Hunger pains: U.S. food program struggles to move forward

After more than 60 years of feeding the world's hungry overseas, the U.S. Agency for International Development is scrambling to overhaul the world's largest government food assistance program. The U.S. spends more than half of its international food aid budget transporting life-saving commodities through a tangled system of special interests and government bureaucracy – more than $9 billion in taxpayer dollars over a recent 10-year period, finds a Medill/USA TODAY investigation.

Virtually every other aid-giving country and the United Nations, which helps coordinate them, use a flexible system in which critically needed grains, oils and other commodities are purchased as close to a crisis or famine zone as possible. When appropriate, many also give cash transfers or vouchers instead of sacks of food, saving money and precious time getting aid to the young, the elderly, the sick and families in crisis.

But since 1954, Congress has mandated that Food for Peace, the flagship U.S. food aid program, primarily would buy American commodities from U.S. suppliers and transport them thousands of miles on U.S.-flagged ships, even when cheaper, faster and better alternatives exist. The journey often takes seven months, as the food moves from Midwestern fields to coastal ports, across the ocean and then by truck or even donkey to its intended recipients. By then, the food may be rotted or too late to be of much help.

"People (have) died waiting for the food to arrive because of the very long logistics chain that's required to get the food all the way from the United States to the location," says Andrew S. Natsios, former administrator of USAID, which runs Food For Peace. "And it's very expensive to move food over that distance."

For decades, USAID's own leadership has lobbied fiercely – and largely unsuccessfully – to shift to the more flexible system used by other countries. In early 2013, USAID Administrator Rajiv Shah unveiled an Obama administration package that he said would save potentially hundreds of millions of taxpayer dollars annually, get food to those who desperately need it weeks or even months faster and feed as many as 4 million additional people a year on the same budget.

But within a year, Congress had killed off most of that proposal. The defeat followed a lobbying blitz targeting lawmakers representing the farmers, milling companies, shippers, private aid organizations and others who benefit from the current system. Those groups, collectively known as the Iron Triangle, argued that millions of dollars in shipping contracts and 13,000 of U.S. jobs would be lost.

"We immediately jumped into action here on the Hill," said Lee Kincaid, president of the American Maritime Congress. "And as a result, (Obama's proposal) didn't fly in the budget."

One major food transporter, Liberty Maritime, spent $1.13 million on lobbyists in 2013, mainly to fight the proposed changes, according to disclosure reports.

Cornell economist and food aid expert Christopher Barrett says the U.S. job loss would be minimal, but that Congress will never pass a substantive overhaul."Those who are enjoying access to the public purse want to continue to feed from that;" he says, "and the fact that they're effectively crowding out starving children in disaster-affected areas for some reason doesn't seem to bother them and remarkably doesn't bother our elected representatives."

Critics, including every USAID administrator since the Reagan Administration, say the U.S. food aid program falls short because of the special interest protections enacted by Congress.

Based on a review of government documents and studies, as well as interviews with dozens of U.S. officials and experts, the Medill/USA TODAY investigation found the problems extend far beyond these special interest protections and include:

• Blue-ribbon studies – including some commissioned by USAID – question the nutritional value of some key U.S. food aid products.
• A program touted as one of USAID's major overhauls – a global system of prepositioning warehouses that can speed food to victims – has been plagued by myriad problems including cost overruns. .
• The Government Accountability Office, the independent watchdog arm of Congress, found that USAID lacked the metrics it needs to determine whether its global network of programs are even working.

Asked for comment, Shah and other USAID officials acknowledged that they are grappling with structural problems, and said the agency is in the early stages of its biggest overhaul ever in an effort to address them.

"We're always looking for ways to increase our effectiveness and efficiency,'' Danielle Mutone-Smith, USAID's acting policy team leader, said in an interview.

