INTERNATIONAL 

FOOD ASSISTANCE

Improved Targeting 

Would Help Enable 

USAID to Reach 

Vulnerable Groups

Report to the Committee on Foreign 

Affairs, House of Representatives

September 2012

GAO-12-862

United States Government Accountability Office

GAO
United States Government Accountability Office

Highlights of GAO-12-862, a report to the 

Committee on Foreign Affairs, House of 

Representatives

September 2012

INTERNATIONAL FOOD ASSISTANCE 

Improved Targeting Would Help Enable USAID to 

Reach Vulnerable Groups

Why GAO Did This Study

In fiscal year 2011, USAID spent 

approximately $1.7 billion on food 

assistance reaching over 46 million 

people in 48 countries. USAID targets 

food assistance so that benefits accrue 

selectively to only a portion of the 

overall population, typically the most 

vulnerable. Effective targeting is 

important to maximize the impact of 

limited resources, especially as USAID

begins to use more nutritious but more 

costly specialized food products to 

address hunger and malnutrition 

among vulnerable groups. GAO was 

asked to (1) describe in-country factors 

that USAID and its implementing 

partners face in targeting vulnerable 

groups, and (2) examine the extent to 

which USAID’s targeting process 

supports effective targeting. GAO 

analyzed program data and 

documents; interviewed relevant 

officials; convened a roundtable of food 

assistance experts and practitioners; 

and conducted fieldwork in Ethiopia, 

Guatemala, Sri Lanka, and Zimbabwe. 

What GAO Recommends

GAO recommends that the 

Administrator of USAID improve 

USAID’s targeting of specialized food 

products to vulnerable groups by (1) 

issuing, as appropriate, improved 

interim guidance to assist 

implementing partners in deciding 

whether and how to target specialized 

food products; and (2) establishing and 

reporting program-specific indicators 

related to targeted vulnerable groups, 

to assess effectiveness in reaching 

such groups. USAID agreed with the

recommendations and provided 

examples of recent efforts to address 

them. 

What GAO Found

In-country, the U.S. Agency for International Development (USAID) and its 

implementing partners face a range of factors that, to varying degrees, affect 

their ability to target food assistance effectively to vulnerable groups. These 

factors include (1) the quality of data used to identify and reach recipients, (2) 

host government policies, and (3) sharing of rations among recipients and 

community members. Targeting effectiveness is reduced when data quality is 

poor, host government policies cause distortions in program design and 

implementation, and sharing prevents food rations from being consumed by the 

intended recipients in the intended amounts. USAID and its implementing 

partners try to mitigate such challenges by, for example, employing technology to 

improve data quality, coordinating closely with government officials to foster 

better relationships, and educating recipients about proper food usage to reduce 

sharing. In some cases, host governments have facilitated targeting efforts by, 

for example, establishing national targeting guidelines that set a common 

standard, or national statistical offices that assist in collecting data. Nevertheless, 

ensuring that food assistance reaches intended recipients remains difficult.

Weaknesses in the design, monitoring, and evaluation phases of USAID’s 

targeting process hinder targeting effectiveness, although the agency is taking 

actions to make improvements. In the design phase of the targeting process, 

USAID does not provide sufficient guidance on whether and how to target 

specialized food products. Specifically, USAID’s guidance on design currently is 

neither up-to-date nor complete, and does not adequately address key benefits 

and risks that inform decisions on whether and how to target specialized food 

products. In USAID’s monitoring and evaluation phases, weaknesses limit 

targeting effectiveness and hinder decision making. USAID currently does not 

require monitoring of key indicators needed to determine the level of targeting 

effectiveness. For example, during implementation USAID does not monitor 

actual recipients in its emergency programs. Furthermore, its evaluations do not 

systematically address targeting effectiveness. Without adequate guidance, 

monitoring, and evaluations, USAID cannot ensure targeting effectiveness in its 

food assistance programs. USAID is taking some steps to improve both guidance 

and monitoring. For example, USAID is updating guidance and plans to track 

indicators such as detailed age breakdowns that are key to better understanding

targeting effectiveness. However, these steps do not fully address the

weaknesses in USAID’s targeting process.

Weaknesses in the Targeting Process Targeting Effectiveness Unknown 

View GAO-12-862. For more information, 

contact Thomas Melito at (202) 512-9601 or

melitot@gao.gov. 
Page i GAO-12-862 International Food Assistance

Letter 1 

Background 4

Various In-Country Factors Affect USAID and Implementing 

Partners’ Ability to Target Food Assistance Effectively to 

Vulnerable Groups 13

Weaknesses in the Design, Monitoring, and Evaluation Phases of 

USAID’s Targeting Process Hinder Targeting Effectiveness, 

Although Some Improvements Are Under Way 20

Conclusions 30

Recommendations for Executive Action 30

Agency Comments and Our Evaluation 31

Appendix I Objectives, Scope, and Methodology 33

Appendix II Organizations That Participated in GAO Roundtable 36

Appendix III Cost Differences between Traditional Food Products and Specialized 

Food Products 37

Appendix IV USAID New Specialized Food Products Pending Introduction 40

Appendix V Comments from the U.S. Agency for International Development 41

Appendix VI GAO Contact and Staff Acknowledgments 45

Related GAO Products 46

Contents
Page ii GAO-12-862 International Food Assistance

Tables

Table 1: Illustrative Examples of Cost Per Ration of Different 

Types of Food Products, for Children 6 Months to 2 Years 

of Age, Based on 2012 Prices 10

Table 2: New Specialized Food Products Purchased with USAID 

Funding, Fiscal Years 2010 to 2012 22

Table 3: Relative Costs of Traditional and Selected Specialized 

Food Products (in U.S. dollars) 37

Table 4: Number of Days Grain-Based or Corn Soy Blend Ration 

Could Be Provided for the Cost of Providing Selected New 

Specialized Food Products 38

Figures

Figure 1: Prevalence of Stunting as an Indicator of Hunger and 

Malnutrition among the Countries That Received Title IIFunded Emergency Assistance in Fiscal Year 2011 7

Figure 2: Commodity Value of USAID Title II Emergency Program 

by Product, Fiscal Year 2011 9

Figure 3: Overview of the Food Assistance Targeting Process 12

Figure 4: Targeting Effectiveness Is Measured by the Magnitude of 

Targeting Error 27
Page iii GAO-12-862 International Food Assistance

Abbreviations

APS Annual Program Statement

CSB corn soy blend

CSB+ corn soy blend plus

CSB++ corn soy blend plus plus

FANTA Food and Nutrition Technical Assistance

FAO Food and Agriculture Organization

FAQR Food Aid Quality Review

FFP Office of Food for Peace

IFRP International Food Relief Partnership

LNS lipid nutritional supplement

MFFAPP Micronutrient-Fortified Food Aid Products Pilot

NGO nongovernmental organization

RUSF ready-to-use supplementary food

RUTF ready-to-use therapeutic food

SUN Scaling-Up Nutrition

UN United Nations

UNDSS United Nations Department of Safety and Security

UNICEF United Nations Children’s Fund

USAID U.S. Agency for International Development

USDA U.S. Department of Agriculture

WFP United Nations World Food Program

WSB wheat soy blend

This is a work of the U.S. government and is not subject to copyright protection in the 

United States. The published product may be reproduced and distributed in its entirety 

without further permission from GAO. However, because this work may contain 

copyrighted images or other material, permission from the copyright holder may be 

necessary if you wish to reproduce this material separately.
Page 1 GAO-12-862 International Food Assistance

United States Government Accountability Office

Washington, DC 20548

September 24, 2012

The Honorable Ileana Ros-Lehtinen

Chairman

The Honorable Howard L. Berman

Ranking Member

Committee on Foreign Affairs

House of Representatives

As the largest international food assistance donor, providing about half of 

global food assistance, the United States plays an important role in 

addressing hunger and malnutrition among vulnerable groups around the 

world.1 Nearly 1 billion people suffer from undernourishment, which 

contributes to more than one-third of child deaths globally, according to 

United Nations (UN) sources.2 In fiscal year 2011, with funding authorized 

under the Food for Peace Act,3 the U.S. Agency for International 

Development (USAID) reported that it spent approximately $1.7 billion on 

food assistance that reached over 46 million people in 48 countries.4

 

1

Vulnerable groups may include pregnant and lactating women; children under 2; and 

individuals who are elderly, handicapped, or afflicted with chronic diseases such as 

HIV/AIDS. 

Of 

this total, USAID spent approximately $1.2 billion on emergency 

programs to help alleviate hunger and malnutrition in countries affected 

2

United Nations (UN) Food and Agriculture Organization (FAO), The State of Food 

Insecurity in the World (Rome, Italy: 2010); and UN Children’s Fund (UNICEF), Tracking 

Progress on Child and Maternal Nutrition: A Survival and Development Priority (New York, 

NY: 2009).

3

Section 3001 of Pub. L. No. 110-246, the Food, Conservation, and Energy Act of 2008, 

changed the title of the underlying legislation from the Agricultural Trade Development 

Assistance Act of 1954, also known as P.L. 480, to the Food for Peace Act. Title II of the 

Food for Peace Act, administered by USAID, addresses donation of agricultural 

commodities for humanitarian purposes. Other U.S. food assistance programs are 

administered through the U.S. Department of Agriculture, including Food for Peace Title I, 

Food for Progress, and the McGovern-Dole International Food for Education and Child 

Nutrition programs. In this report, we refer to the Food for Peace Act as Title II.

