeted: Small children and pregnant and 
lactating women; 
Calories recommended daily ration: 627-1,235; 
Recommended ration or dose (in grams): 120-235; 
Cost of product per daily ration or dose: $0.08-$0.16. 

Type of product: CSB-based rations[B]; 
Product[A]: CSB++; 
Product description: Similar to CSB+, but also contains milk powder, 
dehulled soy, oil, sugar, and tighter microbiological specifications; 
Vulnerable population targeted: Young children, 6 months to 2 years 
old; 
Calories recommended daily ration: 840; 
Recommended ration or dose (in grams): 200; 
Cost of product per daily ration or dose: $0.24. 

Type of product: Micronutrient powders[C]; 
Product[A]: Micronutrient powder--15 vitamins and minerals; 
Product description: Powders made of vitamins and minerals sprinkled 
on prepared food; 
Vulnerable population targeted: Small children, school-aged children, 
and general population; 
Calories recommended daily ration: Does not contain calories; 
Recommended ration or dose (in grams): 1; 
Cost of product per daily ration or dose: 0.03. 

Type of product: Micronutrient powders[C]; 
Product[A]: MixMe Plus™; 
Product description: Powders made of vitamins and minerals sprinkled 
on prepared food; 
Vulnerable population targeted: Small children, school-aged children, 
and general population; 
Calories recommended daily ration: Does not contain calories; 
Recommended ration or dose (in grams): 5; 
Cost of product per daily ration or dose: $0.04. 

Type of product: Nutritional supplements; 
Product[A]: Nutributter®; 
Product description: Peanuts, sugar, vegetable oil, nonfat milk 
powder, whey, maltodextrin, vitamins, and minerals; 
Vulnerable population targeted: Young children 6-24 months old; 
Calories recommended daily ration: 108; 
Recommended ration or dose (in grams): 20; 
Cost of product per daily ration or dose: $0.11. 

Type of product: Ready-to-use supplementary foods; 
Product[A]: High energy biscuits; 
Product description: Wheat flour, vegetable shortening, sugars, soy 
flour, skimmed milk powder, vitamins, and minerals; 
Vulnerable population targeted: Small children 6 months and older; 
Calories recommended daily ration: 450; 
Recommended ration or dose (in grams): 100; 
Cost of product per daily ration or dose: $0.12. 

Type of product: Ready-to-use supplementary foods; 
Product[A]: RUFC India; 
Product description: A chickpea-based product comparable to 
Supplementary' Plumpy® and Plumpy'Doz®; 
Vulnerable population targeted: Young children 6 months and older; 
Calories recommended daily ration: 260; 
Recommended ration or dose (in grams): 50; 
Cost of product per daily ration or dose: $0.13. 

Type of product: Ready-to-use supplementary foods; 
Product[A]: Plumpy'Doz®; 
Product description: Paste of vegetable oil, sugar, peanuts, nonfat 
milk powder, maltodextrin, whey, cocoa, vitamins, and minerals; 
Vulnerable population targeted: Young children 6-36 months; 
Calories recommended daily ration: 247; 
Recommended ration or dose (in grams): 46; 
Cost of product per daily ration or dose: $0.20. 

Type of product: Ready-to-use supplementary foods; 
Product[A]: Supplementary' Plumpy®; 
Product description: Paste of vegetable oil, sugar, peanuts, soy 
protein isolates, maltodextrin, whey, vitamins, and minerals; 
Vulnerable population targeted: Young children 6 months and older; 
Calories recommended daily ration: 500; 
Recommended ration or dose (in grams): 92; 
Cost of product per daily ration or dose: $0.33. 

Type of product: Ready-to-use therapeutic food (RUTF); 
Product[A]: Plumpy'Nut®; 
Product description: Ready-to-use paste composed of vegetable oil, 
sugar, peanuts, nonfat milk powder, whey, maltodextrin, vitamins, and 
minerals; 
Vulnerable population targeted: Children 6 months and older; 
Calories recommended daily ration: 500; 
Recommended ration or dose (in grams): 92; 
Cost of product per daily ration or dose: $0.41. 

Source: GAO analysis based on various studies. 

Notes: The cost of different product rations in this report only 
represents the cost of the food product in a daily ration or dose. 
Transportation costs were not included in the calculations, but affect 
the overall cost. For example, the transportation cost for lipid-based 
products may be lower than for grain products since they are a smaller-
sized product. The studies we reviewed include (1) Camilla Chaparro 
and Kathryn G. Dewey, Use of Lipid-Based Nutrient Supplements (LNS) to 
Improve the Nutrient Adequacy of General Food Distribution Rations for 
Vulnerable Sub-Groups In Emergency Situations, FANTA-2 Food and 
Nutrition Technical Assistance, University of California-Davis (July 
2009); (2) Martin W. baBloom and Saskia De Pee, "Current and Potential 
Role of Specially Formulated Foods and Food Supplements for Preventing 
Malnutrition among 6-to 23-Month Old Children and for Treating 
Moderate Malnutrition among 6-to 59-Month Old Children," Food and 
Nutrition Bulletin, vol. 30 (Nov. 3, 2009) s434-s463; and (3)various 
WFP bulletins. 

[A] These products can also be used to supplement the diet of pregnant 
and lactating women. 

[B] WFP rations of CSB+ and CSB++ are high in kilocalories for young 
children. This amount is a typical ration and is provided in areas of 
high stunting levels and to target the vulnerable population in areas 
where possible sharing may occur. 

[C] Micronutrient powders provide vitamins and minerals and are added 
to calorie-containing food to make a complete ration. Micronutrient 
powders, however, would not be used with a ration that has already 
been fortified. For example, they would not be used in a ration 
containing CSB because CSB is already fortified. Because most 
emergency rations include some CSB, the addition of micronutrient 
powders could result in too much of some micronutrients. 

[End of table] 

U.S. Agencies and Implementing Partners Face Difficulties in Targeting 
Specialized Food Products to Intended Recipients: 

Failure to effectively target more costly specialized food aid 
products to intended beneficiaries can undermine U.S. agencies' and 
implementing partners' efforts to improve beneficiaries' nutritional 
status. Implementing partners often use selective feeding programs to 
distribute specialized food aid products to vulnerable groups at the 
individual level by using a process known as targeting to direct 
specialized food to the intended recipient. Targeting involves 
assessments of needs, program planning to reach vulnerable households 
with adequate food, implementing the distribution of food, usually 
some education on nutrition, and monitoring these activities. 

USAID does not track nutritional outcomes--such as maintenance or 
improvement of nutritional status, reduced stunting, or weight gain-- 
for its emergency FFP programs unless the program has a specific 
nutritional objective, like a supplementary feeding program.[Footnote 
43] According to the Sphere Handbook, food aid distribution systems 
should be monitored to ensure that vulnerable groups are receiving 
their intended amount of food and that timely corrective action is 
taken when necessary.[Footnote 44] A WFP official told us that WFP 
utilizes food aid monitors to conduct post delivery evaluations to 
determine food consumption patterns among targeted food aid 
beneficiaries and uses this information to revise rations, determine 
if WFP is targeting the wrong recipients, or strengthen targeting 
efforts to reach the intended recipients. However, according to 
nutrition experts who drafted USAID's Food Aid Quality Review, 
implementing partners rarely make adjustments to rations based on 
monitoring of local consumption patterns either before or after 
implementation to determine if target beneficiaries are receiving 
their intended share of a ration. Additionally, at the agency level, 
USAID does not have a database to track and aggregate maternal and 
child health nutrition activities supported by FFP emergency funding. 
Saving lives, rather than achieving nutritional outcomes, is the 
programmatic focus of emergency programs. Thus, nutritional outcomes 
are not tracked in these programs. According to USAID officials, when 
FFP does not provide all the resources for a program, it is difficult 
to determine the total number of recipients being served. Absent 
information on nutritional outcomes, and without a reliable number of 
recipients being served, FFP is not able to ensure sufficient 
utilization of food among intended recipients. 

In the field, challenges in targeting the most vulnerable populations 
include difficulty in determining recipients' food requirements using 
needs assessments and in identifying specific vulnerable groups or 
individuals. For example, a recent assessment of FFP programs found 
that needs assessments typically lack detailed data on local 
consumption and nutritional needs of recipients. While 38 of the 45 
programs we surveyed reported that needs assessments had been 
conducted to determine the food rations for general distribution, WFP 
officials agreed that needs assessments currently provide only some of 
the required information about the specific nutritional needs of 
beneficiaries. According to agency officials, needs assessments are 
not always useful when developing rations for food aid programs. 
Instead, WFP or NGOs often request specific food aid commodities based 
on their historical requests of the commodities available for FFP 
procurements rather than recipients' current needs, particularly in a 
rapid onset emergency. 

Even when done well, targeting can be undermined at the recipient 
level by the cultural practice of sharing in local communities. 
Targeting specialized food products to appropriate beneficiaries is 
difficult when rations are shared among members of an entire household 
or community. As a result, the correct recipients may not receive the 
appropriate amount of food, and specialized foods may not reach 
vulnerable recipients. Our survey of FFP officers confirmed that 
recipients of CSB--which is intended to meet the specific nutritional 
needs of infants, young children, pregnant women, and lactating 
mothers--often share the commodity with their entire family. Twenty-
six of the 30 programs we surveyed reported at least some sharing by 
recipients. Sharing of food within the household is widely recognized 
by implementing partners and some programs design their rations to 
take this practice into account. For example, some implementing 
partners may request higher quantities of specialized food products on 
the assumption that only 20 percent of the food provided will reach 
targeted recipients, whereas other implementing partners may not 
adjust rations for sharing at all. According to USAID officials we 
interviewed, food aid commodities are commonly shared not only within 
the household, but also among community members. For example, during 
fieldwork in Zimbabwe, food aid recipients with whom we met stated 
that they shared up to a third of the food aid they receive with other 
community members who had not qualified for food aid but were still in 
need. In addition, during a food aid distribution we witnessed in 
Ethiopia, the implementing partner's list of recipients specified 
three family members eligible to receive CSB as part of a vulnerable 
group feeding program. However, members of the household told us that 
one family member qualified as vulnerable--defined as a child under 5 
or a pregnant or lactating woman. The head of household explained that 
CSB is shared with all members of the family, especially elderly 
individuals and the male head of household, who needs extra energy to 
work in the field. 

Side bar: 

[Figure: Recipients sharing CSB in Ethiopia: photograph] 

Source: GAO. 

[End of side bar] 

USAID officials acknowledged that more research is needed to better 
understand food aid sharing practices, so that FFP can provide 
implementing partners with more guidance on this issue. Currently, 
USAID provides implementing partners with limited guidance on how to 
target and use specialized food products to ensure they reach intended 
recipients. According to a lead author of USAID's Food Aid Quality 
Review, the packaging size of specialized food aid products, such as 
CSB and other fortified and blended foods, may contribute to sharing. 
CSB is packaged and shipped in bags that weigh 25 kilograms (55 
pounds) and implementing partners distribute it to recipients by 
either repackaging or scooping it into carry-home containers or 
serving on-site. Once the original packaging has been removed, 
specialized products are less likely to be differentiated from other 
products consumed by the household. According to a nutrition expert, 
smaller packaging that depicts the intended beneficiary, such as a 
baby or a mother, would convey a clearer programming message to 
recipients about the intended beneficiary of the commodity and 
decrease the likelihood of sharing with other family members.[Footnote 
45] To decrease sharing, WFP plans to establish a standard packaging 
size of 1.5 to 6 kilograms (3.3 to 13.2 pounds) for delivering rations 
of CSB++. Some USAID officials thought that such changes could improve 
efforts to target food aid products to specific individuals but both 
USDA and USAID officials said smaller packaging could also be cost 
prohibitive. 

The Quality of Blended and Fortified U.S. Food Aid Has Generally 
Improved, but Quality Control of the Supply Chain Has Vulnerabilities: 

Overall, the quality of blended and fortified U.S. food aid 
commodities procured has improved with enhanced quality assurance 
activities; however, problems may still arise, and vulnerabilities in 
quality controls, such as data collection and food packaging, make it 
difficult to ensure that the quality of commodities is maintained 
throughout the food aid supply chain. 

Overall Quality of Blended and Fortified U.S. Food Aid Has Improved 
due in Part to USDA's Renewed Quality Assurance Activities, but 
Quality Control Problems Still Occasionally Occur: 

USDA's Renewed Quality Assurance Activities Enhance the Quality of CSB 
and WSB Procured: 

Side bar: Quality definitions: 

Quality is the degree to which food aid commodities adhere to their 
specifications from procurement through distribution to beneficiaries. 

Quality problems are occurrences of spoilage, infestation, 
contamination, or damage to the commodity that can result from factors 
such as failure to meet product specifications, inadequate fumigation, 
poor warehouse conditions, and transportation delays. 

Quality controls are measures to maintain the original quality and 
quantity of the commodity. 