Those actions include:

• Revamping the evaluation and monitoring system
• Funding more research and development for nutritional improvements
• Demanding more data analysis and reporting requirements

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​USAID's scramble to overhaul itself can be seen in the vast, teeming Middle Eastern camps that currently hold more than a million Syrian refugees. There, USAID is working with the United Nations' World Food Program to give refugees freshly baked bread and the ability to purchase what they want, and when, from local stores instead of making them stand in long lines for handouts as decades of food aid recipients have done.

And it can be seen in the dusty villages of Burkina Faso in western Africa, where researchers and private aid organizations are testing new fortified nutritional products to help bring some victims back from the brink of death, and to prevent others from getting sick.

The stakes couldn't be higher. Every year, malnutrition helps kill more than 3 million children worldwide, and untold millions more sick and elderly people. Many nations are paying a steep price: Estimates show that malnutrition decreases a country's economic growth by at least 8%.

"If you don't have food to eat, that is the most basic form of poverty. That often is what stirs other levels of insecurity around the world," Mutone-Smith says, citing numerous recent uprisings that started with a lack of access to food. "We're always out there trying to make sure that we're providing food... to stabilize the world."

Since its inception, even its biggest critics say Food for Peace and related food assistance programs have helped hundreds of millions of victims. Together, they provide roughly 50% of all food aid worldwide, at an average annual cost of $2 billion to U.S. taxpayers.

Many of the problems date back to 1954, when the U.S. food aid program began with its primary mission to help farmers offload crop surpluses and open new foreign markets for U.S. exports.

By 1966, the surpluses were largely gone, and President Lyndon Johnson signed the Food For Peace Act, shifting the focus of the program to shipping food for humanitarian reasons. But while the mission changed, its emphasis on helping U.S. commercial entities didn't, aggravating problems over time as more modern and efficient alternatives went mostly unused, say critics.

The U.S. still relies on a supply and transport chain that is so convoluted that one former senior U.S. aid official, Nelson Randall, estimates it requires food aid to change hands 17 times, sharply driving up transportation costs and risks.

"If you take and count the number of times a bag of peas or a bag of corn or a bag of corn soy blend is handled in this program manually, it's a miracle that it gets to where it can be eaten at all," said Randall, the former chief of international procurement for the U.S. Department of Agriculture, which sells USAID the food it ships as aid.

Supporters say sending U.S.-grown food ensures high quality and that a bag of grain stamped with "From the American People" is worth more than its weight in goodwill. They also say it helps local U.S. farming, food processing and shipping economies and supports the Merchant Marine – a commercial shipping network originally intended as a backup for the U.S. Navy, though it's not often deployed that way.

And without the added benefit of jobs for American suppliers and shippers, Congress – and taxpayers – would be less likely to fund the program at all, says Ellen Levinson, a lobbyist for the Alliance for Global Food Security, which represents more than a dozen international aid groups.

Many other aid groups, however, oppose the current system. And even some major food conglomerates such as Cargill have come out against the inflexibility of the long march of U.S. food aid.

In Congress, a small bipartisan coalition of lawmakers has fought hard for change, saying the system is bloated and inefficient. But other lawmakers have fought to keep the status quo.

For example, in the past decade, according to the Medill-USA TODAY investigation, Pakistan got several shipments of rendered beef fat. Raisins were sent to wartime Iraq in 2003 because there was a surplus in California. Refrigerated containers of Washington state apples went to Russia in 2001 under the Food For Progress Program. And canned salmon is still being sent to several countries in Africa and East Asia under the McGovern-Dole International Food for Education and Child Nutrition Program, thanks to the political clout of a former Alaskan senator.

"It's a problem with a system that is supply driven rather than demand driven," says Rob Bailey, a food policy researcher at the London-based think-tank Chatham House. "You're quite often going to end up potentially sending food to people that don't want to eat it, or don't know how to cook it, or have no real use for it."

Half of the overall U.S. food aid budget is spent on transport and logistics, an average of about $910 million a year, according to USAID data. At least 16% over the past decade, or $3 billion, went toward ocean shipping alone.