4

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

 
 

Page 2 GAO-12-862 International Food Assistance

by natural or man-made disasters, such as drought or conflict.5 USAID 

programs provide three types of food assistance products: (1) traditional 

food products, such as wheat, corn, and sorghum; (2) traditional 

specialized food products, such as corn soy blend (CSB), a nutritionally 

enhanced commodity; and (3) new specialized food products, such as 

ready-to-use supplementary or therapeutic foods.6

USAID’s goal is to focus its food assistance efforts on the reduction of 

hunger and malnutrition in vulnerable groups through targeting. As 

defined by USAID, targeting is any method by which an intervention is 

designed or implemented so that benefits can accrue selectively to only a 

portion of the overall population. Targeting may be categorized by 

geographic area or eligibility criteria, which are usually defined by 

recipients’ characteristics, such as age, gender, income level, asset level, 

or nutritional status. For the purposes of this report, we define the 

effectiveness of targeting as the degree to which USAID and its 

implementing partners are able to (1) accurately assess needs and 

identify recipients using appropriate eligibility criteria, and (2) ensure that 

the food assistance provided reaches and is consumed by the targeted 

Both traditional and 

new specialized food products are intended for vulnerable groups.

 

5

USAID spent approximately $426 million on development programs and the remainder 

on other related efforts. USAID previously referred to these development programs as 

nonemergency programs. Development programs typically include a range of objectives, 

such as agricultural development, health and nutrition, or community development. 

Emergency programs may have some of these same objectives, but as noted above they 

are generally focused on alleviating hunger and malnutrition in countries affected by 

disaster. In this report, we focus on both Title II emergency and development in-kind food 

assistance programs, particularly those that have nutritional goals and include the use of 

specialized food products. We do not focus on other types of food assistance program 

activities, such as food-for-work or food-for-assets.

6

For the purposes of this report, we use the following terms in reference to food products: 

(1) traditional food products, which include grain, pulses (dried beans, peas, and lentils), 

and vegetable oil; (2) traditional specialized food products, which include fortified and 

blended food, such as corn soy blend (CSB) and wheat soy blend (WSB); and (3) new 

specialized food products, which include reformulated fortified and blended food, such as 

Supercereal and Supercereal+; ready-to-use supplementary food (RUSF), such as 

Nutributter and Plumpy’Doz; ready-to-use therapeutic food (RUTF), such as Plumpy’Nut; 

and ready-to-use emergency rations, such as A-20. Traditional and new specialized food 

products are collectively referred to as specialized food products. Not all of the products 

defined in each food product category are currently used in Title II-funded food assistance 

programs.
 

Page 3 GAO-12-862 International Food Assistance

recipients as defined by the eligibility criteria.7 While targeting may never 

be perfect, targeting error indicators can be used to assess effectiveness. 

These indicators include the percentage of intended recipients that did 

not receive food assistance or the percentage of people who were not 

eligible for assistance but still received it.8

Effective targeting is important, particularly in the context of constrained 

resources, continuing humanitarian and food emergencies, and 

increasing focus on addressing malnutrition in vulnerable populations. 

USAID’s food assistance budget has declined from approximately $2.3 

billion in appropriations in fiscal year 2009 to less than $2 billion in fiscal 

year 2011. The demand for international food assistance remains high as 

the threat of drought and famine persists in the Horn of Africa and other 

regions. Moreover, USAID has begun to introduce, for limited use, some 

new but more costly specialized food products designed to improve 

nutritional outcomes for vulnerable groups, such as children under 2 

years of age. However, as we previously reported, providing food that is 

more nutritious but also more costly, within a fixed budget, would result in 

fewer recipients fed.9

As part of our work on international food assistance,10

 

7

For the purposes of this report, we use the term “implementing partners” to refer to the 

UN World Food Program (WFP) and nongovernmental organizations (NGOs) that are 

awarded U.S. government grants to carry out food assistance programs. 

you asked us to (1) 

describe in-country factors that USAID and its implementing partners face 

in targeting vulnerable groups, and (2) examine the extent to which 

USAID’s targeting process supports effective targeting.

8

These indicators are known as exclusion errors, which occur when people who are 

eligible for assistance do not receive it, and inclusion errors, which occur when people 

who are not eligible for assistance receive it. Together, these two measures can be 

referred to as targeting errors.

9

GAO, International Food Assistance: Better Nutrition and Quality Control Can Further 

Improve U.S. Food Aid, GAO-11-491 (Washington, D.C.: May 12, 2011).

10Our current work on international food assistance includes a recently issued report, 

GAO, World Food Program: Stronger Controls Needed in High-Risk Areas, GAO-12-790

(Washington, D.C.: Sept. 13, 2012). In addition, we are conducting a review of the Feed 

the Future initiative, the U.S. governmentwide strategy to address global hunger and food 

security. The strategy was developed pursuant to a U.S. pledge made at the G-8 Summit 

in L’Aquila, Italy, to provide at least $3.5 billion for agricultural development and global 

food security over 3 years.
 

Page 4 GAO-12-862 International Food Assistance

To address these objectives, we met with officials from USAID and its 

implementing partners, including the UN World Food Program (WFP) and 

nongovernmental organizations (NGO). We also met with academics, 

experts, and practitioners associated with research institutes and 

universities, as well as officials from the U.S. Departments of Agriculture 

(USDA) and State (State). In addition, we reviewed USAID’s targeting 

framework, including guidance, related to the food assistance targeting 

process. We analyzed data from USAID and WFP to identify trends in 

food assistance funding, the use of specialized food products, and the 

costs of these products as compared with traditional food products. 

Furthermore, we conducted fieldwork in four countries—Ethiopia, 

Guatemala, Sri Lanka, and Zimbabwe—and met with officials from U.S. 

missions, implementing partners, and relevant host government agencies. 

Finally, we convened a roundtable of 10 experts and practitioners—

including representatives from academia, research organizations, and 

implementing partners such as WFP and NGOs—to further delineate, on 

the basis of our initial work, in-country factors that affect targeting 

vulnerable groups and the process that USAID and its implementing 

partners use to target food assistance. Appendix I provides a detailed 

discussion of our objectives, scope, and methodology.

We conducted this performance audit from October 2011 to September 

2012 in accordance with generally accepted government auditing 

standards. Those standards require that we plan and perform the audit to 

obtain sufficient, appropriate evidence to provide a reasonable basis for 

our findings and conclusions based on our audit objectives. We believe 

that the evidence obtained provides a reasonable basis for our findings 

and conclusions based on our audit objectives.

Combating world hunger and malnutrition is a stated objective of the Food 

for Peace Act, which authorizes international food assistance for 

developing countries. The United States has also stated its commitment 

to the Millennium Development Goal to halve world hunger by 2015, and 

it supports the Scaling-Up Nutrition (SUN) movement to provide 

assistance to country-led efforts to address maternal and child 

Background 

The United States Has 

Stated Its Commitment to 

Combating World Hunger 

and Malnutrition
 

Page 5 GAO-12-862 International Food Assistance

malnutrition.11

In fiscal year 2011, USAID provided about $1.2 billion in Title II 

emergency funding to deliver about 1 million metric tons of food to 33 

countries, as shown in figure 1. Approximately 74 percent of the food 

commodities were delivered to 14 countries that received U.S. emergency 

food assistance every year from fiscal years 2006 through 2011.

To support SUN, the United States and others initiated the 

1,000 Days public-private partnership, which aims to improve nutrition for 

pregnant and lactating mothers and children under 2. Adequate nutrition 

in this critical period in a child’s life is widely recognized to have the 

greatest impact on saving lives, developing a child’s cognitive and 

physical capacity, and mitigating the risk of chronic disease. According to 

the USAID Policy Framework 2011-2015, USAID plans to ensure that the 

quality of U.S. government food aid is improved within 3 years to meet the 

nutritional requirements of vulnerable populations overseas, including by 

developing new blended products and formulations to support pregnant 

and lactating mothers and children under 2.

12 Ten 

countries—eight of them in Africa—accounted for about 83 percent of 

Title II emergency funding.13

 

11SUN promotes the implementation of nutrition interventions, proliferation of successful 

practices, and integration of nutrition goals into sectors such as public health, social 

protection, and agricultural development. The SUN movement currently comprises 27 

member countries, as well as civil society groups, donors, businesses, and international 

organizations.

Seven of these 10 countries consistently 

received Title II emergency food assistance in the last 6 years. Also, 

among these 10 countries, the prevalence of stunting, a standard 

indicator for undernourishment in children under 5, ranged from 32 to 59 

12We previously reported that, although Title II emergency funding is intended to address 

short-term food needs, more than half of the funding in fiscal year 2010 was spent on 

multiyear emergency programs. See GAO-11-491. In 2011, the 14 countries that received 

U.S. emergency food assistance every year from fiscal years 2006 through 2011 were 

Afghanistan, Burundi, Central African Republic, Chad, Colombia, Democratic Republic of 

the Congo, Ethiopia, Kenya, Nepal, Rwanda, Somalia, Sudan, Tanzania, and Uganda. In 

addition, 23 percent of the emergency food commodities were delivered to 15 countries 

that received U.S. food assistance for 3 to 5 years from fiscal years 2006 through 2011. 

Three percent was delivered to four countries that received emergency U.S. food aid for 1 

to 2 years.

13The 10 countries were Afghanistan, Chad, Democratic Republic of the Congo, Ethiopia, 

Kenya, Pakistan, Somalia, South Sudan, Sudan, and Zimbabwe.
 

Page 6 GAO-12-862 International Food Assistance

percent.14 Ethiopia, one of the four countries we visited, received about 

$207 million, which accounted for about 17 percent of total Title II 

emergency funding. A higher percentage of the total population in 

Ethiopia suffers from malnutrition than in most other recipient countries, 

with 51 percent of children under 5 suffering from stunting.