[End of side bar] 

Due in part to renewed government quality assurance activities, the 
quality of CSB and WSB procured for U.S. food aid programs has 
improved. In 2007, we found long-standing concerns about food aid 
quality, specifically with blended and fortified foods such as CSB. We 
reported, for example, that in 2005 some shipments of CSB were 
overfortified with iron[Footnote 46]--which can be toxic when consumed 
by vulnerable groups in large amounts--leading to more than 17,000 
metric tons of CSB not being distributed to intended beneficiaries. 
[Footnote 47] Furthermore, in 2008, an implementing partner in Haiti 
claimed that approximately 400 children had developed diarrhea after 
consuming CSB with fiber content that did not meet specified levels. 
[Footnote 48] The absence of government quality assurance during 
procurement may have contributed to such problems. Prior to 1999, 
USDA's Federal Grain Inspection Service (FGIS) sampled and tested CSB 
and WSB to verify that they were meeting product specifications. In 
1999, however, USDA transitioned to a program called Total Quality 
Systems Audit[Footnote 49] that, for approximately the next 10 years, 
relied solely on the vendors' own quality control system, including 
allowing vendors to self-certify the quality of their commodities. 
KCCO contract terms required vendors to provide a certificate of 
analysis verifying that the commodities met specifications--a practice 
similar to that of the commercial sector.[Footnote 50] Two vendors we 
spoke with explained that certificates of analysis are a standard 
commercial practice in the U.S. food industry because market 
mechanisms--such as impact on reputation or loss of customers--
penalize vendors if they produce poor-quality commodities.[Footnote 
51] However, KCCO was not able to rely on market mechanisms under 
Total Quality Systems Audit, even when multiple quality problems 
arose. For instance, one vendor was responsible for two high-profile 
quality problems with CSB, but KCCO continued procuring commodities 
from that vendor[Footnote 52] because it submitted the lowest bids. In 
commenting on a draft of our report, USDA officials added that this 
vendor also had the largest capacity to manufacture CSB, supplying 
approximately 40 percent of CSB per year. As a result, not purchasing 
CSB from it would have compromised USDA's ability to meet CSB demand. 

To address such quality problems, KCCO, through FGIS, resumed quality 
assurance activities at the source of production for CSB and WSB in 
September 2009,[Footnote 53] including facility inspections and 
commodity sampling and testing.[Footnote 54] Government quality 
assurance activities are meant to prevent the entry of poor-quality 
commodities into the supply chain.[Footnote 55] According to KCCO 
officials with whom we spoke, KCCO contracts stipulate government 
sampling and testing to ensure that a product meets specifications 
before acceptance.[Footnote 56] When FGIS quality assurance activities 
resumed in September 2009, FGIS discovered that considerable amounts 
of food aid samples were not, in fact, meeting specifications as 
indicated by their certificates of analysis. For example, in December 
2009, FGIS took CSB samples from one vendor and discovered quality 
problems such as the presence of salmonella and insects. According to 
KCCO officials, KCCO required the vendor to halt shipment and replace 
the commodities. As another example, in the second quarter of fiscal 
year 2010, more than 9 percent of all CSB samples collected and tested 
by FGIS failed to meet the acceptable specification and discount 
ranges for fiber content; more than 7 percent failed to meet 
specification and discount ranges for the standard plate count test; 
and more than 5 percent failed to meet the specification and discount 
ranges for vitamin A content (see figure 5). 

Figure 5: Percentage of CSB Samples Tested by FGIS that Failed 
Acceptable Product Specification and Discount Ranges, First Quarter of 
Fiscal Year 2010 through First Quarter of Fiscal Year 2011: 

[Refer to PDF for image: vertical bar graph] 

Percentage of test failure: 

Specification[A]: Aflatoxin; 
1st quarter FY 10: 0; 
2nd quarter FY 10: 0.5%; 
3rd quarter FY 10: 0; 
4th quarter FY 10: 0; 
1st quarter FY 11: 0. 

Specification[A]: E.Coli; 
1st quarter FY 10: 0.2%; 
2nd quarter FY 10: 0.5%; 
3rd quarter FY 10: 0.3%; 
4th quarter FY 10: 0; 
1st quarter FY 11: 0.4%. 

Specification[A]: Fat; 
1st quarter FY 10: 0; 
2nd quarter FY 10: 1%; 
3rd quarter FY 10: 1.1%; 
4th quarter FY 10: 0.4%; 
1st quarter FY 11: 2.7%. 

Specification[A]: Fiber; 
1st quarter FY 10: 0.8%; 
2nd quarter FY 10: 9.6%; 
3rd quarter FY 10: 0.5%; 
4th quarter FY 10: 0; 
1st quarter FY 11: 0. 

Specification[A]: Iron; 
1st quarter FY 10: 4.5%; 
2nd quarter FY 10: 1.8%; 
3rd quarter FY 10: 7.3%; 
4th quarter FY 10: 4.7%; 
1st quarter FY 11: 3.1%. 

Specification[A]: Moisture; 
1st quarter FY 10: 0.8%; 
2nd quarter FY 10: 0.5%; 
3rd quarter FY 10: 0.1%; 
4th quarter FY 10: 0; 
1st quarter FY 11: 4.3%. 

Specification[A]: Salmonella; 
1st quarter FY 10: 0.8%; 
2nd quarter FY 10: 0; 
3rd quarter FY 10: 0.1%; 
4th quarter FY 10: 0; 
1st quarter FY 11: 0. 

Specification[A]: Standard plate count (SPC); 
1st quarter FY 10: 5.3%; 
2nd quarter FY 10: 7.1%; 
3rd quarter FY 10: 5.9%; 
4th quarter FY 10: 1.6%; 
1st quarter FY 11: 0.4%. 

Specification[A]: Staphylococcus; 
1st quarter FY 10: 5.7%; 
2nd quarter FY 10: 1%; 
3rd quarter FY 10: 0.9%; 
4th quarter FY 10: 0; 
1st quarter FY 11: 0. 

Specification[A]: Vitamin A; 
1st quarter FY 10: 4.5%; 
2nd quarter FY 10: 5.1%; 
3rd quarter FY 10: 3.1%; 
4th quarter FY 10: 5.5%; 
1st quarter FY 11: 6.7%. 

Source: GAO presentation of FGIS data. 

[A] Since e. coli, salmonella, standard plate count (a measure of the 
density of bacteria in a product), and staphylococcus are all 
microbial food safety indicators, there are no acceptable 
specifications or discount ranges. If a sample contains any amount of 
these microbes, the entire lot is rejected. For aflatoxin, samples are 
permitted to contain up to 20 parts per billion, with no discount 
range. 

[End of figure] 

According to FGIS officials, data show that, due to such quality 
assurance activities, virtually all (approximately 99.5 percent) of 
CSB lots procured by KCCO in the first quarter of fiscal year 2011 met 
acceptable specification and discount ranges.[Footnote 57] KCCO and 
FGIS officials told us that increased government oversight has also 
led to a decrease in the number of CSB samples failing FGIS tests for 
food safety problems (see figure 6), because vendors are more vigilant 
about their own internal quality control practices when they know that 
their products are going to be tested by FGIS. For example, shortly 
after FGIS first resumed testing in September 2009, 3 percent of all 
CSB samples collected and tested by FGIS were found to have food 
safety problems; however, by the first quarter of fiscal year 2011, 
this number was down to less than 0.5 percent. 

Figure 6: Percentage of CSB Samples that Did Not Meet Microbial 
Specifications for Food Safety, First Quarter of Fiscal Year 2010 
through First Quarter of Fiscal Year 2011: 

[Refer to PDF for image: line graph] 

Percentage of test failure: 

1st quarter, FY 10: 3%; 
2nd quarter, FY 10: 2.2%; 
3rd quarter, FY 10: 1.8%; 
4th quarter, FY 10: 0.4%; 
1st quarter, FY 11: 0.2%. 

Source: GAO presentation of FGIS data. 

[End of figure] 

U.S. and foreign government officials, vendors, implementing partners, 
and recipients with whom we met said that the commodities procured for 
food aid programs are of high quality and are generally delivered to 
beneficiaries in sound condition. For example, various implementing 
partners, vendors, and food aid recipients with whom we met in 
Bangladesh, Djibouti, Ethiopia, Mozambique, and Zimbabwe said that the 
quality of U.S. food aid commodities generally is high. According to 
the results of a 2009 survey conducted by an NGO in Ethiopia, 98 
percent of food aid recipients rated the quality of U.S. food aid as 
"good" or "very good." Moreover, reported losses of all food aid 
commodities that occurred after loading at the domestic port average 1 
percent or less per year--comparable to commercial sector benchmarks. 
[Footnote 58] 

Furthermore, under a 2009 revision of regulations governing commodity 
acquisitions (48 CFR 470), KCCO can now utilize other procurement 
approaches, and has begun transitioning away from sealed bidding to a 
negotiated procurement approach that will enable KCCO to consider a 
variety of factors--other than just price--during procurement. For 
instance, new solicitation language states that technical evaluation 
factors, such as quality controls and past performance, are 
significantly more important than commodity price. KCCO published four 
draft requests for proposals in July 2010 and published answers to 
vendor questions about the requests for proposals in October 2010. 
[Footnote 59] KCCO published its final requests for CSB and CSB+ in 
March 2011 and expects to award its first contract in May 2011. 

However, KCCO's ability to ensure ongoing government quality assurance 
activities is uncertain due to unpredictable funding levels and 
funding sources, according to KCCO officials. KCCO requested 
approximately $13 million for government quality assurance activities 
to sample and test all food aid noncommercial commodities in fiscal 
year 2011, but was only apportioned $2.5 million for CSB, CSB+ and WSB 
in October 2010. KCCO was able to secure the remaining $10.6 million 
in late March 2011 through a different budget line item, which 
restricts expenditures to private sector sampling and testing firms, 
in order to test all other noncommercial items, such as vitamin-A 
fortified vegetable oil. However, KCCO officials told us that they are 
unsure about future funding levels.[Footnote 60] However, Office of 
Management and Budget officials have expressed concerns about the cost-
effectiveness of sampling and testing food aid commodities given the 
current fiscal environment. In the case of insufficient funding, KCCO 
officials told us that they may have to return to a reliance on vendor-
provided certificates of analysis. 

Quality Control Problems Still Occasionally Arise and Can Be Time- 
Consuming and Costly to Resolve: 

Despite these recent improvements in the sampling and testing of food 
aid commodities, quality control problems still occasionally arise and 
can be time-consuming and costly to resolve. According to our survey 
results, the most commonly cited challenges to improving quality were 
extreme weather conditions, poor product management, poor storage 
facilities, inadequate port facilities, and lack of mission capacity 
for monitoring.[Footnote 61] In the past 2 years, three major quality 
control problems occurred that led to food aid deterioration.[Footnote 
62] These involved CSB that was (1) bitter in taste, (2) infested with 
rodents, and (3) contaminated with mycotoxins: 

* Bitter CSB. WFP officials spent almost a year and spent an estimated 
$223,000 to dispose of U.S. food aid that was rancid, acidic, and 
unpalatable. In October 2009, USAID officials informed WFP and other 
implementing partners about the possible bitter taste of a delivery of 
CSB. WFP advised its country teams in four countries to stop all 
distribution of the product until further notice. WFP country teams 
subsequently segregated all deliveries of CSB. USAID agreed with WFP's 
proposal to test the CSB in Kenya where by mid-November 2009, focus 
groups declared 60 percent of the 36 sublots tasted "moderately" or 
''very" bitter. By February 2010, more thorough lab results revealed 
that the CSB was rancid, acidic, and unpalatable. At that time, WFP 
requested a formal agreement for disposal from USAID. By May 2010, 
USAID agreed to allow WFP to destroy the CSB and asked WFP to provide 
guidance to other implementing partners on how to dispose of the 
product. In August 2010, WFP field staff in Ethiopia started the 
disposal process. In September 2010, we observed several stacks of the 
bitter CSB quarantined by another USAID implementing partner in a 
warehouse in Dire Dawa, Ethiopia, awaiting its disposal. 

* Rodent infestation. WFP spent 11 days and almost $16,000 on 
operational costs identifying and segregating rat urine-marked bags at 
a foreign port after the problem was identified at a domestic port. On 
January 22, 2010, a U.S.-flag vessel began loading food aid to be 
delivered to various implementing partners and WFP in Kenya and 
Ethiopia. A few days prior to the completion of operations, when 
approximately one-third of the cargo had been loaded, WFP was informed 
that USDA's appointed loading inspector had found evidence of rodent 
infestation in one particular warehouse where CSB and cornmeal were 
being stored prior to loading.[Footnote 63] WFP was told that extra 
measures had been taken to verify that the rest of cargo was free of 
rodent contamination, but no attempt had been made to unload what was 
already on board. WFP later learned that no physical separation had 
been made inside the ocean vessel to distinguish between the infested 
and noninfested commodities. The vessel sailed with all cargo on 
board. Prior to arrival at the foreign port, WFP was informed that the 
infestation was broader than initially ascertained. To handle the 
situation, members of WFP's Food Safety Unit identified blacklighting 
devices and devised a method for bag inspection, which included 
enhanced screening of the suspect commodities in dedicated warehouses. 
Approximately 9.7 metric tons, or about 1.2 percent of the total 
quantity checked, was identified in urine-marked bags and destroyed. 

