1. 1 Better Nutrition and Quality Control Can Further Improve U.S. Food Aid For the full report, visit the GAO Web site, www.gao.gov (GAO-11-491, May 12, 2011).www.gao.gov International Food Aid and Development Conference Kansas City, Missouri June 27-29, 2011

2. 2 Objectives meet the nutritional needs of intended recipients, and maintain the quality of commodities throughout the food aid supply chain. Assess efforts of U.S. food aid programs to

3. 3 Background: Illustrative Example of the U.S. Food Aid Supply Chain Source: GAO

4. 4 Objective 1: U.S. Food Aid for Short-Term Emergencies May Not Be Adequate for Protracted Crises U.S. food aid for general distribution provides essential life- saving calories and nutrients However, it is not always adequate during protracted crises When food is not nutritionally varied, recipients can develop serious micronutrient deficiencies, especially during prolonged emergencies Source: GAO presentation of USAID data.

5. 5 Objective 1: Ne w Products Are Specially Formulated to Meet the Nutritional Needs of the Most Vulnerable Groups, but These Products Are Costly Trade-offs between the costs of more nutritious products and the number of people served within a fixed program budget. Type of productProductCost of product per daily ration or dose Grain-based representative rations Representative complementary ration $0.019 and $0.05 CSB-based rations CSB0.06–0.12 CSB+0.08–0.16 CSB++0.24 Micronutrient powders Micronutrient powder—15 vitamins and minerals 0.03 MixMe Plus™0.04 Nutritional supplementsNutributter®0.11 Ready-to-use supplementary foods High energy biscuits0.12 RUFC India0.13 Plumpy’Doz®0.20 Supplementary’ Plumpy®0.33 Ready-to-use therapeutic food (RUTF) Plumpy’Nut®0.41

6. 66 Insufficient tracking of nutritional outcomes, Inconsistent use of needs assessments, and Sharing practices. Recipients Sharing CSB in Ethiopia Source: GAO. Objective 1: U.S. Agencies and Implementing Partners Face Difficulties in Targeting Specialized Food Products to Intended Recipients

7. 7 Objective 2: Quality of U.S. Food Aid Has Improved Due in Part to USDA’s Renewed Quality Assurance Activities 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

8. 8 Objective 2: Quality Problems Still Occasionally Arise and Can Be Time-Consuming and Costly to Resolve Bitter CSB Rodent infestation CSB contamination Source: GAO.

9. 9 U.S. agencies do not systematically track key quality indicators throughout the supply chain Quality problems that do not result in a loss (e.g., high moisture content or low vitamin fortification levels) Shipping and delivery times Objective 2: U.S. Agencies Do Not Systematically Track Data on Quality Source: GAO.

10. 10 Objective 2: Food Packaging May Not Be Sufficiently Durable for Rugged Conditions Encountered throughout the Supply Chain Source: GAO. Packaging remains one of the biggest quality problems Performance language for packaging durability has not been updated in 10 years Reconstituting damaged packaging may introduce quality problems

11. 11 (1) For food aid that is the sole source of diet for recipients of emergency programs that extend beyond a year, provide 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 products’ performance and cost-effectiveness in achieving their nutritional goals in an appropriate program setting (3) Provide guidance on whether and how best to use new specialized food products, including guidance on targeting strategies to ensure that the products reach their intended recipients Recommendations: Nutrition

12. 12 (1) Strengthen agencies’ monitoring of commodity quality by identifying and systematically tracking key quality indicators to determine the full extent of quality problems, including emerging concerns, throughout the supply chain (2) Evaluate packaging specifications to ensure food packaging is sufficiently durable for conditions encountered throughout the supply chain Recommendations: Quality Control USAID and USDA concurred with our recommendations