In Africa, where famine and conflict are a way of life in countries such as Sudan, Somalia and Ethiopia, USAID spends about 70% of the Food for Peace budget on transportation and logistics, the data shows.

And as transportation and U.S. food costs have risen, so have USAID's problems.

The average price of buying and delivering American food has nearly tripled in the past 12 years, going from $390 per metric ton in 2001 to $1,180 in 2013, according to USAID documents. That has cut deeply into the amount of actual food aid provided.

Over the past decade, Food for Peace's budget has declined by 11%, too. But the program's success in delivering food aid dropped far more precipitously than those cuts and rising costs would suggest, USAID data show. For example:

• In 2012, Food for Peace provided food aid to about 53 million people, or fewer than half of the 123 million people a decade earlier.
• The amount of food sent through Food for Peace dropped from 3.1 million metric tons a year to 1.4 million metric tons in the past decade. The number of countries receiving aid through Food for Peace from 2001 and 2012 declined from 78 to 47, in part due to a shift in policy.

USAID officials from Shah on down say that while change may be slow, it is occurring. They point to the continuing Syria crisis, and USAID's response to it, as an example of what's possible if and when the agency is given the flexibility to innovate.

The yellowed tops of thousands of tents are scattered along the dusty earth of northern Jordan. It's early morning and many of the more than 100,000 Syrians displaced by the war and living in Zaatari – one of the largest refugee camps in the world – are getting up.

Raed, an 11-year-old from Da'ara, who has lived at the camp for over a year, heads down the main road to collect his family's daily ration of fresh bread.

Since 2013, the United Nations has partnered with local bakers to distribute 25 metric tons of bread daily to Zaatari. That's four free pieces of warm bread for every Syrian refugee living in the camp. And it's largely courtesy of USAID, by far the largest donor to the U.N.'s World Food Program.

Raed and his family are part of an experiment – a USAID-led effort to find better and more flexible ways of using U.S. taxpayer dollars to provide food aid around the world. It's an especially urgent challenge in crisis zones such as Syria and surrounding countries such as Jordan, Turkey and Lebanon that have taken in more than a million total refugees.

In Zaatari camp, Raed and his family still line up for boxes filled with small bags of lentils, flour, rice and other commodities. But the camp is moving toward using more food vouchers, small stacks of brightly colored paper that represent a specific amount in the local currency, in this case Jordanian dinars.

"Refugees living outside the camp face different struggles. Jordan is an expensive country. They have to pay rent, electricity and water," said Dina El-Kassaby, spokeswoman for the World Food Program in Jordan. "The voucher program is a way for us to ensure that people are getting the nutrition they need while they are dealing with the other financial burdens of living in an urban setting."

The vouchers are administered through the World Food Program with funds from the United States and other donor countries. Washington contributes five times more than the second largest donor; spending $971 million in food assistance for Syria and neighboring countries since the conflict started.

The U.N. and its partner agencies distribute the vouchers once a month. In Jordan, each represents about $34 in local dinars. Refugees then go to participating shops at their convenience, and decide what kinds of groceries, produce, dairy, and meat they want to buy.

Samuel Terefe, WFP's head of logistics in Jordan, said the widespread use of vouchers in the Syria crisis represents the future of food aid; it's not only faster and more efficient, it restores some sense of dignity to recipients. "It's what the people want and what they need," he says.

About 3,000 miles away from Zaatari, USAID grapples with a different but equally vexing problem: what to feed starving people.

In the impoverished nation of Burkina Faso, decades of famine and drought have created a long-term need not only to fight chronic malnutrition, but the anger, despair, instability and regional conflict.

Malnutrition afflicts nearly 200 million children worldwide. In Burkina Faso, children under the age of 14 make up 45% of the population. And that percentage is increasing. What little food they do have usually does not supply the nutrition they need.

"For the government and for everyone, the first problem in Burkina is food security," says Amidou Kabore, a program director for the Victory Against Malnutrition program in dusty Sanmatenga province. "You can't develop a country when people do not have enough to eat."