* Mycotoxin contamination.[Footnote 64] One of USAID's implementing 
partners halted distribution of CSB for up to 6 months and spent at 
least $35,000 on quality inspections after mycotoxins were found in 
CSB delivered to Guatemala. In September 2009, the implementing 
partner's country officers in Guatemala commissioned the sampling and 
testing of a delivery of CSB after complaints by beneficiaries about 
its taste. Lab results revealed the presence of mycotoxins.[Footnote 
65] To respond, the implementing partner requested and received 
guidance from USAID. In May 2010, the implementing partner started 
investigating various mycotoxins' potential effects on human health. 
Concerned about the effects of mycotoxin ingestion, particularly in 
infants and young children, the implementing partner also began 
sampling and testing the CSB it also received in Burundi and Haiti. In 
October 2010, laboratory results confirmed the presence of mycotoxins 
above the Food and Drug Administration's (FDA) advisory levels in the 
CSB samples drawn from deliveries in Haiti, resulting in the 
implementing partner's decision to suspend all CSB distribution until 
USAID provided further guidance. This suspension affected the 
distribution of the remaining stocks of the 47,725 metric tons of CSB 
that had already been delivered to eight countries in 2010. Meanwhile, 
USAID and FDA officials met and decided that USAID and USDA would not 
pursue the testing of mycotoxins in food aid commodities because FDA 
had not established limits for mycotoxin levels in domestic food 
products, except for aflatoxin.[Footnote 66] USAID provided the 
implementing partner with procedures to resample and test the CSB, 
established new testing protocols for cases where the percentage of 
mycotoxins found in samples exceeded the FDA's advisory levels, and 
provided information about accredited labs where sampling and testing 
can take place. After testing CSB in seven countries, the implementing 
partner resumed distribution in all countries by March 2011. 
Approximately 4,180 metric tons of CSB in the seven countries were 
affected by these procedures. 

In February 2011, the Food Aid Consultative Group established a Food 
Safety and Quality Assurance Working Group to allow food aid program 
stakeholders the opportunity to work together and address a variety of 
issues related to the safety and quality of food aid commodities, 
including mycotoxins and infestations. 

Quality Control of the U.S. Food Aid Supply Chain Has Vulnerabilities 
in Data Tracking and Packaging: 

U.S. Agencies Do Not Systematically Track Data on Quality throughout 
the Supply Chain: 

While U.S. agencies collect data on the quality of some commodities 
during procurement, they do not systematically track data on damage 
and loss through the remainder of the food aid supply chain. WFP does 
not routinely share its data with USAID, despite recent efforts to 
improve food aid information systems and processes. Prior to 
procurement, FGIS collects data on the quality of the commodities it 
tests. As we reported in 2007,[Footnote 67] however, U.S. agencies and 
implementing partners only systematically track damage and losses 
throughout the remainder of the supply chain--even though damage and 
losses are an imperfect indicator for quality because they include 
many nonquality problems such as theft and exclude other quality 
problems that do not ultimately result in damage or loss.[Footnote 68] 
For example, according to WFP officials in Ethiopia, U.S. commodities 
sometimes exceed acceptable moisture content levels--which can be 
problematic in humid climates because commodities with high moisture 
content can spoil more quickly--but if WFP is able to salvage the 
wheat by drying it out, this quality problem will not be reflected in 
WFP's loss data. In addition, before FGIS resumed sampling and testing 
CSB in September 2009, several implementing partners complained to 
USAID about low vitamin-A levels in fortified foods such as CSB--but 
low vitamin A levels do not constitute damage or loss, so this quality 
problem was not reflected in loss data. Moreover, U.S. agencies do not 
systematically track data on shipping and delivery times. For example, 
KCCO does not track the time elapsed between the date that food aid 
commodities arrive at the domestic port and the date that the food is 
off-loaded in the recipient country or delivered to beneficiaries. 
Because U.S. agencies and implementing partners do not systematically 
track data on quality throughout the entire supply chain, they may not 
be aware of the full extent of quality problems and may not be able to 
identify emerging concerns. 

[Figure: Example of food aid losses: photograph] 

Source: GAO. 

This photo shows several bags of U.S. food aid that were damaged by 
ocean water in Durban, South Africa, in September 2010. 

[End of figure] 

U.S. agencies and implementing partners are developing information 
systems and processes to better capture data on food aid commodities, 
but U.S. agencies will continue to systematically track data only on 
damage and losses. For example, USDA launched the new Web-Based Supply 
Chain Management System (WBSCM) on April 1, 2011 that integrates 
multiple existing data systems and tracks food aid commodities 
throughout the supply chain. With WBSCM, vendors and implementing 
partners will eventually be able to voluntarily log complaints, 
including quality problems. In addition, USAID is developing an 
information system called Quarterly Web Interfaced Commodity Reporting 
that enables NGOs to submit their damage and loss reports 
electronically, although there is currently no plan to make NGO usage 
of this system mandatory. USAID has also drafted standard operating 
procedures to resolve food quality complaints--also known as the 
feedback loop--including a complaint log designed as a reporting tool 
to document food quality complaints. However, the log is currently 
kept informally and is not a reliable source of information on quality 
problems, according to USAID officials. (See appendix V for more 
details about USAID's quality incident feedback loop.) None of these 
agencies' information systems or processes is expected to track data 
on quality problems, other than those that result in damage or loss. 
Furthermore, although WFP--which received 78 percent of all emergency 
U.S. food aid in fiscal year 2010--recently procured a food quality 
management software that will enable it to better track food quality 
and food safety indicators directly throughout the supply chain, it 
does not routinely share its data with USAID unless requested. 
[Footnote 69] 

Packaging Specifications May Not Be Appropriate For Rugged Conditions 
Encountered throughout the Supply Chain: 

According to U.S. and foreign government officials, implementing 
partners, and vendors, food aid packaging remains one of the biggest 
quality problems--particularly for tin oil cans used for vegetable oil 
and paper bags used for commodities such as CSB and cornmeal--despite 
recent packaging improvement initiatives by U.S. agencies. For 
example, four of the eight FFP officers overseeing emergency food aid 
distributed by NGOs whom we surveyed cited damage to tin oil cans as a 
quality problem.[Footnote 70] A survey conducted by Tufts University 
also revealed that more than half of the programs surveyed reported 
that CSB bags frequently arrived damaged. Several U.S. agency 
officials agree that U.S. food aid supply chain conditions are more 
rugged than conditions facing commercial food products, so commercial 
benchmarks for packaging may be insufficient. During our fieldwork in 
Djibouti, Ethiopia, South Africa, and Texas, we witnessed hundreds of 
boxes stained with vegetable oil from ruptured cans, as well as 
ruptured CSB bags (see figure 7).[Footnote 71] 

Figure 7: Examples of Vegetable Oil and CSB Packaging Problems: 

[Refer to PDF for image: 2 photographs] 

Source: GAO. 

Improper handling and stacking can impact food quality. The photo on 
the left shows leaking vegetable oil stored within cardboard boxes in 
a warehouse in Dire Dawa, Ethiopia. The photo on the right shows a 
ruptured package of CSB as observed in Jacintoport, Texas. 

[End of figure] 

Despite the importance of packaging for quality management, packaging 
materials currently used for CSB and vegetable oil may not be durable 
enough to withstand conditions encountered throughout the supply 
chain. When packaging is compromised, commodities may spoil, 
deteriorate, or become infested. For instance, when the fat content in 
commodities such as CSB and vitamin-A fortified vegetable oil are 
exposed to heat or oxygen, they may become rancid and unpalatable. One 
port operator in South Africa said that although food aid bags are 
designed to be handled three or four times, packaged commodities are 
actually often handled eight or more times before they reach a final 
distribution point. During the loading of food aid commodities in 
Jacintoport, Texas, we observed full paper bags being dropped up to 20 
feet (see figure 8), with some of them bursting upon impact. 

Figure 8: Loading of U.S. Food Aid Commodities at Jacintoport, Texas: 

[Refer to PDF for image: photograph] 

Source: GAO. 

This photo shows port operators handling and stacking bags of U.S. 
food aid into an ocean vessel’s hold in Jacintoport, Texas, in 
February 2011. 

[End of figure] 

Several implementing partners and vendors we interviewed also said 
that when vegetable oil cans are shipped break bulk[Footnote 72] they 
are often dropped, thrown, or stacked beneath heavier commodities 
causing some of the cans to rupture. Moreover, USAID officials told us 
that due to space constraints in foreign warehouses, U.S. officials 
told us that bags and tin cans may be stacked higher than commodity 
guidelines permit, resulting in ruptured bags and vegetable oil cans. 
[Footnote 73] 

Although port operators and implementing partners may try to salvage 
commodities through reconstitution, this process may introduce other 
quality risks. According to one KCCO official we spoke with, 
implementing partners usually do not order extra bags or tin oil cans, 
because vessel owners may then claim that the implementing partners 
anticipated losses and refuse to cover reconstitution 
expenses.[Footnote 74] As a result, the implementing partner may 
resort to taping bags, buying local bags which lack the requisite 
markings and labels, or using plastic cans to reconstitute vegetable 
oil (see figure 9). Furthermore, several implementing partners and 
U.S. agency officials said that reconstitution may introduce 
contaminants. 

Figure 9: Reconstituting Damaged Bags and Cans: 

[Refer to PDF for image: 2 photographs] 

Source: GAO. 

The photo on the left shows taped CSB bags in Djibouti City, Djibouti, 
and the photo on right shows containers used to reconstitute vegetable 
oil in Dire Dawa, Ethiopia. 

[End of figure] 

U.S. agencies have taken steps recently to address packaging 
complaints, but it is too early to assess their effectiveness. For 
example, the Food Aid Consultative Group Packaging and Transportation 
Working Groups have introduced several packaging alternatives, such as 
the "bliss box" container and plastic vegetable oil containers in 
2010.[Footnote 75] Furthermore, USDA plans to move away from 
specifying packaging characteristics toward specifying desired 
performance outcomes for vegetable oil cans to allow vendors more 
flexibility and be compliant with the Federal Acquisition Regulation. 
For example, in 2009, USDA eliminated the specification requiring a 
spout on the top of vegetable oil containers--which a vendor and 
agency official have identified as a structural deficiency--and now 
only requires a sound, leak-proof seal. However, according to several 
USDA officials, USDA has not updated performance language for 
packaging durability in more than 10 years, and changes to packaging 
performance language is limited to vegetable oil containers. As a 
result, it is unclear whether some packaging designs are still 
appropriate for current conditions throughout the supply chain. 

Conclusions: 

U.S. food aid programs have taken steps to improve nutrition and 
quality controls since we last reviewed these issues in 2007; however, 
opportunities for further improvement remain. With regard to 
nutrition, the prevelence of multiyear emergency food aid programs 
highlights the need for strategies and guidance that addresses 
nutritional deficiencies that may emerge over time through the 
reliance on products designed for short-term food insecurity. 
Furthermore, within a fixed budget, while specialized food products 
offer new opportunities to meet the nutritional needs of the most 
vulnerable groups, the high cost of these products would reduce the 
number of recipients fed. Information on how well the products perform 
in promoting desired nutritional outcomes and the relative cost of 
these products is essential to USAID and its implementing partners 
when making a choice of the products and weighing the complex trade 
offs between nutritional outcomes, quantity of food aid, and number of 
recipients who can be served. In addition, difficulties in targeting 
vulnerable groups, including the absence of guidance on whether and 
how to use these new products, could hamper efforts to ensure that 
intended populations receive these specialized foods. 

With regard to quality controls, recent initiatives by the agencies, 
especially a renewed commitment to testing, have reduced quality 
concerns; however, existing vulnerabilities in current agency 
practices contribute to remaining quality control issues. For example, 
agencies limited tracking of key quality indicators for food aid 
commodities does not systematically provide essential information 
about the condition of commodities throughout the supply chain, 
especially upon arrival at overseas destinations. Furthermore, even if 
U.S. agencies procure high-quality commodities, they may still suffer 
damage or loss during transit and storage due to outdated packaging 
that is not sufficiently durable for the rugged conditions encountered 
throughout the supply chain. 

U.S. food aid is a vital component of U.S. overseas humanitarian 
assistance and foreign policy, especially in response to natural 
disasters and complex, often protracted emergencies, such as conflict. 
However, the rising cost of food increases both the cost of U.S. food 
aid and the number of people requiring food assistance. As such, the 
agencies should explore every opportunity to continue to improve the 
efficiency and effectiveness of U.S. food aid programs. 

Recommendations for Executive Action: 

To enhance U.S. food aid programs' efforts to meet the nutritional 
needs of intended recipients, we recommend that the Administrator of 
USAID and the Secretary of Agriculture work together to take the 
following three actions: 

1. for U.S. food aid that provides the sole source of diet for 
recipients of emergency programs that extend beyond a year, provide 
clear guidance to implementing partners on how to address nutritional 
deficiencies that may emerge; 

2. for new specialized food products designed to meet the nutritional 
needs of the most vulnerable groups, evaluate the performance and cost-
effectiveness of the products in achieving their nutritional goals in 
an appropriate program setting before they are included in the 
agencies' approved list of commodities; and: 

3. provide clear guidance on whether and how best to use new 
specialized food products, including guidance to the agencies' 
implementing partners on targeting strategies to ensure that the 
products reach their intended recipients. 

To improve U.S. food aid programs' efforts to maintain the quality of 
commodities throughout the food aid supply chain, we recommend that 
the Administrator of USAID and the Secretary of Agriculture work 
together to take the following two actions: 

1. strengthen agencies' monitoring of commodity quality by identifying 
and tracking key quality indicators to ensure that agencies and 
implementing partners are aware of the full extent of quality 
problems, including emerging concerns, throughout the supply chain, 
and: 

2. evaluate packaging specifications to ensure food packaging is 
sufficiently durable for conditions encountered throughout the supply 
chain. 