 

14As defined by UNICEF, undernourishment includes stunting (being too short for one’s 

age), a key indicator of hunger and malnutrition. USAID uses wasting as an indicator of 

acute malnutrition in Title II emergency and development programs and stunting as an 

indicator of chronic malnutrition in Title II development programs.
 

Page 7 GAO-12-862 International Food Assistance

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

a

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

Page 8 GAO-12-862 International Food Assistance

b

South Sudan became independent from Sudan in 2011 and first received Title II-funded emergency 

assistance in fiscal year 2011. Stunting data reported include both Sudan and South Sudan.

c

The percentage of stunting among children under 5 is based on World Health Organization data for 

2006-2010, as reported by UNICEF. 

d

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

e

Countries receiving Title II-funded emergency assistance from fiscal years 2006 through 2011, 

according to annual U.S. International Food Assistance Reports issued by USAID and USDA for 2006 

through 2011.

f

Title II emergency food aid tonnage and funding levels for fiscal year 2011 are preliminary based on 

the U.S. International Food Assistance Report (draft) for 2011, to be issued by USAID and USDA.

USAID uses traditional food products, such as grain, pulses, and 

vegetable oil, for the vast majority of its food assistance programs, but 

specialized food products are increasingly being used. For more than 40 

years, USAID has been using fortified blended foods, such as CSB or 

WSB, as the primary food product to provide enhanced nutrition during 

emergencies. Figure 2 provides a breakdown of USAID Title II emergency 

program commodity value by product in fiscal year 2011, with traditional 

specialized food products accounting for 8 percent. Since fiscal year 

2010, USAID has been purchasing small quantities of new specialized 

food products such as ready-to-use emergency rations, making a limited 

supply available in two of its prepositioning sites where food commodities 

are stocked for shipment as necessary.15

 

15In addition, USDA’s Foreign Agriculture Service has a Micronutrient-Fortified Food Aid 

Products Pilot (MFFAPP) that received $10 million in fiscal year 2010 to support the 

development and field testing of new ready-to-use foods, fortified blended foods, highenergy foods, and micronutrient powders to address the micronutrient deficiencies of a 

population or group. The first MFFAPP project was under way in fiscal year 2011, with 

additional pilot projects continuing in fiscal year 2012.

Traditional Food Products 

Account for the Vast 

Majority of Food 

Assistance, with the Use of 

Specialized Food Products 

Increasing
 

Page 9 GAO-12-862 International Food Assistance

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

Year 2011

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

products include CSB and WSB.

In recent years, nutritionists have argued that traditional specialized food 

products may not be appropriate for children under 2 to obtain sufficient 

nutrients.16 As a result, USAID and WFP have introduced new specialized 

food products, including enhanced versions of some of their traditional 

specialized food products, such as CSB+ or Supercereal+, to better meet 

the nutritional needs of vulnerable groups. Recently, USAID also has 

introduced a range of ready-to-use products, which are designed for 

recipients affected by emergencies such as natural disasters or 

conflicts.17

 

16

WFP is the largest provider of global food aid and 

implementing partner of USAID, accounting for 90 percent of U.S. 

emergency food assistance funding. WFP has increased the share of 

specialized food products in its procurement by 10 percentage points 

across a period of 2 years, reaching over 25 percent in its 2011 

GAO-11-491. 

17According to USAID officials, these ready-to-use products also include products that are 

aimed at reducing malnutrition, which can occur even outside of emergencies.
 

Page 10 GAO-12-862 International Food Assistance

procurement. The countries that received the largest amounts of 

specialized food products from WFP were Ethiopia, Pakistan, Kenya, 

Niger, and Somalia.

Specialized food products are designed to meet specific nutritional needs 

of vulnerable groups but are more costly than traditional food products. 

As a result, within a fixed budget, USAID and its implementing partners 

must decide whether to provide more nutritious but more costly food to 

fewer people, or less nutritious and less costly food to more people. In 

other words, they face a quality-quantity trade-off.18

Table 1: Illustrative Examples of Cost Per Ration of Different Types of Food 

Products, for Children 6 Months to 2 Years of Age, Based on 2012 Prices

Table 1 provides 

illustrative examples of cost per ration for the three different types of food 

assistance. See appendix III for a more detailed comparison of cost 

differences between traditional food products and specialized food 

products.

Type of food product Example of product a Cost per daily ration 

or dose

Traditional food product Grain $0.02-$0.06

Traditional specialized food product CSB $0.09-$0.18

New specialized food product Ready-to-use 

therapeutic food (RUTF)

$0.42-$0.46

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

a

The products listed in this table are used for different purposes. This table does not assess which 

products are more effective. We note that USAID does not provide RUTF as part of a general food

distribution ration.

Targeting in food assistance programs is an iterative process that aims to 

ensure that food reaches and is consumed by people whose 

characteristics meet certain eligibility criteria, such as age, gender, 

income level, asset level, or nutritional status. Figure 3 presents a 

simplified schematic of the overall targeting process and its key phases—

design, implementation and monitoring, and evaluation—and steps within 

 

18For the purposes of this report, we define the “quality” of a given food product as the 

degree to which it meets specific nutritional needs of vulnerable groups, not the degree to 

which it adheres to specifications designed to ensure that it is safe for consumption, which 

all USAID food products must meet at a minimum. 

Targeting Is an Iterative 

Process
 

Page 11 GAO-12-862 International Food Assistance

each phase. As key stakeholders in the targeting process, USAID and its 

implementing partners, including WFP and NGOs, play an important role, 

as do host governments. In the design phase, implementing partners 

design food assistance programs and submit proposals to USAID. USAID 

reviews the proposals and decides whether to fund the programs.19

 

19According to USAID and WFP officials, this process functions differently for WFP 

programs. After WFP submits its program design documents, USAID decides whether to 

fund the program in part or in its entirety. 

Feedback occurs within and across each of the phases—both in host 

countries and at USAID headquarters—and is crucial to maximizing 

targeting effectiveness, leading to steps within the process that may not 

be strictly sequential. For example, during the design phase, USAID and 

its implementing partners may conduct an assessment of needs to 

determine the basis for the design of a program; however, as needs may 

change or be clarified, they may retarget or make adjustments during the 

monitoring phase to address issues that may arise.
 

Page 12 GAO-12-862 International Food Assistance

Figure 3: Overview of the Food Assistance Targeting Process

a

This figure illustrates a generalized targeting process for both Title II emergency and development inkind food assistance programs, particularly those that directly distribute specialized food products to 

achieve nutritional goals. It does not necessarily reflect other types of development food assistance 

programs, such as those that do not directly distribute food or have any nutritional goals.
 

Page 13 GAO-12-862 International Food Assistance

USAID and its implementing partners face a range of in-country factors 

that, to varying degrees, affect their ability to effectively target food 

assistance to vulnerable groups. These factors include (1) the quality of 

data used to identify and reach recipients, (2) host government policies, 

and (3) sharing of rations among recipients and community members. 

Targeting effectiveness is reduced when data quality is poor, host 

government policies cause distortions in program design and 

implementation, and sharing prevents food rations from being consumed 

by the intended recipients in the intended amounts. USAID and its 

implementing partners take steps to mitigate such challenges by, for 

example, employing technology to improve data quality, coordinating 

closely with government officials to foster better relationships, and 

educating recipients about proper food usage to reduce sharing. In some 

cases, host governments have facilitated targeting efforts by, for example, 

establishing national targeting guidelines that set a common standard, or 

national statistical offices that assist in collecting data. Nevertheless, 

ensuring that food assistance reaches intended recipients remains 

difficult.20

Poor data quality—lack of timely and accurate information—may affect 

implementing partners’ ability to effectively identify and reach recipients. 

For example, in Zimbabwe, USAID and three implementing partners 

noted that a lack of current and reliable population data made it difficult to 

determine the overall number and geographic distribution of households 

that are in need of food assistance.21

 

20These in-country factors and mitigating measures apply to both emergency and 

development programs.

In Guatemala, an implementing 

partner told us that because it used inaccurate data on average 

21WFP reported that the last census in Zimbabwe was conducted in 2002. Since then, 

uncertainties about the volume of emigration due to economic and other reasons and the 

mortality rate due to HIV/AIDS have led some UN organizations to raise questions about 

official statistics.

Various In-Country 

Factors Affect USAID 

and Implementing 

Partners’ Ability to 

Target Food 

Assistance Effectively 

to Vulnerable Groups

Poor Data Quality May 

Hinder Implementing 

Partners’ Ability to Identify 

and Reach Intended 

Recipients 

Lack of Reliable Population 

and Household Data May 

Hinder Targeting Effectiveness 
 

Page 14 GAO-12-862 International Food Assistance

household size to determine the initial ration size, people who were 

initially identified received more food than they would have received if the 

data had been accurate. Although the error was later corrected, if the 

data had been accurate, resources could have been used more optimally 

to reach people in need.

USAID and implementing partners we spoke with stated that sudden 

natural disasters or conflicts could raise security concerns for 

implementing partners, hindering their ability to reach the originally 

targeted recipients. Furthermore, gathering reliable data on transient 

populations is challenging. For example, USAID and an implementing 

partner in Ethiopia told us that in some areas of the country, it is difficult 

to determine the number and location of people in need of food 

assistance, particularly pastoralists, who move often as a traditional way 

of life and to cope with drought or natural disasters. As a result, it is 

difficult for implementing partners to accurately assess the needs in a 

particular geographic area and design an appropriate food assistance 

program.

In addition, natural disasters or conflicts may raise security concerns, 

hindering ability to reach targeted recipients. We recently reported that 

security concerns prevented WFP from conducting field monitoring of 

food distribution to determine whether the food rations reached the 

originally targeted recipients in some high-risk areas of Ethiopia, Kenya, 

and Somalia.22

 

22See 

For example, WFP noted that it has been unable to 

access six districts in the Somali region of Ethiopia since May 2011. As a 

result, WFP’s ability to collect data to ensure that the intended recipients 

received their food assistance in these high-risk areas is limited.