USAID has been fighting this problem in Burkina Faso for many years. From 2010 to 2014, Food for Peace provided the country with $74.8 million in emergency and developmental food assistance. Now, it plays a bigger role, as part of a major new research and development campaign to improve its response to malnutrition.

USAID's new campaign was launched recently after critics, some of them U.S. government-funded, said the agency has been sending some key food aid products that were nutritionally substandard from America to Burkina Faso, and vast swaths of Africa and elsewhere in the developing world.

USAID's new nutrition strategy will likely mean big changes in the way it feeds millions of people worldwide, and what kinds of food aid products it ships.

No product illustrates the nutrition controversy – and the challenges facing USAID – better than corn soy blend, a yellow flour boiled in water to make a simple porridge, which many mothers in Burkina Faso have long relied on to feed their infants.

You can't find the blend, also known as CSB, on the shelves of any American food store. But for half a century the mix, grown and milled in the Midwestern heartland, has made up about 6% of all U.S. food aid.

Some aid groups and nutritional experts have complained for years that more nutrient-rich alternatives to corn soy blend exist, and that USAID should ship them instead. Doctors Without Borders, an influential NGO, says children under the age of two are particularly vulnerable. The group, and USAID itself, now say that corn soy blend isn't providing them with vitamins and nutrients needed for critically important growth and development.

Applying the latest in nutrition science, USAID's food aid basket "is undergoing the largest transformation since the program began in 1954,'' USAID Administrator Shah says.

USAID is working to modernize and diversify the types of products it provides, including fortified pastes called ready-to-use therapeutic foods (RUTFs) that can bring starving children back from the brink of death.

Other next-generation products are in use or scheduled to come out soon – from non-perishable meal bars that fed survivors in the aftermath of Typhoon Haiyan, to ready-to-use supplementary food (RUSFs) that are specially formulated to prevent child malnutrition.

"Until recently, a starving child had to make it to a medical facility if she had any hope of survival," Shah said in a speech last year. "Today, she can be treated at home with products that don't require refrigeration and don't need to be mixed with water—a serious limitation where clean water is scarce."

One of the most important testing grounds for these new products is in the capital of Ouagadougou, in the tiny offices of Burkina Faso's Research Institute of Health Sciences. The work isn't glamorous by any stretch, but USAID officials say it is vitally important to the future of U.S. food aid.

Nadira Saleh was a field research coordinator at the institute, contracted by Tufts University and USAID to help administer a 3 ½ year study that last spring began distributing four supplementary nutritional products to Sanmatenga's children. More test products are coming.

"This research has the potential to change policy and products that people are receiving as part of a greater campaign to reduce malnutrition," Saleh said in a recent interview. "This deals with the immediate needs that families may face, so if we can fortify those or make them stronger, that's definitely a wonderful thing for us to be involved with."

Saleh has since left Burkina Faso, but the study continues. It is just one of 68 studies underway around the globe focused on related nutrition and food aid research. "It's the collective science that will influence the future direction of USAID," says Patrick Webb of Tufts' Friedman School of Nutrition Science and Policy. He led the 2011 study and is involved in some ongoing ones.

USAID confirmed that one top priority is testing the RUSFs and other specialized food products that weren't available until recently, and comparing their effectiveness to that of corn soy blend. First purchased by USAID in 2013, the nutrient-rich RUSFs are designed to prevent malnutrition in the same high-risk populations that CSB is meant to target.

"This is definitely an area that we see potential growth in because it's something that we see ourselves doing more of in the future," USAID's Mutone-Smith says.

USAID budget cuts may affect that, since many of the new products are prohibitively expensive. In June 2013, the government paid around $700 per metric ton for corn-soy blend and about $3,000 per metric ton for an RUSF, according to USDA data.

USAID's overhaul efforts will also be influenced by Congress, and pork-barrel politics. The Obama USAID proposal and legislation promoting it would have shifted far more emphasis away from U.S.-grown products such as corn soy blend, resulting in layoffs at Didion and Bunge and the loss of important overseas markets for American corn and soybeans.