Agency Comments and Our Evaluation: 

USAID and USDA--the two principal U.S. agencies to whom we directed 
our recommendations--provided written comments on a draft of this 
report. We have reprinted their comments in appendixes VI and VII. 
These agencies, along with the Department of State, the Office of 
Management and Budget, and WFP, also provided technical comments and 
updated information, which we have incorporated throughout this 
report, as appropriate. The Departments of Transportation and the 
Treasury, and the Office of Management and Budget did not provide 
written comments. 

USAID and USDA generally concurred with our recommendations. Both 
agencies provided examples of recent or ongoing efforts to address our 
recommendations to enhance U.S. efforts to meet the nutritional needs 
of intended recipients. USAID, for example, expects to enhance the 
nutritional impact of food aid rations in both emergency and 
development settings by implementing the recommendations of USAID's 
Food Aid Quality Review. USAID is also in the process of field-testing 
new fortified blended foods, evaluating the feasibility of 
reformulating milled grains and fortified vegetable oil, and 
establishing guidance to provide to implementing partners on how to 
address nutritional deficiencies in these new products. Although 
emergency programs are largely under the purview of USAID, USDA agreed 
to support USAID's efforts through changes in commodity procurement 
and program coordination. USAID also recently developed and tested the 
nutrition of new ready-to-use food products and expects them to be 
ready for shipment in October 2011. Both USAID and USDA agreed to 
review these new specialized food products' relative cost-
effectiveness and evaluate the results of field testing in order to 
determine if they should be included in future programs, but USAID 
said additional funding and authorizations may be necessary. Lastly, 
USAID issued two papers as guidance to implementing partners on 
targeting strategies,[Footnote 76] and created a new program to assist 
implementing partners with assessment, monitoring, and evaluation of 
programs so that they may identify and achieve desired nutritional 
outcomes. 

USAID and USDA also provided examples of how they can address our 
recommendations to improve U.S. efforts to maintain the quality of 
commodities throughout the food aid supply chain. For example, both 
agencies agreed to consider ways to collaborate with relevant agencies 
and stakeholders to determine the cost-effectiveness of developing a 
comprehensive quality control system that tracks quality indicators of 
food aid programs within the context of a constrained budget 
environment. USDA noted that it works with relevant agencies to 
minimize instances of quality problems and continues to strive for 
greater accountability in food aid contracts. Concerning the 
durability of food aid packaging, both USAID and USDA agreed to review 
specifications and determine what further actions can be taken to 
improve packaging. USAID also noted that it recently approved, and 
made available to implementing partners, specific changes to vegetable 
oil packaging that may reduce damage in handling and distribution, as 
recommended by the packaging working group of the Food Aid 
Consultative Group. 

We are sending copies of this report to interested members of 
Congress; the Administrator of USAID; the Secretaries of Agriculture, 
State, Transportation, and the Treasury; and relevant agency heads. 
The report is also available at no charge on the GAO Web site at 
[hyperlink, http://www.gao.gov]. 

If you or your staffs have any questions about this report, please 
contact me at (202) 512-9601 or melitot@gao.gov. Contact points for 
our Office 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 VIII. 

Signed by: 

Thomas Melito: 
Director, International Affairs and Trade: 

List of Requesters: 

The Honorable Debbie Stabenow: 
Chairwoman: 
The Honorable Pat Roberts: 
Ranking Member: 
Committee on Agriculture, Nutrition and Forestry: 
United States Senate: 

The Honorable Frank D. Lucas: 
Chairman: 
The Honorable Collin C. Peterson: 
Ranking Member: 
Committee on Agriculture: 
House of Representatives: 

The Honorable Howard L. Berman: 
Ranking Member: 
Committee on Foreign Affairs: 
House of Representatives: 

The Honorable Donald M. Payne: 
Ranking Member: 
Subcommittee on Africa, Global Health, and Human Rights: 
Committee on Foreign Affairs: 
House of Representatives: 

The Honorable Saxby Chambliss: 
United States Senate: 

The Honorable James P. McGovern: 
House of Representatives: 

[End of section] 

Appendix I: Objectives, Scope, and Methodology: 

Our objectives were to assess U.S. efforts to (1) meet the nutritional 
needs of intended recipients and (2) maintain the quality of 
commodities throughout the food aid supply chain. 

To address these objectives, we analyzed emergency food aid program 
and budget data provided by the U.S. Agency for International 
Development (USAID), the U.S. Department of Agriculture (USDA), and 
the World Food Program (WFP). We determined that the data obtained 
were sufficiently reliable for our purposes. Our review focuses on 
USAID emergency food aid programs administered by USAID's Office of 
Food for Peace (FFP). Approximately 79 percent of FFP food aid funding 
was for emergency programs in 2010. However, since the United States 
provides many of the same commodities to both nonemergency and 
emergency food aid programs, and the commodities generally go through 
the same food aid supply chain, our findings may be applicable to both 
types of programs. 

We sent survey questionnaires to the 29 countries with active FFP 
emergency food aid programs in fiscal year 2010 and received responses 
from 25 of them. Our survey included two sets of questions about the 
nutritional content and quality of USAID emergency food. We developed 
and pretested our instrument between August and November 2010, and 
administered it in late November 2010. In total, the 25 countries that 
responded to our survey were responsible for 45 programs. Twenty-four 
of the 25 countries had WFP programs, of which 7 also reported having 
nongovernmental organizations (NGO) programs. One country reported 
only having NGO programs. As a result, a total of eight countries 
reported having NGO programs and completed the sections on the quality 
of U.S. food aid. We requested that officials from FFP country program 
offices answer questions on quality only for programs administered by 
NGOs and asked officials at WFP headquarters to answer similar 
questions. We conducted follow-up by email with FFP officers to 
determine the completeness, accuracy, and reliability of the 
information provided within their written responses to the survey. 

In Washington, D.C., we interviewed officials from USAID; USDA; the 
Departments of State, Transportation, and the Treasury; and the Office 
of Management and Budget. We also met with officials representing NGOs 
that serve as implementing partners to USAID in carrying out U.S. food 
aid programs overseas; a freight forwarding company; nutrition 
experts; and international surveyors. In Rome, Italy, we met with 
officials from the Food and Agriculture Organization, the 
International Fund for Agricultural Development, U.S. Mission to the 
United Nations, and WFP, and conducted a roundtable with bilateral 
donors. We also conducted fieldwork in three countries that receive 
emergency U.S. food aid--Djibouti, Ethiopia, and Zimbabwe--and met 
with officials from U.S. missions, implementing organizations, and 
relevant host government agencies. We visited Jacintoport, Texas from 
which food is prepositioned and shipped; two food aid destination 
ports and prepositioning sites in Djibouti and South Africa; and 
several warehouses where food aid may be stocked prior to shipping, 
handling, or distribution to final recipients. 

To provide context and background, we analyzed total food aid budget 
and tonnage data for fiscal years 2006 to 2010 provided by USAID. We 
did not assess the reliability of the data that we used for background 
purposes. We also reviewed international standards, program 
authorities, and regulations to determine nutrition and quality 
control requirements in food aid programming. 

To assess U.S. food aid programs' efforts to meet the nutritional 
needs of intended recipients, we reviewed U.S. government documents, 
including USAID's program guidance and strategic plans for Food for 
Peace Title II emergency programs. We interviewed officials from NGOs, 
USAID, USDA, WFP, and other research institutions. We examined data 
gathered from our survey to analyze the nutritional content of the 
rations provided to emergency food aid programs. We analyzed external 
studies on the costs and effectiveness of new specialized food 
products developed for use in food aid programs that were conducted by 
universities and research institutions, such as the University of 
California-Davis. Our review focused on new products developed to 
treat or prevent mild to severe malnutrition among small children 6 to 
24 months of age. The scope of the report did not include nonemergency 
nutritional interventions, such as nutrition education programs. In 
addition, we did not try to estimate the cost and benefits that would 
be obtained by reducing malnutrition. We reviewed internal evaluations 
conducted by USAID and WFP, including those related to needs 
assessments and targeting. We incorporated information from our past 
reports as appropriate. 

To assess U.S. food aid programs' efforts to maintain the quality of 
commodities throughout the food aid supply chain, we reviewed numerous 
U.S. government documents, including U.S. agencies' food aid product 
specifications, rules and regulations, a commodity complaint logs, 
quality control guidelines, audit reports, and draft documents 
concerning how to respond to food quality problems. We also conducted 
interviews with and reviewed reports by commodity suppliers; recipient 
governments; and officials from the Kansas City Commodity Office 
(KCCO), NGOs, USAID, USDA's Federal Grain Inspection Service (FGIS), 
and WFP. We also analyzed and conducted data reliability assessments 
for (1) commodity loss data provided by KCCO and WFP, (2) sampling and 
testing data provided by FGIS, and (3) food aid procurement data 
provided by USAID and KCCO. We examined the KCCO and WFP commodity 
loss data for reliability through interviews with agency officials 
that manage the data and found the data to be sufficiently reliable to 
represent trends in food aid commodity losses. We examined FGIS 
sampling and testing data of corn soy blend to determine the 
percentage of corn soy blend samples not meeting specifications since 
2009, and determined the data to be sufficiently reliable for our 
purposes. We also observed the loading of food aid onto the Myra, a 
foreign-flag vessel, in Jacintoport, Texas, and the unloading of food 
aid from the Noble Star, a U.S.-flag vessel, in Durban, South Africa. 
Lastly, we incorporated information from our past audits, as 
appropriate. 

We conducted this performance audit from April 2010 to May 2011 in 
accordance with generally accepted U.S. government auditing standards. 
Those standards require that we plan and perform the audit to obtain 
sufficient, appropriate evident to provide a reasonable basis for our 
findings and conclusions based on our audit objectives. We believe the 
evidence obtained provides a reasonable basis for our findings and 
conclusions based on our audit objectives. 

[End of section] 

Appendix II: International and U.S. Commitments and Actions to Address 
Food Security and Nutrition: 

As shown in figure 10, both the international donor community and the 
U.S. government have made commitments and have undertaken a number of 
key actions over the years in their efforts to address global food 
security and nutrition. 

Figure 10: International and U.S. Commitments and Actions to Address 
Food Security and Nutrition, 1996 through 2015: 

[Refer to PDF for image: time line with photograph] 

1996: 
The United States and about 180 other countries set a target to halve 
hunger world by 2015. 

International: 

1996: 
Nutriset, a French company, developed the first ready-to-use food 
intended specifically for the treatment of severe acute malnutrition. 

2000: 
United Nations (UN) establishes the Millennium Development Goals (MDG) 
and sets a target to halve the proportion of undernourished people in 
the world who suffer from hunger by 2015. 

2006: 
Micronutrient Forum is established. 

2007: 
UN Secretary-General establishes the UN MDG Africa Steering Group. 

World Bank launches Global Food Crisis Response Program. 

2008: 
World Economic Forum identifies food insecurity among the top threats 
to the global economy in 2008 and for decades to come. 

World Bank announced its New Deal for Global Food Policy to focus on 
hunger, malnutrition, and access to food. 

Copenhagen Consensus Center identifies combating malnutrition among 
undernourished children as the world’s best investment. 

UN Chief Executives Board establishes UN High-Level Task Force on the 
Global Food Security Crisis. 

2009: 
G8 commits $20 billion for agriculture and global food security in 
L’Aquila, Italy. 

World Summit on Food Security is held in Rome, Italy. 

2010: 
U.S. and Ireland launch a joint campaign, 1000 Days: Change a Life,
Change the Future. 

World Bank issues the report, Scaling Up Nutrition: What Will it Cost? 

2015: 
Target year to achieve both the World Food Summit and MDG targets to
halve hunger. 

United States: 

1999: 
The NGO SUSTAIN publishes its report on the fortification of food aid,
which had been commissioned by USAID in 1996. 

2001: 
The NGO SUSTAIN publishes its report on the fortification of food aid 
which had been commissioned by USAID in 1996. 

2002: 
Congress authorizes McGovern-Dole International Food for Education and
Child Nutrition Program. 

2007: 
USDA issues Commodity Concerns Feedback Guide and Standardizing 
Existing Commodity Specifications. 

2008: 
2008 Farm Bill reauthorizes the Farmer-to-Farmer Program, authorizes a 
4-year local and regional purchase pilot program in developing 
countries, and creates the National Institute of Food and Agriculture 
(NIFA). 

SUSTAIN issues report to USDA on harmonized commodity requirement 
description templates and recommendations on micronutrient quality 
assurance. 

USDA establishes commodity sampling and testing protocol. 

USAID launches Global Food Security Response. 

2009: 
The administration launches a new global hunger and food security 
initiative called “Feed the Future.” 

USDA finalizes new federal regulations to standardize U.S. food aid 
contracting procedures. 

USAID commissions Tufts University to conduct a Food Aid Quality 
Review (FAQR). 

2010: 
NIFA announces Food Aid Nutrition Enhancement Program. 

Micronutrient-Fortified Food Aid Products Pilot is implemented under 
the authority of the McGovern-Dole Food for Education Program. 