GAO-12-790. In the countries where WFP operates, the United Nations Department 

of Safety and Security (UNDSS) assesses the general security environment in specific 

geographic areas using five categories of threats: armed conflict, terrorism, crime, civil 

unrest, and hazards. UNDSS rates each area at one of six security levels, with level 6 

indicating the most dangerous environment. The UN Security Management System uses 

these ratings to assess security risks to UN agencies, funds, and programs; on the basis 

of these assessments, WFP determines appropriate risk mitigation measures to protect its 

staff and operations.

Natural Disasters or Conflicts 

May Cause Population 

Movements and Raise Security 

Concerns, Hindering Ability to 

Reach Targeted Recipients 
 

Page 15 GAO-12-862 International Food Assistance

USAID and implementing partners have taken some measures to improve 

data quality by building capacity through technology, training, and other 

activities. For example, USAID funds the Famine Early Warning Systems 

Network (FEWS NET), which is used to monitor and prepare for changes 

in food assistance needs. FEWS NET monitors and analyzes vulnerability 

information, using multiple sources such as satellite imagery and field 

observations. Moreover, some countries, such as Ethiopia, have 

established national statistical offices that can assist in collecting data for 

targeting food assistance. In addition, a 2011 report on food assistance 

stated that implementing partners are working on increasing the speed, 

accuracy, accessibility, and comparability of information.23

Even with efforts to improve the data used to identify and reach 

recipients, data quality remains a challenge in targeting food assistance. 

A 2011 food assistance report points out that implementing partners often 

lack disaggregated information, such as household-level data, that would 

help them design an effective targeted food assistance program.

Implementing 

partners in two countries we visited told us that they are using mobile 

devices, such as tablets and phones, to collect recipient and distribution 

data. The use of technology enables the implementing partners to better 

identify and track recipients throughout the program and identify needs. In 

the aforementioned example about excess ration size in a Guatemala 

program, the implementing partner used tablets to collect information on 

recipient consumption patterns. In this way, the implementing partner 

ultimately discovered the ration error and corrected the ration size for 

each household, freeing up resources to reach more recipients as a 

result. Also, implementing partners in Guatemala and Sri Lanka indicated 

that they train their staff and community volunteers on data collection, and 

work with the host governments to improve the governments’ ability to 

collect data. In addition, some countries, such as Sri Lanka, have 

conducted repeated assessments of food assistance needs over several 

years, which can lead to improvements in the precision of the data 

collected.

24

 

23Christopher B. Barrett, Andrea Binder, and Julia Steets, Uniting Food Assistance: The 

Case for Transatlantic Cooperation, 1st ed. (Oxford, UK; and New York City: 2011), 55.

Similarly, implementing partners we spoke with stated that the detailed 

data necessary for effective targeting are often not available, while 

acknowledging that data quality differs across countries. An implementing 

24Barrett, et al., 67.

USAID and Its Implementing 

Partners Have Taken Some 

Measures to Address Data 

Quality Issues, but They 

Remain a Challenge 
 

Page 16 GAO-12-862 International Food Assistance

partner in Guatemala stated that data need to be improved continuously 

to measure outcomes and impacts of targeting, particularly for programs 

with a nutritional objective.

Host government policies may lead to distortions, hampering targeting 

effectiveness, but implementing partners have made some efforts to 

reduce these adverse effects. We previously reported that one of the key 

challenges to accurately assessing the needs of vulnerable groups was a 

lack of coordination among key stakeholders—especially with host 

governments—on assessments of food assistance needs.25 In addition, 

some host country governments have been criticized for underestimating 

actual needs or directing implementing partners to operate only in certain 

geographic areas, due to political or other reasons.26 As a result, 

implementing partners may not be able to reach recipients or locations 

most in need of food assistance.27

In some instances, however, host government policies may facilitate 

targeting efforts. For example, the government of Sri Lanka has worked 

closely with WFP to identify vulnerable groups and has supported efforts 

to improve both data collection and the analysis of food needs, including 

by supporting the research organization that partners with WFP in 

For example, an implementing partner 

in Ethiopia reported to USAID that the government of Ethiopia set an 

artificial quota for the number of people targeted in each household that in 

some cases did not reflect the actual needs, and severely hampered the 

partner’s ability to reach vulnerable groups as a result. However, USAID 

and implementing partner officials in Ethiopia also told us that working 

with the government’s distorted figures is less challenging now than in the 

past, due in part to recent efforts of local and regional government 

officials to improve the validity and documentation of needs assessments 

as well as better stakeholder coordination.

 

25GAO, Foreign Assistance: Various Challenges Impede the Efficiency and Effectiveness 

of U.S. Food Aid, GAO-07-560 (Washington, D.C.: Apr. 13, 2007).

26GAO-07-560; and Barrett, et al., 65.

27For example, a 2001 study found evidence that the government of Ethiopia, which plays 

an important role in deciding where food assistance programs may operate, has at times 

transferred food assistance to favored regions. T.S. Jayne, J. Strauss, T. Yamano, and D. 

Molla, “Targeting of food aid in rural Ethiopia: chronic need or inertia?” World 

Development, Vol. 29, No. 5, pp. 887-910 (2001).

Host Government Policies 

May Cause Distortions, 

Limiting Targeting 

Effectiveness
 

Page 17 GAO-12-862 International Food Assistance

conducting assessments of needs for food assistance.28 In another 

example, the government of Ethiopia has published National Targeting 

Guidelines that are intended to standardize and improve targeting 

efforts.29

To address host government policies that cause distortions, implementing 

partners undertake efforts to coordinate with stakeholders and verify 

information on food assistance needs. Implementing partners we spoke 

with told us they work with each other and with host governments in the 

initial phase of the targeting process to increase transparency, in an effort 

to encourage more accurate government estimates of actual needs. For 

example, in Ethiopia, USAID officials told us that to increase 

transparency, donors are working with the government to introduce 

software tools and technology that facilitate access to information and 

increase public awareness and thereby discourage government 

authorities from manipulating data on food assistance needs. Moreover, 

to help facilitate distribution of food assistance to intended recipients in 

Guatemala, implementing partners stated that it is essential to closely 

coordinate with government authorities at the beginning of the targeting 

process to obtain approval for the use of new products and to set up the 

appropriate distribution channels and protocol. In addition, in Sri Lanka, 

an implementing partner told us that it plans to use local organizations to 

conduct independent verification of the potential recipient list, which is 

largely selected by the government. Doing so would help the 

implementing partner ensure that only recipients who qualify for food 

assistance are included on the list, increasing the likelihood that food 

assistance reaches the intended recipients. Despite these efforts, 

implementing partners have limited ability to influence host government 

policies.

This document helps all food assistance stakeholders in the 

country operate under a commonly understood set of targeting policies 

and practices.

 

28The Hector Kobbekaduwa Agrarian Research and Training Institute (HARTI), an entity 

that is funded in part by the government of Sri Lanka, partners with WFP to conduct the 

food security assessments.

29Federal Democratic Republic of Ethiopia, Ministry of Agriculture, National Guidelines on 

Targeting Relief Food Assistance (Addis Ababa, Ethiopia: Aug. 2011). 
 

Page 18 GAO-12-862 International Food Assistance

Sharing within recipient households and among community members 

may result in food rations being consumed by unintended recipients or in 

unintended amounts, but implementing partners have taken some 

measures to reduce sharing. External assessments suggest that sharing 

of food rations is a widespread and established coping mechanism when 

insufficient food is available. The 2011 Food Aid Quality Review (FAQR) 

report30 and the 2011 WFP guidance on targeted food assistance 

programs acknowledge that sharing of specialized food products is a 

concern, and according to a 2011 USAID assessment of a food 

assistance program in the Somali region of Ethiopia, sharing of food 

rations is widespread. In addition, in countries we visited, USAID and its 

implementing partners told us that both CSB and traditional food products 

are routinely shared within and among households in some 

communities—a finding we previously reported in 2011.31

Implementing partners have made efforts to reduce the likelihood of 

sharing, especially of specialized food products. Specifically, 

implementing partners have employed various strategies to teach 

recipients how to use specialized food products and have monitored 

recipient food ration consumption. For example, one implementing 

partner in Guatemala requires pregnant or lactating women to attend 

education sessions, where they learn about the benefits of the specialized 

food products and how to properly prepare them, before they can receive 

rations. Implementing partners in Guatemala also print culturally relevant 

instructional images on the food packages or the canvas bags given to 

recipients to carry the rations. The images explain how to prepare the 

The 2011 

USAID assessment also notes that sharing is an established coping 

mechanism for the recipient community when not everyone in the 

community receives food rations. When food rations are shared, the 

intended recipients may not consume the intended food products in the 

desired amounts, which may reduce targeting effectiveness by limiting 

nutritional impact, particularly for specialized food products that are 

intended for vulnerable groups.

 

30The 2011 Food Aid Quality Review was a 2-year study conducted by Tufts University 

that recommended 35 changes to U.S. food aid products and programs to deliver 

improved nutrition. Food Aid Quality Review: Delivering Improved Nutrition: 

Recommendations for Changes to U.S. Food Aid Products and Programs (April 2011).

31Both USAID and implementing partners recognized that food rations are shared within 

and among recipient households. For example, 26 of the 30 programs we surveyed in 

2010 reported at least some sharing of CSB by recipients. See GAO-11-491. 