To protect their interests, Didion, which started producing corn soy blend in the early 1990s, has been paying lobbyists since at least 2005, spending $220,000 since 2010. Bunge spent almost $2 million over the past two years lobbying for American-made food aid products, including corn soy blend, lobbying records show.

Congress responded to the lobbying by taking smaller steps in moving away from domestic products.

As USAID tries to change, it has been broadsided by an array of other criticisms, including reports highlighting problems in the global food aid system.

The Government Accountability Office, or GAO, the independent watchdog arm of Congress responsible for investigating how the federal government spends taxpayer dollars, has been especially critical of USAID.

The GAO reported that USAID faces significant challenges in maintaining quality controls throughout the long and tortuous supply chain. The office also says USAID had serious problems in funding development projects through the purchase, shipment, and overseas sale of U.S. commodities. That process is known as monetization, and GAO – and other critics – say it is so inefficient that it reduced the funding available for development assistance projects by $219 million over a recent three-year period. Monetization, like emergency food aid shipments, can also be harmful, GAO says, because it can swamp regional markets and put local farmers out of business.

USAID doesn't even know if many of its key programs are working effectively because it lacks the kind of basic oversight mechanisms needed to track and evaluate them, GAO has said.

In 2012, USAID failed to target food assistance effectively to vulnerable groups, and ensure that food aid gets to those who need it most. Effective targeting is critically important in order to maximize the impact of limited resources, GAO said in one report, but even more important as USAID begins to use more nutritious but costly specialized food aid products such as RUSFs. It concluded the program was significantly undermined by weaknesses in the design, monitoring and evaluation phases of the targeting effort.

For instance, USAID didn't provide significant guidance to the many aid groups that distribute its food on whether and how to target specialized food products. It also wasn't monitoring actual recipients in its emergency programs, and its evaluations "do not systematically address targeting effectiveness," GAO said.

In 2014, GAO criticized both USAID and USDA for serious problems in a $187 million program that had been established the year before to manage the sprawling U.S. international emergency food aid procurement system. Known as the Web Based Supply Chain Management system, it was supposed to allow the two agencies to work together on tracking food aid shipments, since USDA procures the food and USAID doles it out. That includes procuring ocean freight for bulk commodities and managing food inventories, including those prepositioned at sites overseas for quick distribution in emergencies.

Congress established the warehouses in 2000 to help speed the delivery of U.S. food aid by setting up warehouses at strategic U.S. and overseas locations. USAID orders food before it is needed and stores it in warehouses in or near regions with historically high needs.

And while prepositioning can shave a month or two off of the long delivery times of U.S. aid shipments, it costs U.S. taxpayers potentially tens of millions a year in extra storage, shipping and commodity costs.

USAID's own investigators also have questioned its effectiveness – and even whether it speeds the delivery of food. A January 2013 audit by USAID's inspector general found that despite a huge recent shift toward prepositioning, especially for food headed to Africa, USAID "did not determine whether the benefits of prepositioning overseas outweigh costs."

"To reduce delivery times for food shipments, more have been prepositioned overseas. Despite this effort, some food prepositioned in the United States reached the Horn sooner than food prepositioned overseas," the audit said. "USAID lacked comprehensive analysis showing that prepositioning commodities overseas resulted in timelier delivery than domestically, although a 2008 cost-benefit analysis found prepositioning commodities overseas was about seven times more expensive than doing so in the United States."

Thomas Melito, the GAO auditor responsible for most of the critical audits of USAID, said in an interview that USAID's recent successes in pushing through at least some changes present it with perhaps its biggest challenge yet. USAID had been doing things the old way for so long, he says, that it now lacks a clear way forward, and will have to make major changes on the fly, and without a blueprint or room for failure.

"When do you preposition, and when do you use vouchers or procure locally? Every one of these has daunting challenges, and they have to figure it out," he said. "There's no obvious answer here."