Food Aid Quality Review Phase III: Technical Report No. 4...Food Aid Quality Review Phase III:...

Food Aid Quality Review Phase III:

Technical Report No. 4 October 2016 – December 2016

This report was produced for the United States Agency for International Development. It was prepared by Tufts University, under the terms of contract AID-OAA-C-16-00020 awarded to the Friedman School of Nutrition Science and Policy.

Tufts Friedman School of

USAID Food Aid Quality Review Phase III October-December 2016

Acronyms AMS Agricultural Marketing Service (USDA) CAWeC Community Action for the Welfare of Children CBO Country Bureau Officer COR Contracting Officer’s Representative CSB Corn-Soy Blend CSB+ Corn-Soy Blend Plus CSWB Corn-Soy-Whey Blend DDL Development Data Library DEC Development Experience Clearinghouse FACG Food Aid Consultative Group FAQR Food Aid Quality Review FBF Fortified Blended Foods FFP Office of Food for Peace (USAID) FVO Fortified Vegetable Oil FY 2017 Fiscal Year 2017 GMP Good Manufacturing Practices HACCP Hazard Analysis and Critical Control Points HEB High Energy Biscuit ICN International Congress of Nutrition IFT Institute of Food Technologists iLiNS International Lipid-Based Nutrient Supplements LNSP National Public Health Laboratory IRB Institutional Review Board IRSS Institut de Recherche en Sciences de la Santé LRP Local and Regional Procurement MAM Moderate Acute Malnutrition MNP Micronutrient Powder MOU Memorandum of Understanding MQ-LNS Medium Quantity-Lipid-Based Nutritional Supplement NGO Non-governmental organization PHU Peripheral Health Unit PI Principal Investigator PM2A Preventing Malnutrition in Children Under 2 POD Program Operations Division PPB Project Peanut Butter PVO Private Voluntary Organization RA Research Assistant REFINE Research Engagement on Food Innovation for Nutritional Effectiveness RUF Ready-to-Use Food



RUSF Ready-to-Use Supplementary Food RUTF Ready-to-Use Therapeutic Food SBCC Social Behavior Change Communication SQ-LNS Small Quantity-Lipid-based Nutritional Supplements TAG Technical Advisory Group TOPS Technical and Operational Performance Support Program USAID United States Agency for International Development USDA United States Department of Agriculture USG United States Government UN United Nations UNICEF United Nations Children’s Fund ViM Victory Against Malnutrition WFP World Food Programme



Food Aid Quality Review (FAQR) Phase III Quarterly Technical Report Summary Summary: During the first quarter of fiscal year 2017 (FY 2017), the Food Aid Quality Review project accelerated its activities aimed at: i) generating new scientific evidence on the cost-effectiveness of various specialized nutritious food aid products on child malnutrition; ii) developing strategic guidance on supply chain optimization and policies for pre-positioning; and iii) streamlining the approach to harmonizing product specifications, food safety standards and uses of evidence. This has involved three main streams of work: 1. Evidence building and dissemination

1.1 Highlighting findings from the Malawi study on packaging size, behavior change and appropriate preparation of fortified blended food products via presentations, draft journal articles and sharing of datasets through the Development Experience Clearinghouse (DEC). 1.2 Completing data collection in Burkina Faso and initiating data cleaning and analysis; and preparation for presentations later in FY 2017 on preliminary findings. 1.3 Preparation for the new study in Sierra Leone including: moving staff to the study site, establishing relations with local non-governmental organizations (NGOs) and government partners and ensuring the shipment of foods needed for the study. 1.4 Development of a “Score Card” listing sustainable impacts of its work for engagement with a wider stakeholder audience in the context of upcoming Farm Bill negotiations.

2. Guidance on supply chain optimization and pre-positioning

2.1 In-depth and ongoing interactions with key United States Agency for International Development (USAID) and United States Department of Agriculture (USDA) staff relating to accessing relevant data, leading to preliminary analyses and a framework for model development. This will be further elaborated upon in the coming quarters leading to clear guidance to The Office of Food for Peace (FFP) on selecting the most cost-effective food aid responses.

3. Close collaboration among United States Government (USG) and United Nations (UN) agencies

3.1 Engagement of partners to promote convergence in thinking across agencies regarding Ready-to-Use Food (RUF) product specifications; continued engagement with Codex through United Nations Children’s Fund (UNICEF), leading to a greater role and influence for FFP in the global dialogue. 3.2 Technical-level engagement on food safety issues between FFP and USDA, supported by FAQR, leading to a greater consensus on priority issues to be addressed.

Additional FAQR activities during this quarter have involved assessing FFP guidance materials,



reviewing ongoing and planned food aid research (for dissemination via the new Research Engagement on Food Innovation for Nutritional Effectiveness [REFINE] website) and continued engagement with suppliers on audit needs, product development and future innovation potential. Key FAQR Activities:

• Developed a preliminary draft mathematical model for supply chain optimization based on data provided by the USAID/FFP.

• Launched a redesigned and more user-friendly website for REFINE (www.refinenutrition.org). • Assessed the current food safety and quality feedback loop developed by FFP’s Program

Operations Division (POD), with a view to recommending improvements. • Conducted a landscape analysis of current resources available through the FFP website (e.g.,

Commodity Fact Sheets, Commodity Management Information and the Commodity Reference Guide, etc.) in order to assess the structure of materials available online.