Sharing Reduces Targeting 

Effectiveness If Food 

Rations Are Not Consumed 

by the Intended Recipients 

in the Intended Amounts
 

Page 19 GAO-12-862 International Food Assistance

food products and depict the type of person for whom the products are 

intended—such as a pregnant woman or a child under 2 years of age. 

One of these implementing partners reported that it had seen an 

improvement in recipient participation in these education sessions and 

expected that these sessions would reduce sharing.

In addition, implementing partners use community volunteers to monitor 

effectiveness or consumption of food products. For example, in 

Guatemala, implementing partners train “mother leaders”—mothers who 

are also recipients—to provide training to other recipients on how to 

prepare food and monitor outcomes by, for example, observing 

improvement in a child’s weight or overall health appearance. In Sri 

Lanka, another implementing partner uses health volunteers from the 

recipient community and coordinates with the host government to ensure 

that specialized food products are consumed by the children through 

monthly monitoring of their nutritional status at government-run clinics 

and weighing stations. The health volunteers also follow up with the 

mothers of these children, who are receiving specialized food products, if 

they do not bring their children to the monthly checkup. While 

implementing partners have taken these and other steps to address 

sharing, evidence of the impact of these steps has yet to be determined.32

 

32GAO-11-491; Food Aid Quality Review (April 2011).
 

Page 20 GAO-12-862 International Food Assistance

Weaknesses in the design, monitoring, and evaluation phases of USAID’s 

targeting process hinder targeting effectiveness, although the agency is 

taking actions to make improvements. In the design phase of the 

targeting process, USAID does not provide sufficient guidance on 

whether and how to target specialized food products. Specifically, 

USAID’s guidance on design for both emergency and development 

programs is neither up-to-date nor complete, and does not adequately 

address key benefits and risks that inform decisions on whether to target 

specialized food products. In both USAID’s monitoring and evaluation 

phases, weaknesses limit targeting effectiveness and hinder decision 

making. USAID currently does not require monitoring of key indicators 

needed to determine the level of targeting effectiveness for either 

emergency or development programs. Furthermore, its evaluations do not 

systematically address targeting effectiveness.33 Without adequate 

guidance, monitoring, and evaluations, USAID cannot ensure targeting 

effectiveness in its food assistance programs. USAID is taking some 

steps to improve both guidance and monitoring. For example, USAID has 

a contract with Tufts University to develop updated guidance, and the 

agency is taking steps to improve monitoring by planning to track 

indicators such as detailed age breakdowns that are key to better 

understanding targeting effectiveness. However, these steps do not fully 

address the weaknesses in USAID’s targeting process.

 

33We selected 20 of USAID’s final evaluations for review. Our sample included final 

evaluations for both emergency and development programs and provided coverage of all 

years going back to 2009 and all geographic regions to which USAID provides food 

assistance. For the purposes of this report, we refer to these final evaluations as 

evaluations.

Weaknesses in the 

Design, Monitoring, 

and Evaluation 

Phases of USAID’s 

Targeting Process 

Hinder Targeting 

Effectiveness, 

Although Some 

Improvements Are 

Under Way

USAID Does Not Provide 

Sufficient Guidance in the 

Design Phase on Whether 

and How to Target 

Specialized Food Products, 

Although the Agency Is 

Starting to Make 

Improvements
 

Page 21 GAO-12-862 International Food Assistance

We found that USAID’s guidance for targeting is neither up-to-date nor 

complete for both emergency and development programs, which reduces 

the ability of implementing partners to make informed decisions in the 

design phase. USAID currently provides its implementing partners with a 

range of guidance and tools. Of these, the Commodities Reference 

Guide34 is USAID’s official standard reference for food assistance 

programs and is intended to be used by USAID and implementing partner 

staff in deciding how to plan, manage, control, evaluate, and use Title IIfunded food products. It is available on USAID’s public website and 

provides information on available food products, including nutritional 

values, physical properties, and storage and handling guidelines.35

We found that the lack of updated and complete guidance has hindered 

implementing partners’ ability to make better-informed targeting 

decisions. One participant at our roundtable, for example, told us that his 

organization was unable to find all of the products it was using for a 

program in the outdated Commodities Reference Guide. As a result, it 

was not able to use these products in its program. Furthermore, USAID 

has recently deployed some limited quantities of various new specialized 

products without providing official standard guidance on how to use them. 

We recommended in 2011 that USAID provide clear guidance on whether 

and how best to use new specialized food products, including guidance to 

its implementing partners on targeting strategies to ensure that the 

products reach their intended recipients.

However, USAID has not updated the Commodities Reference Guide 

since 2006 and has not included guidance in the Commodities Reference 

Guide on all of the products currently used in USAID food assistance 

programs. The 2011 Food Aid Quality Review also noted that the 

Commodities Reference Guide and other USAID guidance relevant to 

targeting are neither up-to-date nor complete and recommended, for 

example, that USAID improve its guidance to enable implementing 

partners to better determine whether to use certain products for 

programs.

36

 

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

USAID concurred with our 

35USAID also provides other forms of guidance to its implementing partners, including a 

commodities price calculator, which is used to estimate the cost of food aid commodities. 

According to USAID officials, the calculator is updated quarterly and available on USAID’s 

public website.

36GAO-11-491. 

USAID’s Guidance for 

Targeting Is Neither Up-to-Date 

Nor Complete, Hindering 

Decision Making
 

Page 22 GAO-12-862 International Food Assistance

recommendation and is taking steps to develop new guidance, but has 

deployed new specialized food products in the interim. USAID has 

purchased relatively small quantities of new specialized food products 

over the past 2 years, including those shown in table 2 below. For 

example, USAID purchased just over $6.5 million worth of these products 

in 2011, as compared with $502 million of traditional food products and 

$42 million of traditional specialized food products purchased through 

Title II emergency program funding.

Table 2: New Specialized Food Products Purchased with USAID Funding, Fiscal 

Years 2010 to 2012

Fiscal 

year

a

Total cost of 

purchase Product type

Cost of 

purchase

Metric 

tons

2010 $1,965,484 Lipid nutritional supplement $1,965,484 b 302

2011 $6,565,820 Lipid nutritional supplement $1,998,920 b 315

Ready-to-use therapeutic food 

(RUTF)

$4,566,900 990

2012 $5,693,940 Ready-to-eat meal 

replacements

$660,000 110

Ready-to-eat meal 

replacements

$715,000 110

Ready-to-eat meal 

replacements

$649,000 110

Ready-to-use therapeutic food 

(RUTF)

$2,065,200 500

CSB+ $819,040 1,000 

CSB+ $64,800 80

CSB+ $720,900 890

Total $14,225,244 $14,225,244 4,407

Source: GAO analysis of USAID documents.

a

As of August 22, 2012.

b

In addition, USAID is planning to introduce nine new or reformulated 

products in the final part of 2012 and 2013, including new RUTFs and 

ready-to-use supplementary foods (RUSFs) (see app. IV). USAID has not 

issued fully updated or complete guidance for all of these products. 

However, it has issued some guidance on their use. Moreover, USAID 

officials told us that they are providing the products only on a limited basis 

These purchases were made with funding available through USAID’s International Food Relief 

Partnership. This program enables USAID to award grant agreements to U.S. NGOs to produce and 

stockpile shelf-stable, prepacked commodities for use in emergency food assistance programs.
 

Page 23 GAO-12-862 International Food Assistance

to organizations such as UNICEF that have experience using them in 

controlled environments, such as clinics, and have issued their own 

guidance on the use of these products.

USAID guidance inadequately addresses key benefits and risks of using 

specialized food products, according to USAID and implementing 

partners we spoke with during our field visits and our expert roundtable. 

This inadequate guidance hinders decision making on whether to use 

these products. As discussed earlier, the benefit of specialized food 

products is that, while more costly, they are also more nutritious, or of 

higher quality, than traditional food products. However, USAID has not 

quantified or clearly defined the degree of benefit that specialized food 

products may provide. In 2011, we reported that in recent years, 

nutritionists have debated the appropriateness of using fortified and 

blended foods to prevent and treat malnutrition in young children 6 to 24 

months old, who have smaller stomachs, making it more difficult for them 

to eat enough of the product to obtain sufficient nutrients.37 As a result, 

the benefits of some traditional specialized food products are not clear. In 

addition, limited information on new specialized products is available. As 

we previously reported, USAID and implementing partners do not know 

how well new specialized food products perform in promoting nutritional 

health indicators, such as weight gain and growth, particularly in a 

program setting, or how well they perform in comparison to traditional 

food products.38

USAID also lacks guidance on how to adequately address risks of using 

specialized food products, according to implementing partners we spoke 

with during our field visits and our expert roundtable. A key targeting risk 

is that various factors implementing partners face in-country may reduce 

targeting effectiveness to such a degree that the additional cost of using 

specialized food products outweighs the potential benefit. This trade-off 

becomes more significant with the higher cost of new specialized food 

The efficacy of new specialized products, or the extent to 

which these products promote desired outcomes, is still being studied by 

USAID, WFP, nutritionists, and other researchers. As a result, while 

USAID is building knowledge about these products, it is not providing

sufficient guidance on the benefits of specialized food products to 

implementing partners.

 

37GAO-11-491. 

38GAO-11-491. 