USAID issued technical guidelines called “Preventing Malnutrition in 
Children under 2 Approach” (PM2A), which is a food-assisted approach 
to reducing the prevalence of child malnutrition by targeting a 
package of health and nutrition interventions to all pregnant women,
mothers of children 0-23 months and children under 2 in food-insecure 
program areas, regardless of nutritional status. 

2011: 
USAID commissions field testing of product modifications and other
operations research around food aid programming. 

USAID releases FAQR. 

Source: GAO. 

[End of figure] 

[End of section] 

Appendix III: Processes within Each Stage of the Food Aid Supply Chain: 

The following table outlines the processes within each stage of the 
food aid supply chain depicted in figure 3. 

Table 4: Processes within Each Stage of the Food Aid Supply Chain: 

Stage 1: Domestic: Planning.
* The World Food Program (WFP) or a nongovernmental organization (NGO) 
submits a food order proposal designed to meet program objectives to 
Food for Peace (FFP) or the U.S. Department of Agriculture's (USDA) 
Foreign Agricultural Service in the new Web-Based Supply Chain 
Management System (WBSCM). Food orders are based upon a preapproved 
program budget; 
* FFP or the Foreign Agricultural Service reviews the order to ensure 
its suitability for the program and country area with regard to the 
quantity and type of commodity requested. Once approved, the commodity 
request is forwarded to the procurement office, USDA's Farm Service 
Agency, and USDA's Kansas City Commodity Office (KCCO); 
* USDA-KCCO collects commodity orders with like delivery dates for 
placement on a solicitation. USDA-KCCO reviews orders to ensure no 
incongruities with established commodity and packaging specifications, 
considers the food industry's capacity, and consults with 
administering agencies with regard to priority of orders, before 
finalizing and issuing a solicitation. 

Stage 1: Domestic: Procurement.
* USDA-KCCO issues a solicitation for commodity vendors to offer their 
products for sale to USDA. Concurrently, administering agencies, WFP, 
or freight forwarders for NGOs issue a solicitation for ocean freight 
services to deliver these commodities to overseas destinations; 
* Ocean carriers submit offers electronically through WBSCM. 
Administering agencies review the ocean offers to identify 
programmatic issues, such as ensuring rates are fair market prices and 
considering achievement of cargo preference flagging requirements year-
to-date; 
* Commodity vendors enter offers electronically through WBSCM. KCCO 
reviews offers to ensure they are responsive to the terms of the 
solicitation; 
* Responsive offers are evaluated by a linear program to determine the 
combination of commodity and ocean carrier offers that together 
provide for the lowest landed cost. Lowest landed cost is determined 
through successive linear program runs to apply statutory and 
regulatory requirements within port capacity limits, and commodity or 
freight vendor minimum and maximum quantities, as follows: 
- allocating up to 25 percent of tonnage to Great Lakes ports without 
regard to vessel flag; 
- applying 75 percent U.S.-flag preference; 
- awarding required quantity to mandatory AbilityOne source, and; 
- applying other socioeconomic program set-asides, such as HUBZones, 
Small Business Administration's 8(a) Business Development Program, 
Service-Disabled Veteran Owned small business, and other small 
business set-asides. 

Stage 1: Domestic: Decisions.
* USDA-KCCO coordinates with FFP or the Foreign Agricultural Service 
as to the results of the lowest landed cost evaluation; 
* FFP or the Foreign Agricultural Service gives authorization to 
proceed with procurement in consideration of their program needs and 
budgets; 
* USDA-KCCO then awards commodity contracts. Administering agencies 
determine how to proceed with any commodity orders not awarded; 
* USAID's Transportation Division provides WFP or NGOs with a 
procurement plan to inform them of the ocean carriers that resulted in 
the lowest landed cost. WFP and NGOs award ocean transportation 
contracts on the basis of this procurement plan, provided the vessels 
can meet their programmatic needs; 
* USAID's Transportation Division, with confirmation from the U.S. 
Department of Transportation's Maritime Administration, recommends the 
fair and reasonable rate for the ocean carrier to WFP and NGOs in 
those cases where a fair and reasonable rate guideline is required; 
* Commodity vendor receives contract and begins production to meet the 
contracted shipping schedule: 
- Government contract quality assurance takes place to ensure 
compliance with contract specifications. For corn soy blend and wheat 
soy blend, USDA's Federal Grain Inspection Service samples and tests 
commodity at source. For other blended, fortified products, commodity 
suppliers sample and test their own products and certify the results. 
For products with established U.S. grade standards, including bulk 
grains, contractors are required to obtain official Federal Grain 
Inspection Service grading certificates. 

Stage 1: Domestic: Delivery.
* Commodity vendor delivers products into the care and custody of the 
ocean carrier at the contracted delivery point. This may be at the 
vendor's facility, a bridge location, or a domestic load port: 
- If the contracted delivery point is the vendor's facility, the 
commodity vendor is responsible for stuffing products into intermodal 
containers provided by ocean carriers; the ocean carrier then 
transports the containers to the domestic load port; 
- If the contracted delivery point is at a bridge location, stevedores 
transload the product from railcars and trucks into containers which 
are transport by the ocean carrier to domestic load ports; 
- If contracted the delivery point is "free along side" vessel at a 
domestic load port, stevedores unload products from railcars and 
trucks for loading onto ocean vessels. If the ocean vessel has not 
arrived, the product is placed into short-term storage in port 
warehouses until the vessel arrives; 
* Port operators and stevedores load food aboard the ocean vessel or 
stuff containers on behalf of the ocean carrier; 
* USDA-KCCO-hired vessel loading observation contractor observes the 
stuffing of containers and loading of vessels to ensure that proper 
loading procedures are followed, damaged bags are not loaded, and 
quantities of damaged product are documented for USDA-KCCO claims 
actions. 

Stage 2: Shipping: Ocean transport.
* Ocean vessel departs from the domestic port; 
* Ocean vessel arrives at the foreign port. 

Stage 3: Foreign: Discharge.
* Port operators and stevedores unload food from the ocean vessel, bag 
it (if in bulk), and load it into a warehouse or truck; 
* USDA's independent marine cargo surveyor or a surveyor hired by WFP 
or a NGO counts the cargo as it is being offloaded from the vessel. If 
a quality issue is noted, the surveyor may be requested to take 
samples for further quality testing at an accredited lab. USDA, on 
behalf of the NGOs, pays for a second cargo survey (count) either at 
the discharge port or delivery at the final destination. WFP 
independently conducts survey sampling and testing; 
* Some host government officials conduct quality inspections by 
sampling and testing food; 
* WFP or an NGO takes possession of the food either at the ocean 
vessel or at its final destination; 
* WFP or an NGO (or USAID's warehouse contractor if the food's 
destination is a prepositioning warehouse) manages reconstitution and 
rebagging of damaged commodities and inspects warehouses and food 
stocks at least once a week so that prompt action can be taken if 
problems occur, such as physical damage, staining caused by water, or 
evidence of theft. 

Stage 3: Foreign: Inland transport.
* WFP or an NGO (or the ocean carrier if the terms of the contract are 
"through bill of lading") transports the food to its final destination. 

Stage 3: Foreign: Distribution.
* WFP or an NGO distributes the food to recipients; 
* WFP or an NGO provides documentation of tonnage delivered to USDA- 
KCCO in WBSCM; 
* WFP or an NGO (or USDA on behalf of some NGOs) files claims against 
ocean carriers for lost quantities of food. 

Source: GAO. 

[End of table] 

[End of section] 

Appendix IV: Nutrition and Quality Control Guidance and Standards for 
U.S. Food Aid Programs: 

Several key government and implementing partner documents provide 
guidance and standards for U.S. food aid programs (see table 4). For 
example, USAID's Commodities Reference Guide provides guidance to 
implementing partners on commodity selection during emergency 
programs, needs assessments, the appropriate use of food aid, 
targeting beneficiaries, and developing program activity objectives. 
Table 4 describes each document that provides standards and/or 
guidance for U.S. food aid programs. 

Table 5: Nutrition and Quality Control Guidance and Standards: 

Nutrition guidance and standards: 

Commodities Reference Guide; 
USAID's Commodities Reference Guide, last updated in January 2006, 
provides guidance to implementing partners on commodity selection 
during emergency programs, conducting needs assessments, determining 
the appropriate use of food aid, targeting beneficiaries, and 
developing program activity objectives. Guidance on commodity 
selection during emergency programs includes the following five steps 
for selecting food rations: (1) program design, (2) suitability of 
food commodities, (3) ration specifications, (4) ration calculations, 
and (5) ration ranking and selection. 

Sphere Handbook; 
A group of NGOs, including the Red Cross, published the Humanitarian 
Charter and Minimum Standards in Disaster Response (commonly referred 
to as the Sphere Handbook) in 2000, which lists universal minimum 
standards in core areas of humanitarian assistance, including minimum 
standards in food security, nutrition, and food aid. The Sphere 
Handbook sets standards for nutritional issues relating to programs 
that prevent or correct malnutrition and provides guidance on 
nutritional requirements for food aid provisions. 

The Codex Alimentarius; 
The United Nations' Food and Agriculture Organization and World Health 
Organization established the Codex Alimentarius, a collection of 
internationally recognized standards, codes of practice, guidelines 
and other recommendations relating to foods, food production, and food 
safety. 

Quality control guidance and standards: 

Master Solicitation for Commodity Procurements; 
KCCO's Master Solicitation for Commodity Procurements document, last 
updated on April 1, 2011, lists all solicitation provisions and 
contract clauses that pertain to international food aid, including 
provisions specific to KCCO, Federal Acquisition Regulation, and 
Agriculture Acquisition Regulations. This document has been updated 24 
times since it was first published in September 2005. 

Commodity Requirement Document; 
USDA's Commodity Requirement Document specifies commodity 
specification requirements, such as quality assurance, quality 
discounts, and performance specifications, as well as container, 
packaging, and marking requirements for each commodity or product. 

22 CFR 211 (Regulation 11); 
USAID's Regulation 11 implements the Food for Peace Act, which 
authorizes USAID to transfer food commodities for use in disaster 
relief, economic development, and other assistance. Regulation 11 
designates program procedures including obligations of implementing 
partners and requirements for processing, repackaging, labeling, 
handling, disposing, and assigning liability for loss of food aid 
commodities. 

Source: GAO based on USDA, USAID, and internationally recognized 
standards. 

[End of table] 

[End of section] 

Appendix V: USAID Quality Incident Feedback Loop: 

In 2009, a subgroup of the Food Aid Consultative Group--including 
officials from USAID, USDA, and external stakeholders--drafted a flow 
chart of standard operating procedures to resolve food quality 
complaints, also known as the feedback loop. As of August 2009, USDA 
officials had incorporated into the draft feedback loop additional 
details concerning halting food distribution and shortening the 
response time. According to the most recent draft feedback loop, 
depending on the magnitude of the quality control problem, it can take 
up to 3 months to work through the required steps to resolve a food 
quality complaint. Table 6 outlines the steps required for reporting 
and resolving quality control problems to FFP. 

Table 6: Steps Required for USAID FFP Title II Food Aid Commodity 
Quality Feedback Loop: 

Step: 1; 
Requirement: Implementing partner field staff send urgent information, 
such as packaging contract numbers, lot numbers, and photos of 
packaging and product, on a questionnaire to implementing partner 
headquarters and FFP staff at the mission or embassy in that country 
and in Washington, D.C.; 
Days (range): 5 hours to 1 day. 

Step: 2; 
Requirement: FFP and USDA designate a media point-of-contact for 
collaboration and reporting to the implementing partner; 
Days (range): 1-2. 

Step: 3; 
Requirement: FFP (in Washington, D.C.) initiates a tracking 
spreadsheet and disseminates incident report to all stakeholders; 
Days (range): 1-2. 

Step: 4; 
Requirement: USDA, USAID, and experts determine if product 
distribution should be halted and quarantined; 
Days (range): 1-5. 

Step: 5; 
Requirement: If consensus is reached to continue distribution, USAID 
and USDA media point-of-contact conveys guidance to implementing 
partner and documents the incident in a quality complaint spreadsheet 
for status reporting; 
Days (range): 1-5. 

Step: 6; 
Requirement: If consensus is reached to halt and quarantine 
distribution, USDA, USAID, and experts collaborate to draft and 
finalize initial public quarantine advisory with the new expert 
committee; notify the mission or embassy staff, as well as the 
implementing partner headquarters, which notifies its field office; 
and disseminate the quarantine notice to the field office; 
Days (range): 1-2. 

Step: 7; 
Requirement: USAID and USDA collaborate with experts to disseminate 
follow-up guidance on quarantine advisory. If distribution is resumed, 
skip to step #13; 
Days (range): 1-5. 

Step: 8; 
Requirement: If distribution was halted and quarantined, USAID and 
USDA collaborate with experts to develop a sampling protocol with 
reporting requirements for review by USAID, USDA, and experts, 
including producers or millers and new expert committee; 
Days (range): 10-15. 

Step: 9; 
Requirement: If USAID and USDA approve an expert lab analysis, USAID 
and USDA review lab analysis report with USAID Food Technologist and 
Nutrition Advisor and expert committee. USAID shares written report 
with implementing partners' headquarters. Implementing partners' 
headquarters forwards the report to field staff. Or, if implementing 
partner arranges an analysis, it is forwarded to USAID; 
Days (range): 1-14. 

Step: 10; 
Requirement: USAID and USDA officials consult with independent expert 
to determine if commodity is fit for human consumption; 
Days (range): 1-30. 

Step: 11; 
Requirement: If FDA or other expert consultation is required, USAID, 
in coordination with USDA, the implementing partner, and the expert 
committee, requests approval to proceed with additional expert 
analysis. USAID apprises the media and the implementing partner's 
headquarters notifies its field offices. Skip to step #13; 
Days (range): 1-30. 

Step: 12; 
Requirement: If further consultation is not necessary, USAID 
determines when the quarantine can be lifted. The implementing partner 
submits a final disposition plan and associated costs to USAID for 
approval and determines that the implementing partner may resume 
distribution. USAID collaborates with USDA on final public advisory 
notice and written report to the Food Aid Consultative Group. Skip to 
step #15; 
Days (range): 5. 

Step: 13; 
Requirement: If additional consultation is necessary, USAID shares 
final second analysis report with USDA and communicates results to 
media. USAID then coordinates with implementing partner's headquarters 
regarding additional costs for testing; 
Days (range): 5. 

Step: 14; 
Requirement: USAID-FFP updates the final disposition in tracking 
spreadsheet for reporting to the Food Aid Consultative Group; 
Days (range): 1. 

Step: 15; 
Requirement: USAID seeks guidance from Food Technologist and Nutrition 
Advisor, USDA, and experts and consults the Food Aid Consultative 
Group on ways to avoid recurrences or make systematic improvements in 
the supply chain for final reporting to the Food Aid Consultative 
Group; 
Days (range): 1. 

Total (Maximum); 
Days (range): 81 days[A]. 

Source: GAO based on USAID Title II Feedback Loop Guide. 

[End of table] 

[A] According to USAID, each food aid commodity quality issue is 
different and steps to resolve the issue will vary from case to case. 
Dates and time frames are best-and worst-case scenarios, depending 
upon the magnitude of the quality issue. 

[End of section] 

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

U.S. Agency for International Development: 
From the American People: 

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

Dear Mr. Melito: 

I am pleased to provide the U.S. Agency for International 
Development's formal response to the GAO draft report entitled 
"International Food Assistance: Better Nutrition and Quality Control 
Can Further Improve U.S. Food Aid" (GAO-11-491). 

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: 

Sean Carroll: 
Chief Operating Officer: 
U.S. Agency for International Development: 

Enclosure: a/s: 

[End of letter] 

USAID Comments on GAO Draft Report No. GA0-11-491: 

I. General Comments: 

USAID welcomes this GAO report and its recommendations on food aid 
programming nutrition and quality control. USAID has recently taken 
several steps to address the recommendations made in this report. 

In December 2010, USAID's Office of Food for Peace issued a draft 
report from a two-year Food Aid Quality Review (FAQR) undertaken with 
Tufts University Friedman School of Nutrition, and in consultation 
with industry, PVOs, technical experts, UN agencies, and others. The 
review aimed to identify ways to better match the nutritional quality 
of Title II food aid with the nutritional requirements of vulnerable 
populations overseas. "The FAQR focused on the formulation of food aid 
products, how programs use food aid products and product quality 
assurance. 

The final summary FAQR report was issued in April 2011 and Food for 
Peace has begun implementing the review's recommendations which 
include reformulating fortified, blended foods; improving composition 
and use of fortified vegetable oil; improving fortified cereals used 
in general food distributions; use of ready-to-use products when 
appropriate; modification of programming guidance; and revision of the 
process for approving new products. The entire FAQR report will be 
available in July 2011. USAID expects that the implementation of these 
recommendations will dramatically enhance the nutritional impact of 
food aid rations in both emergency and development settings. 

II. Recommendation Comments: 

Recommendation 1: To enhance U.S. efforts to meet the nutritional 
needs of intended recipients, we recommend that the Administrator of 
USAID and the Secretary of Agriculture work together to take the 
following three actions: 

1. For U.S. food aid, provided through general distribution programs 
during emergencies, provide clear guidance to implementing partners on 
how to address nutritional deficiencies that emerge when such programs 
extend beyond a year; 

USAID Management Response: As part of our implementation of the
FAQR, USAID is evaluating the feasibility of reformulating our milled 
grains and fortified vegetable oil to better address micronutrient 
deficiencies in malnourished populations. USAID is also working to 
develop and field test a new fortified blended food which includes 
dairy protein specifically to meet the needs of older infants and 
young children. If realized, these changes will go a long way towards 
reducing nutrition deficiencies in populations relying on food aid for 
more than a year. Guidance for implementation partners will accompany 
any new products. 

2. For new specialized food products designed to meet the nutritional 
needs of the most vulnerable groups, evaluate the products' 
performance in achieving nutritional goals within program settings and 
their relative cost-effectiveness before they are included in the 
agencies approval list of commodities; 

USAID Management Response: USAID and USDA, with support from the 
Institute of Medicine, FANTA-2 and U.S. Army Natick Research,
Development, and Engineering Center have recently developed new ready-
to-use food products for the first stages of an emergency. These 
products will enhance USAID's ability to respond to crises around the 
world, providing a means of delivering ready-to-eat food quickly to 
populations that do not have immediate access to food or means of 
cooking because of an emergency. USAID plans to pre-position these new 
products so they can be moved as needed to provide the U.S. first line 
response to disaster. USAID expects these new products will be ready 
for shipment in October 2011. These new emergency products all 
received extensive nutritional testing prior to their solicitation. 
Subject to Title II resource availability and flexibility, any new 
specialized foods developed as a result of the FAQR will also receive 
nutritional testing and be evaluated for cost effectiveness and 
potential impact. Additional programming evaluation research would 
also prove invaluable but would require additional funding and 
authorizations. 

3. Provide clear guidance on whether and how best to use new 
specialized food products, including guidance to the agencies' 
implementing partners on targeting strategies to ensure that the 
products reach their intended recipients. 

USAID Management Response: USAID agrees on the importance of guidance 
on new food aid product usage and beneficiary targeting. USAID
currently issues guidance for implementing partners, providing 
extensive information on targeting and nutrition in emergency 
situations. Recent guidance has included "Emergencies in Urban 
Settings: A Technical Review of Food-Based Program Options" and 
"Household Hunger Scale: A Cross-Cultural Method to Measure Household 
Hunger." Additionally, the Technical and Operational Performance 
Support (TOPS) Program was recently created to advance networking 
among Title II emergency and development partners through training and 
information sharing on best practice and lessons learned. TOPS will 
provide guidance to implementing partners to assist them with 
assessment, monitoring, and evaluation efforts that are critical to 
ensuring that their programs identify and achieve the desired 
nutritional outcomes. Also, as previously noted, any new specialized 
foods developed as a result of the FAQR will be accompanied by 
guidance to implementing partners. 

Recommendation 2: To improve U.S. Efforts to maintain the quality of 
commodities throughout the food aid supply chain, we recommend that the
Administrator of USAID and the Secretary of Agriculture work together 
to take the following two actions: 

1. Strengthen agencies' monitoring of commodity quality by identifying 
and systematically tracking key quality indicators to ensure that 
agencies and implementing partners arc aware of the full extent of 
quality problems, including emerging concerns, throughout the supply 
chain; USAID Management Response: Development of a comprehensive quality
control system for food aid programs will require extensive 
collaboration amongst agencies and stakeholders to determine cost-
effectiveness and ability to develop uniform quality indicators, and 
an automated, systematic way of measuring and reporting. USAID 
welcomes this suggestion and will make future decisions on this issue 
within the context of the new, constrained budget environment, and 
budgetary implications of researching, developing and implementing 
such a structure. 

2. Evaluate packaging specifications to ensure food packaging is 
sufficiently durable for conditions encountered throughout the supply 
chain. 

USAID Management Response: As indicated in the report, all USG food 
aid meets commercial packaging standards. However, USAID agrees that 
the unique nature of the food aid supply chain may require additional
specifications for durability. Under the Food Aid Consultative Group,
USAID established a packaging working group to look at packaging 
weaknesses and improvements for existing packaging, and design ways to 
introduce and pilot new packaging prototypes with USDA and other 
experts. Most recently, this working group recommended changes to 
vegetable oil packaging that may reduce the amount of damage in 
handling and distribution. These recommendations were approved and the 
new packaging is now available to implementing partners during the 
call forward process. 

[End of section] 

Appendix VII: Comments from the U.S. Department of Agriculture: 

USDA: 
United States DEpartment of Agriculture: 
Farm and Foreign Agricultural Services: 
Foreign Agricultural Services: 
1400 Independence Avenue, SW: 
Suite 1001: 
Washington, DC 20250-1001: 

Thomas Melito: 
Director, International Affairs and Trade: 
United States Government Accountability Office: 
441 G Street, N.W. 
Washington. D.C. 20548: 

Dear Mr. Melito: 

The U.S. Department of Agriculture (USDA) appreciates this opportunity 
to provide a substantive response to the Government Accountability 
Office (GAO) draft report. "Better Nutrition and Quality Control Can 
Further Improve U.S. food Aid" (GAO-11-491). In	this draft, GAO offers 
specific recommendations to the Secretary of Agriculture and the 	
Administrator of the U.S. Agency for International Development (USAID) 
regarding attention to nutritional deficiencies during protracted 
emergencies, evaluation and guidance concerning the performance and 
costs of specialized food products for vulnerable populations, 
tracking quality indicators, and a review of packaging	specifications 
for durability. USDA agrees with the GAO recommendations and will work 
with USAID to take the necessary actions to address them. 
	
USDA is committed to providing nutritious and high-quality products 
through its food aid programs that meet the needs of recipients. USDA 
is pleased that the GAO acknowledges improvements that already have 
been accomplished in the quality of food aid products. Over the past 
four years USDA and USAAID have invested substantial resources to 
review the quality and nutritional content of food aid products, and 
to make improvements. The recommendations made in the recent SUSTAIN 
and Tufts University studies are also being considered and will be 
used to guide appropriate, cost-effective actions. 
	
Meeting the Nutritional Needs of Recipients: 

The report recommends that USDA and USSAID improve guidance provided to 
implementing partners in emergency feeding programs, particularly 
where the need to maintain nutritional content is concerned. Though 
emergency programs are largely under the purview of USAID, USDA will 
support USAID's efforts through changes in commodity procurement and 
program coordination. In recognition of micronutrient concerns, USDA 
and USAID already have taken several measures to improve the quality 
of food rations and commodities. 

The Tufts University study recommended that a commodity review group 
be established to determine the cost effectiveness and appropriateness 
of new commodities in food aid programs. USDA will join USAID in 
exploring the possibility of establishing such a group. 

USDA also will review the performance and relative cost effectiveness 
of newly-developed micronutient-fortified products, as the GAO 
recommends. USDA is currently funding the development and field 
testing of a dairy protein paste, UltraRice, and lipid-based products. 
In 2012 USDA will evaluate the results of this field testing to 
determine if those products should be in included in future programs. 

Food Aid Quality Controls: 

USDA believes strongly in maintaining quality controls for food aid 
products. To ensure that high commodity standards are met, USDA's Farm 
Services Agency, FAS, and USAID staff regularly communicate and 
exchange information about any commodity quality issues that may 
arise. USDA generally agrees with the GAO recommendation to establish 
and track quality indicators throughout the supply chain. USDA will 
explore the feasibility and cost options of implementing this 
recommendation. 

The GAO draft report notes several instances of food aid quality 
problems. In addition to this written response to the draft report, 
USDA provided the GAO with several technical comments about individual 
quality issues. The technical comments provide background
and clarification regarding specific situations, especially as they 
relate to corn soy blend. Explanations of past quality issues are not 
easily summarized in this letter because of complexities related to 
the inclusion of multiple inputs, fats, and micronutriets. USDA 
continues to work with USAID and the Federal Grain inspection Service 
to reduce the instances of future quality problems. USDA also 
continues its efforts to compel greater accountability for performance 
from those operating under USDA food aid contracts. 

Finally, USDA with USAID will continue to review packaging 
specifications.	USDA recognizes that packaging must withstand harsh 
environments and has worked within the Food Aid Consultative Group, 
which includes private industry partners, to develop high-quality 
along with similar findings in the Tufts University study, to 
determine what actions can be taken to improve packaging. 

USDA thanks the GAO for its helpful review of food aid nutrition and 
quality control. The GAO's comments and recommendations will be taken 
into account when making future program decisions and will provide a 
basis for further program consultations with field experts. It remains 
a top priority at USDA to continually improve the quality and 
nutrition of food aid products. 

Sincerely, 

Signed by: 

[Illegible] for: 
John D. Brewer: 
Administrator: 
Foreign Agricultural Service: 

[End of section] 

Appendix VIII: GAO Contact and Staff Acknowledgments: 

GAO Contact: 

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

Staff Acknowledgments: 

In addition to the individual named above, Joy Labez (Assistant 
Director), Julia Ann Roberts, Carol Bray, Ming Chen, Debbie Chung, 
Martin De Alteriis, Mark Dowling, Etana Finkler, Heather Jensen, Nancy 
Meyer, and Jena Sinkfield made key contributions to this report. Other 
contributors include Pedro Almoguera, Ann Baker, Kenneth Bulle, Sharon 
Dooley, Brian Egger, Kendall Helm, Amanda Hinkle, Erin Lansburgh, 
Marya Link, Douglas Manor, Sarah McGrath, John Miller, Susan Offutt, 
Ernest Powell, Jerome Sandau, Phillip Thomas, Ryan Vaughan, and Bill 
Woods. 