USAID’s Guidance 

Inadequately Addresses Key 

Benefits and Risks That Inform 

Decisions on Whether to Target 

Specialized Food Products
 

Page 24 GAO-12-862 International Food Assistance

products, for which the cost per ration can be more than triple the cost of 

traditional food products. Poor data quality, host government policies, and 

sharing may reduce implementing partners’ ability to identify and reach 

recipients, but USAID’s existing guidance does not adequately inform 

decisions on whether the reduction in targeting effectiveness is of such a 

degree that the use of specialized food products is no longer justified.39

USAID is taking some steps to enhance guidance on whether and how to 

use new specialized food products, but fully up-to-date and complete 

guidance will not be completed until at least late 2013. In response to our 

2011 recommendation on improved targeting guidance, USAID stated in 

its official agency response in July 2011 that it would work to address our 

recommendations through the second Food Aid Quality Review study 

now under way with Tufts University. This work is expected to include 

cost-effectiveness analyses on new specialized food products, adding 

information important to help determine whether and how to use them. In 

addition, according to USAID documents and officials, USAID is updating 

and improving the Commodities Reference Guide and other guidance 

related to targeting, including for new specialized food products. 

However, this work will not be completed until September 2013 at the 

earliest, according to USAID officials. USAID also plans to introduce other 

guidance before September 2013, including updated fact sheets for 

individual products. According to USAID officials, this interim guidance 

will be released on an as-needed basis, beginning in October 2012. In 

addition, USAID has existing guidance that helps inform implementing 

partners’ decision making, including its Annual Program Statement (APS), 

Food for Peace Information Bulletins, and some Food and Nutrition 

Technical Assistance (FANTA) guidance.

 

39We previously reported that USAID officials acknowledged that more research is needed 

to better understand sharing of CSB, so that the agency can provide partners with more 

guidance on this issue. See GAO-11-491. 

USAID Is Taking Steps to 

Improve Targeting Guidance 
 

Page 25 GAO-12-862 International Food Assistance

USAID does not require monitoring of key indicators needed to determine 

the level of targeting effectiveness, although it is beginning to make 

improvements in this area.40 Information on indicators that are consistent 

with the goals of the program is critical to determining how effectively a 

program targets food assistance.41

 

40In 2009 we reported on the overall monitoring and evaluation efforts of USAID’s Office of 

Food for Peace development programs. At that time, we acknowledged that USAID 

monitors a wide range of indicators related to assessing the extent to which development 

programs are achieving their goals. For example, we noted that USAID has monitored 

indicators on height-and-weight for age, maternal and child health practices, and 

household food security. We also reported that USAID’s monitoring and evaluation 

practices for development programs were consistent, to varying degrees, with good 

practices set by the American Evaluation Association. See GAO, International Food 

Assistance: USAID Is Taking Actions to Improve Monitoring and Evaluation of 

Nonemergency Food Aid, but Weaknesses in Planning Could Impede Efforts, GAO-09-

980 (Washington, D.C.: Sept. 28, 2009).

Targeting effectiveness can be 

measured by the extent to which food assistance reaches correctly 

41In its efforts to monitor in-kind food assistance, USAID collects data on both recipients 

and beneficiaries. Recipients and beneficiaries are related but different, and the 

differences between them are important to understanding the extent to which USAID can 

measure targeting effectiveness. According to USAID definitions, recipients are individuals 

who receive food assistance rations, while beneficiaries are individuals who benefit from 

food assistance rations. Specifically, beneficiaries include all recipients and any other 

individuals who may benefit from the food assistance. For example, in a food-for-work 

program, only one person—the recipient—actually receives targeted food assistance, but 

other members of the recipient’s family or community may benefit from that individual’s 

participation in the program, making them all beneficiaries. Therefore, while beneficiary 

data are useful to USAID in its efforts to monitor overall program effectiveness, they are of 

limited use in measuring targeting effectiveness. Recipient data are better suited to that 

purpose. As noted above, USAID collects a wide range of beneficiary data that are useful 

for many program purposes. For the purposes of this report, we refer to USAID indicators 

that are specifically about recipients and are directly related to measuring targeting and 

targeting effectiveness, such as the degree of targeting error.

Weaknesses in USAID’s 

Monitoring and Evaluation 

Efforts Related to 

Targeting Could Limit 

Targeting Effectiveness 

and Hinder Decision 

Making, but the Agency Is 

Starting to Take Steps to 

Improve Monitoring

USAID Does Not Monitor Key 

Indicators of Targeting 

Effectiveness, but Is Initiating 

Improvements in This Area
 

Page 26 GAO-12-862 International Food Assistance

targeted recipients—that is, the percentage of intended recipients that 

actually receive food assistance in the intended amounts (see fig. 4).42

Effectively targeted programs reduce the magnitude of these errors. 

USAID guidance states that monitoring should be used to measure 

progress toward planned program results.43 Additionally, FANTA 

guidance states that monitoring efforts should allow USAID and its 

implementing partners to assess the extent to which targeted recipients 

received intended food assistance.44

USAID monitoring is inadequate for both emergency and development 

programs because it does not monitor key data on recipients that would 

allow USAID to measure whether food assistance is actually reaching the 

intended recipients. Specifically, for emergency programs, USAID collects 

the total number of intended recipients from its implementing partners, but 

does not collect the total number of actual recipients or indicators such as 

breakdowns of age and gender for intended or actual recipients. 

According to USAID, these types of more specific indicators may not be 

as important for some emergency programs that focus solely on rapid 

lifesaving. However, these indicators are important for emergency 

programs that do have specific targeting goals, such as reaching severely 

According to a USAID official, 

USAID field staff do consider targeting during their routine monitoring of 

food assistance programs. In addition, USAID requires its implementing 

partners to collect some data, such as the number of intended recipients 

for all food assistance programs, and requires other indicators to be 

monitored depending on the type of program—emergency or 

development. However, USAID does not currently require sufficient 

monitoring of key indicators consistent with program goals that would 

allow its implementing partners to report on levels of targeting 

effectiveness. For example, it cannot determine the effectiveness of a 

program targeting children under 2 because it does not monitor the age of 

the actual recipients in either emergency or development programs.

 

42As noted above, for the purposes of this report we define targeting effectiveness as the 

degree to which USAID and its implementing partners are able to (1) accurately assess 

needs and identify recipients using appropriate eligibility criteria, and (2) ensure that food 

assistance provided reaches and is consumed by the targeted recipients as defined by the 

eligibility criteria.

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

44FANTA, Food Security Indicators Framework for Use in the Monitoring and Evaluation of 

Food Aid Programs (Washington, D.C.: Jan. 1999). 
 

Page 27 GAO-12-862 International Food Assistance

malnourished children. For development programs, USAID collects both 

the total number of intended and actual recipients from its implementing 

partners, but as with its monitoring of emergency programs, does not 

collect data on key indicators such as breakdowns of age and gender. 

Without monitoring full sets of data for both intended and actual 

recipients, including key indicators consistent with program goals, USAID 

has limited ability to learn about the magnitude of targeting errors or the 

degree to which its implementing partners are achieving their program 

goals.

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

According to USAID and implementing partner officials, it is particularly 

complex to gather monitoring information on indicators related to targeting 

effectiveness about actual recipients, due in part to cost and data quality 

issues. These challenges are heightened for programs using new 

specialized food products, which are designed to provide nutritional 

benefits to very specific vulnerable groups, such as malnourished children 

or pregnant or lactating women. Identifying and selecting recipients for 

such programs requires using indicators that are more complex than 

those used for programs designed for the general population. Some of 

the indicators, such as nutritional status, are costly to measure and prone 

to errors. For example, implementing partners we spoke with during our 

fieldwork in Guatemala and Sri Lanka told us that they have difficulty in 

collecting data for some indicators in other, non-USAID programs using 
 

Page 28 GAO-12-862 International Food Assistance

new specialized food products due to resource constraints, lack of 

technical capacity by some local NGO staff, or problems with unreliable 

data.

USAID is making improvements in monitoring of some nutrition-focused 

development programs, for example, by planning to require implementing 

partners to collect data on the age of young children, a common criterion 

for new specialized food products. However, as mentioned earlier, 

indicators key to measuring targeting effectiveness are not consistently 

monitored across all USAID food assistance programs. According to the 

Standards of Internal Control in the Federal Government, program 

managers need to compare actual performance to planned results and 

analyze significant differences.45

USAID’s evaluations of its food assistance programs do not 

systematically discuss targeting effectiveness. As a result, the agency 

may be missing opportunities to learn important lessons about targeting 

effectiveness and apply them to current and future programs.

Without reporting targeting 

effectiveness, USAID cannot compare actual targeting effectiveness to 

planned results. As a result, USAID may not be able to make fully 

informed targeting decisions for both ongoing and future food assistance 

programs. For example, USAID may not be able to track the performance 

of food assistance programs’ targeting over time or across programs and 

may therefore miss opportunities to identify improvements to the targeting

effectiveness of these programs.

46

 

45GAO, Standards for Internal Control in the Federal Government, 

Specifically, the 17 development and 3 emergency USAID evaluations 

going back to 2009 that we examined did not systematically discuss 

targeting in general and targeting effectiveness in particular. These 

evaluations addressed targeting effectiveness to varying degrees—

ranging from an entire section on targeting that included a discussion of a 

targeting effectiveness indicator, to no mention of targeting at all. The 

GAO/AIMD-00-21.3.1 

(Washington, D.C.: Nov. 1999).

46USAID’s targeting evaluations are not systematic, in part, because they are not routinely 

conducted. USAID requires evaluations to be completed for all of its development 

programs but does not require them for its emergency programs. Instead, emergency 

programs are required to submit Annual Results Reports, which contain many of the same 

types of information as evaluations, but for which no baseline assessment is conducted. 

According to USAID officials, the difference between these requirements is due to the fact 

that emergency programs are by nature typically in places where there may not be the 

time or resources available to do a proper baseline assessment.