[End of section] 

Related GAO Products: 

Global Food Security: U.S. Agencies Progressing on Governmentwide 
Strategy, but Approach Faces Several Vulnerabilities. [hyperlink, 
http://www.gao.gov/products/GAO-10-352]. Washington, D.C.: March 11, 
2010. 

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. 

USAID Acquisition and Assistance: Challenges Remain in Developing and 
Implementing a Strategic Workforce Plan. [hyperlink, 
http://www.gao.gov/products/GAO-09-607T]. Washington, D.C.: April 28, 
2009. 

Foreign Aid Reform: Comprehensive Strategy, Interagency Coordination, 
and Operational Improvements Would Bolster Current Efforts. 
[hyperlink, http://www.gao.gov/products/GAO-09-192]. Washington, D.C.: 
April 17, 2009. 

Foreign Assistance: State Department Foreign Aid Information Systems 
Have Improved Change Management Practices but Do Not Follow Risk 
Management Best Practices. [hyperlink, 
http://www.gao.gov/products/GAO-09-52R]. Washington, D.C.: November 
21, 2008. 

USAID Acquisition and Assistance: Actions Needed to Develop and 
Implement a Strategic Workforce Plan. [hyperlink, 
http://www.gao.gov/products/GAO-08-1059]. Washington, D.C.: September 
26, 2008. 

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. 

Intellectual Property: Strategy for Targeting Organized Piracy (STOP) 
Requires Changes for Long-term Success. [hyperlink, 
http://www.gao.gov/products/GAO-07-74]. Washington, D.C.: November 8, 
2006. 

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. 

Darfur Crisis: Progress in Aid and Peace Monitoring Threatened by 
Ongoing Violence and Operational Challenges. [hyperlink, 
http://www.gao.gov/products/GAO-07-9]. Washington, D.C.: November 9, 
2006. 

Rebuilding Iraq: More Comprehensive National Strategy Needed to Help 
Achieve U.S. Goals. [hyperlink, 
http://www.gao.gov/products/GAO-06-788]. Washington, D.C.: July 11, 
2006. 

Results-Oriented Government: Practices That Can Help Enhance and 
Sustain Collaboration among Federal Agencies. [hyperlink, 
http://www.gao.gov/products/GAO-06-15]. Washington, D.C.: October 21, 
2005. 

Maritime Security Fleet: Many Factors Determine Impact of Potential 
Limits of Food Aid Shipments. [hyperlink, 
http://www.gao.gov/products/GAO-04-1065]. Washington, D.C.: September 
13, 2004. 

United Nations: Observations on the Oil for Food Program and Iraq's 
Food Security. [hyperlink, http://www.gao.gov/products/GAO-04-880T]. 
Washington, D.C.: June 16, 2004. 

Combating Terrorism: Evaluation of Selected Characteristics in 
National Strategies Related to Terrorism. [hyperlink, 
http://www.gao.gov/products/GAO-04-408T]. Washington, D.C.: February 
3, 2004. 

Foreign Assistance: Lack of Strategic Focus and Obstacles to 
Agricultural Recovery Threaten Afghanistan's Stability. [hyperlink, 
http://www.gao.gov/products/GAO-03-607]. Washington, D.C.: June 30, 
2003. 

Foreign Assistance: Sustained Efforts Needed to Help Southern Africa 
Recover from Food Crisis. [hyperlink, 
http://www.gao.gov/products/GAO-03-644]. Washington, D.C.: June 25, 
2003. 

Food Aid: Experience of U.S. Programs Suggest Opportunities for 
Improvement. [hyperlink, http://www.gao.gov/products/GAO-02-801T]. 
Washington, D.C.: June 4, 2002. 

Foreign Assistance: Global Food for Education Initiative Faces 
Challenges for Successful Implementation. [hyperlink, 
http://www.gao.gov/products/GAO-02-328]. Washington, D.C.: February 
28, 2002. 

Foreign Assistance: U.S. Food Aid Program to Russia Had Weak Internal 
Controls. [hyperlink, 
http://www.gao.gov/products/GAO/NSIAD/AIMD-00-329]. Washington, D.C.: 
September 29, 2000. 

Foreign Assistance: U.S. Bilateral Food Assistance to North Korea Had 
Mixed Results. [hyperlink, 
http://www.gao.gov/products/GAO/NSIAD-00-175]. Washington, D.C.: June 
15, 2000. 

Managing for Results: Barriers to Interagency Coordination. 
[hyperlink, http://www.gao.gov/products/GAO/GGD-00-106]. Washington, 
D.C.: March 29, 2000. 

Foreign Assistance: Donation of U.S. Planting Seed to Russia in 1999 
Had Weaknesses. [hyperlink, 
http://www.gao.gov/products/GAO/NSIAD-00-91]. Washington, D.C.: March 
9, 2000. 

Foreign Assistance: North Korea Restricts Food Aid Monitoring. 
[hyperlink, http://www.gao.gov/products/GAO/NSIAD-00-35]. Washington, 
D.C.: October 8, 1999. 

Food Security: Factors That Could Affect Progress toward Meeting World 
Food Summit Goals. [hyperlink, 
http://www.gao.gov/products/GAO/NSIAD-99-15]. Washington, D.C.: March 
22, 1999. 

Food Security: Preparations for the 1996 World Food Summit. 
[hyperlink, http://www.gao.gov/products/GAO/NSIAD-97-44]. Washington, 
D.C.: November 7, 1996. 

[End of section] 

Footnotes: 

[1] United Nations, Food and Agriculture Organization, The State of 
Food Insecurity in the World, Addressing Food Insecurity in Protracted 
Crises (Rome, Italy, 2010). 

[2] As defined by the United Nations Children's Fund, undernourishment 
means being underweight for one's age, too short for one's age 
(stunted), dangerously thin (wasted), or deficient in vitamins and 
minerals (micronutrient malnutrition). 

[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 aid 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. 

[4] Food insecurity exists when people do not have physical or 
economic access to sufficient food to meet their dietary needs for a 
productive and healthy life. 

[5] For the purposes of this report, processed, blended, or value-
added commodities will be referred to as products. Specialized food 
products include enhanced versions of corn soy blend, micronutrient 
powders, lipid-based nutrient supplements, and ready-to-eat food in 
emergencies. 

[6] For the purposes of this report, we define quality as the degree 
to which food aid commodities adhere to specifications. Quality 
problems are occurrences of spoilage, infestation, contamination, or 
damage to the commodity that can result from factors such as failure 
to meet product specifications, inadequate fumigation, poor warehouse 
conditions, and transportation delays. We define food spoilage as 
deterioration in the nutritional value of food that is primarily due 
to quality control problems. Quality controls are measures to maintain 
the original quality and quantity of the commodity. 

[7] For the purposes of this report, we define the food aid supply 
chain as a three-stage process covering (1) the domestic phase of the 
food aid supply chain, including approval, procurement, bidding, 
decisions, production, and delivery; (2) the shipping phase, which 
entails ocean transportation from a domestic port to a foreign port; 
and (3) the foreign phase, which includes truck, rail, and barge 
transportation, and distribution. 

[8] These are international humanitarian aid organizations that 
include, for example, Cooperative for Assistance and Relief 
Everywhere, Inc. and Catholic Relief Services, as well as local aid 
organizations such as the Relief Society of Tigray in Ethiopia. 

[9] See 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). 

[10] This includes reviews of the McGovern-Dole International Food for 
Education program (forthcoming, May 2011) and monetization of U.S. 
food aid (forthcoming, June 2011). 

[11] Food for Peace Title II resources fund emergency and nonemergency 
programs. Emergency programs provide resources to meet the immediate 
food aid needs of those affected by the most severe crises. 
Nonemergency programs, also known as multiyear development programs, 
are approved to operate for 3 to 5 years and target chronically food- 
insecure populations. 

[12] Implementing partners refer to WFP and NGOs that are awarded U.S. 
government grants to carry out the distribution of food aid. 

[13] See 7 U.S.C. 1691. 

[14] United Nations High-Level Task Force on the Global Food Security 
Crisis, Updated Comprehensive Framework for Action (New York, N.Y., 
September 2010). 

[15] The Food and Agriculture Organization's recent estimate of 925 
million people undernourished worldwide was higher in 2010 than before 
the food and economic crises in 2008. The Food and Agriculture 
Organization stated that the number of undernourished people in the 
world remained unacceptably high. 

[16] Harold Alderman, Susan Horton, and Juan A. Rivera, Copenhagen 
Consensus 2008 Challenge Paper: Hunger and Malnutrition (May 2008). 
The Copenhagen Consensus Center is a research organization based in 
Denmark that advises governments and philanthropists about the best 
ways to spend aid and development money. 

[17] Jana Krystene Brooks, Susan Horton, Ajay Mahal, Christine 
McDonald, and Meera Shekar, Scaling Up Nutrition, What Will it Cost?, 
World Bank (Washington, D.C., 2010). 

[18] In September 2008, SUSTAIN issued its report, including 
recommendations related to product specification templates and 
performance language. 

[19] Feed the Future is 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 G8 Summit in L'Aquila, Italy, to provide 
at least $3.5 billion for agricultural development and global food 
security over 3 years. In L'Aquila, Italy, and the subsequent G20 
Summit in Pittsburg, Pennsylvania, other donors pledged about $18.5 
billion, bringing the total to $22 billion. See Feed the Future Guide 
(May 2010), [hyperlink, http://www.feedthefuture.gov]. 

[20] GAO, Global Food Security: U.S. Agencies Progressing on 
Governmentwide Strategy, but Approach Faces Several Vulnerabilities, 
[hyperlink, http://www.gao.gov/products/GAO-10-352] (Washington, D.C.: 
Mar. 11, 2010). 

[21] USAID's Food Aid Quality Review: Delivering Improved Nutrition: 
Recommendations for Changes to U.S. Food Aid Products and Programs 
(April 2011). 

[22] In addition to Food for Peace Act funding to USAID for emergency 
food aid, the U.S. government may provide funding for emergency food 
aid through other sources. For example, the Department of State's 
Bureau of Population, Refugees, and Migration (PRM) provides funding 
contributions to WFP for specific operations to purchase food locally 
and globally to remedy shortages in refugee feeding. WFP may use such 
funding to purchase specialized food products, but PRM does not 
specify what products to purchase. In fiscal year 2010, PRM provided 
just more than $25.6 million for WFP feeding operations. 

[23] Seventeen of the 30 countries are in Africa, 9 in Asia, and 4 in 
Latin America and the Caribbean. 

[24] USAID funds therapeutic feeding programs through other means such 
as the Office of U.S. Foreign Disaster Assistance, which in fiscal 
year 2009 provided more than $48 million to support emergency and 
preventive nutrition interventions in 15 countries around the world. 
These interventions included treatment for severe and moderate acute 
malnutrition, as well as infant and young child feeding, among others. 

[25] USDA also administers a local and regional procurement pilot 
project. 

[26] According to USAID and USDA officials, some food aid deliveries 
take longer and others take shorter than 4 to 6 months. In at least 1 
case, delivery took over a year from production to distribution in a 
recipient country. 

[27] We visited three locations--Jacintoport, Texas; the port of 
Durban, South Africa; and the port of Djibouti, Djibouti--where USAID 
has food aid stocks prepositioned to be in close proximity to regions 
where emergency food aid has traditionally been provided. USAID uses 
the food stocks stored in its warehouse in Texas to respond to 
emergencies in the Caribbean and Central and South America; South 
Africa to respond to emergencies in the Southern African region, and 
Djibouti to respond to emergencies in Ethiopia, Sudan, and other 
countries in or near the Horn of Africa. In addition, USAID has 
prepositioned warehouses in Lomé, Togo to respond to emergencies in 
West Africa and one more warehouse in Colombo, Sri Lanka, to respond 
to emergencies in Southeast Asia and the Middle East. 

[28] Food aid rations refer to the quantity and type of commodities 
included in the feeding programs. The rations can be defined by the 
type of recipients (individual ration or household ration), the length 
of time the food is intended for (weekly or monthly ration), or the 
purpose of the feeding program (general food or supplementary feeding 
rations). 

[29] A pipeline break is an interruption to the funding or the flow of 
goods at a given point in the supply chain that leads to disruptions 
or delays to planned food aid distribution. 

[30] Vulnerable groups or populations may include pregnant and 
lactating women; children under 5; and individuals who are elderly, 
handicapped, or afflicted with chronic diseases such as HIV/AIDS. This 
distinction varies by program. For the purposes of this report, we 
define vulnerable groups as those most at risk of undernourishment-- 
children under the age of 2 and pregnant or lactating women. 

[31] Food and Nutrition Needs in Emergencies, by the United Nations 
High Commissioner for Refugees, United Nations Children's Fund, WFP, 
and World Health Organization. These organizations have jointly 
developed the guidelines as a practical tool for assessing, estimating 
and monitoring the food and nutrition needs of populations in 
emergencies. The guidelines are aimed at field staff involved in 
planning and delivering a basic general food ration for emergency- 
affected populations. 