USAID Evaluations Do Not 

Systematically Address 

Targeting Effectiveness, Which 

May Hinder Decision Making 
 

Page 29 GAO-12-862 International Food Assistance

evaluations that discussed targeting effectiveness included information on 

the magnitude of inclusion or exclusion errors and the level of community 

satisfaction with targeting. For example, USAID’s evaluation of an 

emergency program in Zimbabwe discussed inclusion and exclusion 

error, a key measure of targeting effectiveness, within a section focused 

exclusively on targeting. Similarly, USAID’s evaluation of an emergency 

program in Ethiopia mentioned the level of community satisfaction with 

targeting: almost 90 percent of the respondents to a survey of community 

members were generally satisfied with the fairness of the program’s 

targeting. Some evaluations, however, contained only a brief mention of 

targeting in general, with no mention of targeting effectiveness. For 

example, an evaluation of a development program in Bolivia mentioned 

targeting and contained tables showing monitoring indicators for the 

baseline compared against the final evaluation, but did not explain how 

the recipients were originally targeted or how the final evaluation results 

were verified. Other evaluations, such as a 2011 evaluation of a 

development program in Guatemala, did not discuss targeting or targeting 

effectiveness at all.

USAID policy and guidance call on USAID and its implementing partners 

to use evaluations as opportunities to learn about past programs to inform 

decision making for new programs. USAID policy calls for evaluations to 

“systematically generate knowledge about the magnitude and 

determinants of program performance, permitting those who design and 

implement programs...to refine designs and introduce improvements to 

future efforts.”47 USAID guidance states that evaluations should assess 

the extent to which the program is meeting its stated objectives.48 For 

example, if a program is providing food assistance to a vulnerable 

subpopulation, effective targeting is an important program objective. 

However, USAID’s evaluations of its food assistance programs do not 

systematically address targeting effectiveness, and as a result, the 

agency’s ability to assess the extent to which a program is meeting its 

stated objectives is hindered, and it may miss opportunities for learning 

lessons that could be useful when designing new programs or improving 

ongoing ones.

 

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

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

Page 30 GAO-12-862 International Food Assistance

The use of specialized food products, especially some of those most 

recently introduced, offers the promise of providing better nutrition to the 

most vulnerable. However, the increased cost of these new specialized 

products means that their use may likely reduce the overall number of 

recipients receiving food assistance under a fixed program budget—a 

quality-quantity trade-off. Choosing more costly specialized food products 

over less costly traditional food products may be the optimal policy option 

in certain circumstances, including areas with a high percentage of 

children suffering from hunger and malnutrition. However, the 

achievement of this policy goal requires effective targeting of food 

assistance so that food ultimately reaches the intended recipients. If food 

assistance is not targeted effectively, the program may fail to achieve its 

nutritional goals while simultaneously feeding fewer people.

USAID recognizes the need to update and broaden its guidance on the 

use of specialized food products, but this revision will not be completed 

until late 2013 at the earliest. Issuance of improved interim guidance 

related to food assistance targeting will help USAID and its implementing 

partners make better-informed decisions about whether and how to 

deploy the range of food products that are available, particularly new 

specialized products. Moreover, the monitoring and reporting of key 

indicators consistent with program objectives are necessary to ensure 

that specialized food products are, in fact, reaching intended recipients. 

Improved targeting—which takes an approach that is appropriate to the 

circumstances and conditions—would better ensure that valuable food 

resources are put to their most optimal use and that vulnerable groups 

receive the most effective assistance available to them.

To improve USAID’s targeting of specialized food products to vulnerable 

groups, such as children under 2 and pregnant women, we recommend 

that the Administrator of USAID take the following two actions:

• As USAID continues to purchase new specialized food products 

without updated guidance, it should issue, as appropriate, improved 

interim guidance to assist implementing partners in deciding whether 

and how to target specialized food products.

• When USAID chooses to provide specialized food products to 

targeted vulnerable groups, it should establish and report programspecific indicators related to each targeted group to allow USAID to 

assess its programs’ effectiveness in reaching these groups.

Conclusions 

Recommendations for 

Executive Action
 

Page 31 GAO-12-862 International Food Assistance

We provided a draft of this report to USAID, USDA, and State for 

comment. In its written comments, reproduced in appendix V, USAID 

concurred with our recommendations. USDA and State provided no 

written comments. We also provided relevant excerpts of this report to 

WFP for comment. USAID, USDA, and WFP provided technical 

comments that were incorporated, as appropriate. 

USAID strongly agreed with our recommendation on improving interim 

guidance to help implementing partners decide whether and how to target 

specialized food products. USAID provided examples of recent and 

ongoing efforts that are expected to contribute to improved guidance on 

new specialized food products. For example, USAID expects to publish 

on its website updated fact sheets on food products provided in its food 

assistance programs and will prioritize issuing those relating to 

specialized food products. Although USAID noted that some existing 

guidance is available for three of the new specialized food products it is 

introducing, such as CSB+, the agency also acknowledged that it expects 

to issue its own guidance on all new products and update the 

Commodities Reference Guide. 

USAID agreed with our recommendation on establishing and reporting 

program-specific indicators to allow USAID to assess its programs’ 

effectiveness in reaching targeted groups. USAID agreed with us on the 

need to develop new, program-specific indicators to assess the nutrition 

goals of new specialized food products for its Title II emergency programs 

and indicated that it would engage with partners on demonstrating impact 

and results. To that end, USAID indicated that it is in the process of 

recruiting a nutritionist to ensure that products used match their intended 

purpose and high-value specialized products are properly targeted.

We are sending copies of this report to appropriate congressional 

committees, the Administrator of USAID, the Secretaries of Agriculture 

and State, and relevant agency heads. The report is also available at no 

charge on the GAO website at http://www.gao.gov. 

Agency Comments 

and Our Evaluation
 

Page 32 GAO-12-862 International Food Assistance

If you or your staff have any questions about this report, please contact 

me at (202) 512-9601 or melitot@gao.gov. Contact points for our Offices 

of Congressional Relations and Public Affairs may be found on the last 

page of this report. GAO staff who made major contributions to this report 

are listed in appendix VI. 

Thomas Melito

Director, International Affairs and Trade
Appendix I: Objectives, Scope, and 

Methodology

Page 33 GAO-12-862 International Food Assistance

Our objectives were to (1) describe in-country factors that the U.S. 

Agency for International Development (USAID) and its implementing 

partners face in targeting vulnerable groups, and (2) examine the extent 

to which USAID’s targeting process supports effective targeting.

To address these objectives, we met with officials at USAID and its 

implementing partners, including the World Food Program (WFP) and 

nongovernmental organizations (NGOs). In addition, we met with officials 

at the U.S. Department of Agriculture (USDA) and the U.S. Department of 

State. We also spoke with academics, experts, and practitioners 

associated with research institutes, universities, and NGOs. We 

examined USAID program documents, including guidance and tools, 

related to food assistance targeting processes. Furthermore, we 

conducted fieldwork in four countries—Ethiopia, Guatemala, Sri Lanka, 

and Zimbabwe—and met with officials from U.S. missions, implementing 

partners, and relevant host government agencies. We also convened a 

roundtable of 10 practitioners and experts—including representatives 

from implementing partners such as NGOs and WFP, academia, and 

research organizations—to discuss in-country factors that affect the ability 

of USAID and its partners to target vulnerable groups, as well as the 

guidance and monitoring and evaluation tools that USAID and its 

implementing partners use to target food assistance activities (see app. II 

for the list of participating organizations in our roundtable).

To provide context and background, we analyzed data from USAID and 

WFP to identify trends in U.S. funding for international food assistance 

and procurement data on the use of traditional and specialized food 

products. As these data were for background purposes, we did not 

assess their reliability. In addition, we reviewed data that we reported on 

in 2011 concerning cost information for specialized food products relative 

to traditional food products. We then reviewed similar data to obtain 

updates about the costs and relative length of feeding for these products 

and interviewed USAID, WFP, and Tufts University about the reliability of 

the updated data. We used this information to create an analysis 

comparing the amount of time various commodities could be provided for 

the cost of other commodities. We found that these updated data were

sufficiently reliable for the purposes of this report, in that they 

demonstrated the order of magnitude of the relative cost of different types 

of food products used in food assistance programs. Although commodity 

prices may fluctuate and suggested feeding lengths may vary by program 

or individual recipient, the data were sufficiently reliable to demonstrate 

that there are large differences in the cost of feeding, depending on the 

products used. In addition, we reviewed various literature on the targeting 

Appendix I: Objectives, Scope, and 

Methodology 
Appendix I: Objectives, Scope, and 

Methodology

Page 34 GAO-12-862 International Food Assistance

process, as well as USAID guidance and tools to facilitate targeting 

decisions.

To describe in-country factors USAID and its implementing partners face 

in targeting vulnerable groups, we reviewed literature on targeting and 

new specialized food products issued by academics, research institutes, 

implementing partners, USAID contractors, UN organizations involved in 

humanitarian assistance, and independent international organizations; 

spoke with in-country officials such as relevant host government officials 

and implementing partners; and obtained the input of our roundtable 

participants.