[32] USAID's guidelines recognize the importance of micronutrients 
(vitamins and minerals), but do not specify the recommended levels of 
micronutrients in general food aid distributions. 

[33] Bulk grains include unprocessed commodities such as corn, wheat, 
and sorghum. Milled cereals are usually fortified with micronutrients 
and include flours, cornmeal, and bulgur. Pulses include dried beans, 
peas, and lentils. CSB is a blend of partially cooked cornmeal, soy 
flour, salt, and vegetable oil, with vitamins and minerals. It is 
often used for weaning-age children in the form of a thin drinkable 
gruel. Besides grain, pulses, fortified blended foods, and oil, 
implementing partners can provide other commodities as part of the 
ration funded through other sources. Thirty-three of the 45 programs 
that responded to our survey reported providing additional items 
funded by other donors. For example, a WFP program in the Democratic 
Republic of the Congo provided salt and sugar funded by the European 
Commission and Japanese donors. 

[34] In fiscal year 2010, 21 out of 30 countries received U.S. 
emergency food aid for 4 years or more. The 21 countries are 
Afghanistan, Burundi, Cameroon, Central Africa Republic, Chad, 
Colombia, Democratic Republic of Congo, Djibouti, Ethiopia, Haiti, 
Kenya, Nepal, Niger, Pakistan, Rwanda, Somalia, Sri Lanka, Sudan, 
Tanzania, Uganda, and Zimbabwe. Eight countries received emergency 
food aid for 2-3 years: Algeria, Congo, Ecuador, Guatemala, 
Madagascar, the Philippines, Tajikistan, and Yemen. One country (Laos) 
received emergency food aid for 1 year. 

[35] For the purposes of this report, we use WFP's definition of 
protracted operations--emergencies that receive food aid for more than 
24 months--and USAID's definition of prolonged emergencies--emergency 
programs that extend beyond a single year. 

[36] Pellagra is a severe deficiency of vitamin B3 and can cause 
diarrhea, skin inflammation, and dementia. Beriberi is a severe 
deficiency in vitamin B1 and can cause pain and weakness in the legs 
and arms, nerve damage, edema (fluid under the skin), and irregular 
heart rate. Scurvy is a severe deficiency in vitamin C and can cause 
poor wound healing, fatigue, leg pain, rash on the legs, and gum 
disease. 

[37] For example, on March 30, 2011, USDA issued a request for 
proposals for the procurement of noncommercial emergency food 
products, such as ready-to-eat meal replacements, for use in various 
international food assistance programs. 

[38] Thirty-six of the 45 programs that were covered by our survey 
reported including fortified food items in the general rations or 
providing them to high-risk groups. 

[39] For example, USAID's Food Aid Quality Review has recommended a 
number of improvements in fortified foods and programming to better 
meet the nutritional needs of recipients and minimize antinutrient 
properties. 

[40] Lipid-based nutrient supplements refer to a range of products in 
which vitamins and minerals are embedded in fat-based food products 
and are generally composed of vegetable oil, peanut paste, milk 
powder, sugar, and micronutrients. Lipids are a broad group of 
naturally occurring molecules which includes fats. Although the term 
lipid is sometimes used as a synonym for fats, fats are a subgroup of 
lipids. A minimum amount of dietary fat is necessary to facilitate 
absorption of fat-soluble vitamins (A, D, E and K). 

[41] USAID is supporting studies on lipid-based products in Guatemala, 
and a study comparing CSB++, Supplementary Plumpy®, and a soy-
fortified ready-to-use spread for treatment of moderate acute 
malnutrition in Malawi. 

[42] The cost is for a grain-based ration that includes some CSB. 

[43] According to USAID officials, the World Health Organization has 
not specified nutritional requirements for general distribution 
feeding programs. 

[44] The Sphere Handbook is a handbook published by a group of 
humanitarian organizations, such as the Red Cross, which lists 
universal minimum standards in core areas of humanitarian assistance, 
including standards in food security, nutrition, and food aid. 

[45] USAID's Food Aid Quality Review recommended that USAID reduce the 
packaging size of CSB and WSB from 25 kilogram (55 pound) sacks to 
monthly ration sizes of 6 kilograms to 10 kilograms (13.2 to 22 
pounds) in order to reduce sharing at the household level. However, 
the study noted that the capacity and cost of smaller packaging, as 
well as the impact on consumption among targeted consumers, has not 
been fully evaluated under field conditions. 

[46] U.S. agency officials said that subsequent laboratory tests 
revealed that the problem may have been caused by rancid full fat soy 
flour rather than overfortification of iron. 

[47] [hyperlink, http://www.gao.gov/products/GAO-07-560]. 

[48] According to USDA officials, the cause of diarrhea was never 
conclusively established. The fiber content determined by laboratory 
tests was slightly higher than the 2.5 percent allowed by CSB 
specifications. KCCO conducted research and was unable to establish a 
causal link between the fiber levels present and the illnesses 
experienced. 

[49] The Total Quality System Audit program involved inspecting the 
vendor's quality control system and relying on that system to assure 
the quality of the end product. 

[50] A certificate of analysis is documentation of the laboratory 
analysis of the chemical, physical, functional, and microbiological 
characteristics of a product lot. When provided, a certificate of 
analysis should guarantee that the product characteristics are as 
stated in the specification and that when appropriately sampled and 
tested for verification, equivalent analytical results are obtained 
within the range of normal statistical error. 

[51] An extensive federal regulatory system oversees the domestic food 
industry. For example, the Centers for Disease Control and Prevention 
determine whether food-borne disease outbreaks have occurred and, with 
other federal agencies, link those outbreaks to particular foods or 
vendors. Meanwhile, USDA (for meat, poultry, and processed egg 
products) and the Food and Drug Administration (FDA) (for all other 
food) have authority through the courts to seize, condemn, and destroy 
adulterated or misbranded food under their jurisdiction. Both agencies 
disseminate information about foods that are believed to present a 
danger to public health. In addition, on January 4, 2011, the FDA Food 
Safety Modernization Act gave FDA improved capacity to prevent food 
safety problems by requiring food manufacturers to abide by hazard 
analysis and risk-based preventive controls. The act also envisions a 
role for USDA and directs the Secretaries of Agriculture and Health 
and Human Services to develop a national agriculture and food defense 
strategy, and directs the Secretary of Health and Human Services to 
coordinate with the Secretary of Agriculture on targeting food 
inspection resources, among other things. 

[52] KCCO primarily uses a type of procurement approach called "sealed 
bidding" to procure food aid commodities, an approach that was 
required by regulation (7 CFR 1496) until that regulation was 
eliminated in May 2009. The Federal Acquisition Regulation governing 
sealed bidding require selection of vendors based solely on price and 
price-related factors--not on technical factors such as a vendor's 
prior performance or quality controls. 

[53] KCCO also determined at this time that elements of the Total 
Quality Systems Audit program were not compliant with the Federal 
Acquisition Regulation, specifically its prequalification requirement. 
Certificates of analysis were not in violation of the Federal 
Acquisition Regulation, and continue to be used for certain commercial 
commodities. 

[54] FGIS samples and tests wheat, corn, sorghum, soybeans, rice, 
beans, peas, lentils, and buckwheat commodities for which federal 
grading standards exist. Testing of CSB, and WSB is conducted pursuant 
to KCCO contract requirements. For flour, bulgur, cornmeal, and 
vegetable oil, KCCO still relies on certificates of analysis from 
vendors. 

[55] However, USDA officials noted that FGIS sampling and testing 
procedures do not test for potential rancidity, so CSB products that 
are already rancid at the point of manufacture may still enter the 
supply chain. 

[56] Acceptable product ranges include the specification range and the 
discount range. KCCO procures commodities that fall within the 
specification range at full price, and procures commodities that fall 
within the discount range at a discounted price. However, KCCO does 
not consider commodities that fall within discount ranges poor-
quality. For example, the specification range for fiber content in CSB 
is between 0 and 2 percent. If a CSB sample contains 2.01 to 2.5 
percent fiber, KCCO will still procure the commodity, but at a 
discounted rate. If the CSB sample contains more than 2.5 percent 
fiber, the sample falls outside both the specification and discount 
range and will not be procured. 

[57] For the remaining 0.5 percent of commodities not meeting 
specifications, KCCO negotiated with the CSB vendor over price when 
the samples showed levels of iron or vitamin A, among other nutrients, 
that fell outside the acceptable ranges. KCCO does not negotiate with 
vendors over price when its samples reveal moisture or food safety 
specifications outside the acceptable ranges. 

[58] According to one port operator we met with, the commercial 
benchmark for marine losses is 0.5 percent for containerized 
shipments. Similarly, according to the Global Humanitarian Food Aid 
Risk Assessment Summary for Fiscal Year 2008, "excessive losses" are 
losses greater than 0.5 percent for containerized shipments and 1 
percent for bulk shipments. 

[59] The four requests for proposals covered corn products, sorghum, 
vegetable oil, and wheat products. 

[60] Four different funding sources are available to support quality 
assurance activities. Funds made available to the USDA Commodity 
Credit Corporation to implement Section 11 of the Commodity Credit 
Corporation Charter Act support FGIS quality assurance activities, and 
funds made available to implement Section 4(g) of that act support 
private contractor sampling and testing. In addition, USAID could use 
Food for Peace funds to pay for sampling and testing, or the vendor 
could pay for sampling and testing through higher commodity prices. 
However, U.S. agency officials have noted that the two latter options 
would result in fewer beneficiaries being fed. 

[61] Eight of the 25 missions that responded to our survey reported 
that they oversaw NGO programs, and the challenges to quality reported 
are based on their responses. 

[62] Food deterioration includes changes in perceived quality, 
nutritional value, food safety, aesthetic appeal, color, texture, and 
flavor. Factors that cause food to deteriorate include microorganisms 
such as bacteria, yeast, and molds; infestations by insects, 
parasites, and rodents; inappropriate temperatures during processing 
and storage; loss or gain of moisture; physical stress or abuse; and 
time, among others. 

[63] In response to the concerns of U.S. food aid providers regarding 
the sanitation and security of agricultural commodities temporarily 
stored and handled in U.S. warehouses in preparation for transport 
overseas, on March 15, 2011, USDA issued a request for comment 
proposing to extend the United States Warehouse Act licensing program 
to port and transload facility operators that handle or store export 
food aid commodities. This voluntary program would require that 
licensees' warehouses meet basic sanitation and cleanliness 
requirements. Currently, USDA issues licenses under the U.S. 
Warehouses Act (7 U.S.C. 241-256) for agricultural products stored or 
handled for the purposes of interstate or foreign commerce. 

[64] Mycotoxins are toxic metabolites produced by certain fungi that 
can infect and proliferate on various agricultural commodities in the 
field or during storage. The occurrence of these toxins on grains, 
nuts, and other commodities susceptible to mold infestation is 
influenced by environmental factors such as temperature, humidity, and 
extent of rainfall during the preharvesting, harvesting, and 
postharvesting periods. 

[65] The mycotoxins found in the samples included Ochratoxin A, a 
fungal metabolite, and Fumonisin, a natural toxin. 

[66] USDA's FGIS tests all CSB for Aflatoxin, a metabolic product of 
mold. According to CRS officials, the samples drawn from Haiti had 
other mycotoxin levels exceeding FDA's "advisory," but not 
"actionable," levels. 

[67] [hyperlink, http://www.gao.gov/products/GAO-07-560]. 

[68] For example more than 75 percent of WFP losses were unrelated to 
commodity quality problems in 2009, according to our analysis of WFP 
data. 

[69] WFP releases an annual report summarizing losses, but it does not 
disaggregate losses by donor nation. USAID officials explained that, 
upon request, WFP has always worked with USAID to provide additional 
information on U.S. commodity losses. However, it is USAID policy not 
to regularly request additional reports from multinational 
organizations such as WFP. 

[70] On a 5-point scale ranging from "never," to "very often," three 
of eight respondents indicated that damage to tin oil cans occurred 
sometimes and one indicated that it occurred often. The other four 
respondents indicated that this problem occurred rarely or never. 

[71] Some damage during transit is normal; however, USAID does not 
have benchmarks for damage rates or systematically track data on 
damaged commodities, so it is not clear whether damage levels fall 
within acceptable ranges. 

[72] Break bulk vessels carry nonuniform items, such as bagged 
commodities, that are secured within interior holds of the ship. 

[73] Although USAID's Commodities Reference Guide states that paper 
bags should not be stacked more than 20 layers high and tin oil cans 
more than 8 layers high, we frequently saw stacks exceeding these 
limits during our fieldwork. 

[74] According to KCCO data, from fiscal years 2007 through 2009 more 
than $190,000 was spent on reconstitution at the foreign country 
discharge port, excluding shipments to WFP. Reconstitution costs are 
not tracked after commodities depart the discharge port. 

[75] The "bliss box" is a cardboard container designed to increase the 
amount of vegetable oil that can be shipped in a 20-foot container by 
25 percent and reduce losses during transport. 

[76] USAID Office of Food for Peace, Occasional Paper 6, Emergencies 
in Urban Settings: A Technical Review of Food-based Program Options 
(August 2008); and USAID and Food and Nutrition Technical Assistance, 
Technical Note No.12, Introducing a Simple Measure of Household Hunger 
for Cross-Cultural Use (February 2011). 

[End of section] 

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