To examine the extent to which USAID’s targeting process supports 

effective targeting, we analyzed responses and information from the 

general methodologies listed above. To examine the extent to which 

USAID provides guidance to its implementing partners on targeting, we 

reviewed existing USAID guidance for targeting and USAID’s contract 

with Tufts University and spoke with USAID and Tufts University officials 

about the scope of work for this contract, including the section on 

updating guidance. We reviewed information from USAID about the 

product types, costs, and tonnage of new specialized food products 

purchased since fiscal year 2010. We interviewed USAID about the 

sources of this information and also compared it to data about these 

products from other sources of information. These included the requests 

for applications that USAID provides to its implementing partners for new 

specialized food products, including ready-to-use therapeutic foods and 

lipid nutritional supplements; USAID’s commodity price calculator; and 

relevant legislation authorizing the use of these products. We found that 

the data were sufficiently reliable for the purposes of this report, in that 

they showed the magnitude and trends of purchases of new specialized 

food products with USAID funding in recent years. To examine the extent 

to which USAID monitors and evaluates targeting effectiveness and other 

related information, we analyzed monitoring information provided to us by 

USAID about numbers of planned recipients and actual beneficiaries for 

Title II food assistance programs since 2009. We reviewed current USAID 

policies and procedures on monitoring and evaluation. We also reviewed 

guidance provided by Food and Nutrition Technical Assistance (FANTA), 

under a cooperative agreement with USAID. This guidance covers 

aspects of monitoring and evaluation, such as the performance measures 

to be used for food assistance programs. Through searches of USAID’s 

website and discussions with cognizant officials, we identified a total of 30 

final evaluations of USAID programs going back to 2009. Final 

evaluations are conducted at the end of a program. However, USAID 
Appendix I: Objectives, Scope, and 

Methodology

Page 35 GAO-12-862 International Food Assistance

could not assure us that it had provided all of the evaluations conducted 

for its development programs, and also noted that it does not require 

evaluations of its emergency programs. We selected 20 of these final 

evaluations for review based on the following criteria: we included all 3 

final evaluations for the single-year programs, and selected 17 final 

evaluations for the multi-year programs to ensure that we had coverage 

by year and geographic region. We reviewed these evaluations to 

examine the extent to which they had addressed targeting issues. Finally, 

we reviewed evaluations that WFP conducted of those of its programs 

that were implemented with USAID funding.

We conducted this performance audit from October 2011 to September 

2012 in accordance with generally accepted government auditing 

standards. Those standards require that we plan and perform the audit to

obtain sufficient, appropriate evidence to provide a reasonable basis for 

our findings and conclusions based on our audit objectives. We believe 

that the evidence obtained provides a reasonable basis for our findings 

and conclusions based on our audit objectives.
Appendix II: Organizations That Participated in 

GAO Roundtable

Page 36 GAO-12-862 International Food Assistance

The following organizations participated in our roundtable of experts and 

practitioners held in May 2012:

• CARE

• Catholic Relief Services

• Cornell University

• FHI 360

• International Food Policy Research Institute

• Mercy Corps

• Save the Children

• World Food Program

• World Vision

Appendix II: Organizations That Participated 

in GAO Roundtable
Appendix III: Cost Differences between 

Traditional Food Products and Specialized 

Food Products

Page 37 GAO-12-862 International Food Assistance

Table 3 provides a comparison of cost differences between traditional and 

selected specialized food products, which include both traditional 

specialized food products and new specialized food products. For 

example, to feed a child 6 to 23 months old, a traditional grain-based 

representative ration costs $0.02 to $0.06 per day, a CSB+ ration, $0.10 

to $0.21 per day, and a ready-to-use therapeutic food (RUTF) ration, 

$0.42 to $0.46 per day.

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

Product Description a Cost per ration for child

Overall cost for 

suggested length 

of useb

Traditional food product

Grain-based representative ration Grain, pulse, CSB, and vegetable oil $0.02 - 0.06 90 - 120 days

$2.07 - $7.45

Traditional specialized food product 

CSB fortified blended food Processed cornmeal, soy flour, soybean oil, 

vitamins, and minerals 

$0.09 - $0.18 90 - 120 days

$8.41 - $22.07

New specialized food products

CSB+ (WFP Supercereal) WFP formulation for children over 6 months old $0.10 - $0.21 90 - 120 days

$9.22 - $25.58

Ready-to-use therapeutic food 

(RUTF)

Nutritionally dense food for community-based 

treatment of severe acute malnutrition

$0.42 - $0.46 42 - 90 days

$17.77 - $41.40

Lipid nutritional supplement (LNS) Supplementary complementary food for children 6 

to 24 months old to prevent stunting

$0.10 - 0.13 180 – 545 days

$17.06 - $71.90

Emergency food bars

(A-28 rice & A-29 wheat) 

Meal replacement used during onset of 

emergencies 

$0.32 - $0.33 3 - 15 days

$0.97 - $5.00

Emergency food paste (A-20) Meal replacement used during onset of 

emergencies 

$0.29 3 - 15 days

$0.86 - $4.28

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

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

a

The products listed in this table are used for different purposes. This table does not assess the 

relative effectiveness of each product. We note that USAID does not provide RUTF as part of a 

general food distribution ration.

b

The suggested lengths of use in this table are fairly wide ranges of time (for example, 180-545 days) 

that reflect uncertainty, in part because limited data from actual application are currently available. 

The suggested lengths of use could change as more data become available for more precise 

estimates.

Appendix III: Cost Differences between 

Traditional Food Products and Specialized 

Food Products
Appendix III: Cost Differences between 

Traditional Food Products and Specialized 

Food Products

Page 38 GAO-12-862 International Food Assistance

The cost per ration is one aspect of the relative cost of food assistance 

products; the length of time a product is used in a food assistance 

program also affects its overall relative cost. Some experts suggest that, 

although an individual daily ration of a new specialized food product may 

be relatively expensive, it may ultimately be less costly overall because it 

may be fed for a shorter period of time based on its suggested length of 

use. However, we found that some new specialized food products with a 

relatively shorter suggested length of use may still cost relatively more 

overall. For example, as shown in the table, although an RUTF’s 

suggested length of use (42 to 90 days) for a child 6 to 23 months old is 

shorter than that of a traditional grain-based ration (90 to 120 days), the 

RUTF may still cost more overall ($17.77 to $41.40) than the grain-based 

ration ($2.07 to $7.45). Despite their higher overall costs, RUTFs may be 

the optimal choice in certain circumstances, such as for emergencies in 

areas with a high percentage of children suffering from severe acute 

malnutrition.

Table 4 illustrates the number of days that traditional food products 

(grain-based rations) or traditional specialized food products (CSB) can 

be provided for the cost of providing a new specialized food product 

based on its suggested length of use. For example, for the cost of 

providing a nutritional supplementary paste fortified ration for 180 to 545 

days, a grain-based ration could be provided for 741 to 3,121 days and a 

CSB ration could be provided for 183 to 769 days.

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

Specialized Food Products

New specialized food product

Suggested length of use 

of a specialized food 

product

(number of days) a

Number of days a grainbased ration could be 

provided for the same 

cost b

Number of days a CSB 

ration could be 

provided for the same 

cost c c

Nutritional supplementary paste 180 - 545 741 - 3,121 183 - 769

Ready-to-use therapeutic food (spread) 42 - 90 772 - 1,797 190 - 443

A-20 paste (ready-to-eat meal replacement) 3 - 15 37 - 186 9 - 46

A-29 wheat bar (ready-to-eat meal replacement) 3 - 15 42 - 211 10 - 52

A-28 rice bar (ready-to-eat meal replacement) 3 -15 43 - 217 11 - 53

CSB+ (WFP Supercereal) 90 - 120 400 - 1,110 99 - 274

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

a

The products listed in this table are used for different purposes. This table does not assess which 

products are more effective. We note that USAID does not provide RUTF as part of a general food 

distribution ration.
Appendix III: Cost Differences between 

Traditional Food Products and Specialized 

Food Products

Page 39 GAO-12-862 International Food Assistance

b

The suggested lengths of use in this table are fairly wide ranges of time (for example, 180-545 days) 

that reflect uncertainty, in part because limited data from actual application are currently available. 

The suggested lengths of use could change as more data become available for more precise 

estimates.

c

Cost of a grain-based ration for a child 6 months old. 
Appendix IV: USAID New Specialized Food 

Products Pending Introduction

Page 40 GAO-12-862 International Food Assistance

USAID has thus far deployed a relatively limited quantity of new 

specialized food products but plans to introduce the following products to 

address various needs:

• Ready-to-use supplementary food (RUSF) - Nutritionally dense and 

highly fortified for management of moderate acute malnutrition.

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

• Fortified milled cereals - Reformulated and standardized to improve 

general rations.

• CSB++ (WFP Supercereal+) - Formulated by WFP for children 6 to 24 

months of age.

• CSB-14 – Reformulated CSB to be prepared with vegetable oil.

Appendix IV: USAID New Specialized Food 

Products Pending Introduction
Appendix V: Comments from the U.S. Agency 

for International Development

Page 41 GAO-12-862 International Food Assistance

Appendix V: Comments from the U.S. Agency 

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

for International Development

Page 42 GAO-12-862 International Food Assistance
Appendix V: Comments from the U.S. Agency 

for International Development

Page 43 GAO-12-862 International Food Assistance
Appendix V: Comments from the U.S. Agency 

for International Development

Page 44 GAO-12-862 International Food Assistance
Appendix VI: GAO Contact and Staff 

Acknowledgments

Page 45 GAO-12-862 International Food Assistance

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

In addition to the person named above, Joy Labez (Assistant Director), 

Carol Bray, Marc Castellano, Ming Chen, Anna Chung, Debbie Chung, 

Martin De Alteriis, Mark Dowling, Etana Finkler, David Schneider, and

Jeremy Sebest made key contributions to this report. Sada Aksartova, 

Vida Awumey, Teresa Heger, Erin McLaughlin, Michael Maslowski, Julia 

Ann Roberts, Barbara Shields, and Phillip Thomas also contributed to this 

report.

Appendix VI: GAO Contact and Staff 

Acknowledgments 

GAO Contact

Staff Acknowledgment
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Page 46 GAO-12-862 International Food Assistance

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GAO-12-790. Washington, D.C.: September 13, 2012.

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Washington, D.C.: April 24, 2012.

International Food Assistance: Funding Development Projects through 

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Washington, D.C.: October 29, 2009.

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D.C.: March 21, 2007.

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