• Developed interview guides for key informants from Save the Children and ACDI/VOCA in Burkina Faso about their experiences with the last mile of food distribution as part of the FAQR Burkina Faso Prevention study.

• Continued startup operations for the FAQR Treatment Study in Sierra Leone. The field team set up and opened the main offices for the clinic and survey research teams in Pujehun Town (enumerators were hired and received five weeks of training).

• Developed a draft “Scorecard Report” listing sustainable achievements from FAQR III to be used to inform the 2018 Farm Bill.

Reports and Publications: 1. “Introduction of New and Improved Food Aid Products, 2011-2015: Lessons Learned and Recommendations.”1 2. “Using Title II Reporting Requirements to Build an Evidence Base for Programming.”2 3. "Cooking Instruction Development and Acceptability Tests of Corn-Soy Blend Porridges: Pujehun District, Sierra Leone." (Pending approval to post to DEC) Meetings and Events: International Food Assistance and Food Security Conference (Des Moines, IA, Oct. 10-12, 2016): FAQR held a breakout session presenting an overview of results from FAQR I & II, key objectives of FAQR III and progress toward making food aid more cost-effective and of longer-lasting

1https://dec.usaid.gov/dec/content/Detail.aspx?ctID=ODVhZjk4NWQtM2YyMi00YjRmLTkxNjktZTcxMjM2NDBmY2Uy&rID=Mzg1MzE02 http://pdf.usaid.gov/pdf_docs/pa00mjps.pdf



positive impact. FAQR also organized a side meeting for suppliers and U.S. government representatives from the United States Department of Agriculture (USDA) and USAID to discuss product innovations.

Supplier Visits (Wisconsin and Illinois, Oct. 31-Nov. 3, 2016): FAQR visited food aid commodity suppliers to discuss food quality and safety challenges, packaging technologies, supply chain and existing feedback systems for issues which occur along the supply chain.

MIT Tech Conference (Cambridge, MA, Nov. 10-12, 2016): FAQR participated in a panel presentation at the MIT Technology and Development Conference. The presentation focused on FAQR’s work on analyzing the cost-effectiveness of specialized nutritious food aid products for treating and preventing moderate acute malnutrition (MAM) and why this analysis is crucial to assessing the overall effectiveness of these foods.

Meeting with USAID/FFP POD (Washington, DC, Dec. 13, 2016): FAQR met with Greg Olson, FFP’s Operations Team Leader, and other USAID/FFP staff to review currently available supply chain data and to discuss the supply chain model, country context, current data needs and FFP tools and resources useful for framing the supply chain data. Upcoming Activities in FY 2017:

• The FAQR team will visit Natick Research and Development Laboratories to discuss issues related to food technology, processing and packaging, and to learn about ongoing research in these areas.

• FAQR will plan and help facilitate the semi-annual U.S. Interagency Meeting in February. • FAQR will launch a redesigned and more user-friendly website (www.foodaidquality.org). • The team will finalize protocols for three FAQR Sierra Leone Treatment study sub-studies on

body composition, environmental enteropathy, and saccadic reaction time and submit to the Tufts University Institutional Review Board (IRB).

• Commodities for the FAQR Sierra Leone Treatment study will arrive in Pujehun and data collection for the Sierra Leone study will begin.



I. Background The United States Agency for International Development’s (USAID) Office of Food for Peace (FFP) awarded the Food Aid Quality Review Phase III contract to Tufts University’s Friedman School of Nutrition Science and Policy for the period covering Feb. 1, 2016 to Jan. 31, 2019 with two option years. The Food Aid Quality Review (FAQR) seeks to provide USAID and its partners with actionable recommendations on ways to improve nutrition among vulnerable people for whom the direct distribution of food aid can make a significant impact.

The first phases of FAQR involved reviews of nutrition science. FAQR Phase I recommendations were published in Delivering Improved Nutrition: Recommendations for Changes to U.S. Food Aid Products and Programs3. This report led to FAQR Phase II’s focus on reformulating Fortified Blended Foods, the inclusion of lipid-based products in FFP’s commodity list and testing new products under field conditions. A full summary of FAQR Phase II accomplishments is highlighted in the Food Aid Quality Review Phase II Closeout Report4.

FAQR Phase III concludes Phase II activities, while also responding to additional (new) FFP priorities. FAQR III focuses on generating links between research on food product formulation and recommendations on cost-effective programming and policy-level action among national and multilateral institutions engaged in food assistance. Tufts is working closely with several domestic and international collaborators: USAID, USDA and UN partners, all of whom are committed to strengthening the evidence base for use of specialized food products for targeted nutrition goals.

Phase III Priority Areas include:

1. Researching the effectiveness and cost effectiveness of new food products; 2. Studying improved packaging and delivery approaches to enhance logistics, while maintaining

product quality; 3. Organizing consultative and expert meetings synthesizing state-of-the-art evidence on food-based

nutrition delivery; 4. Defining and disseminating improved field tools for calculating the cost-effectiveness of

alternative foods and programming approaches; 5. Exploring food technology innovation in food product processing; 6. Enhancing supply chain oversight; 7. Establishing stronger and more user-friendly food quality assurance; and 8. Facilitating institutional harmonization and enhanced processes.

The framework for FAQR III focuses on: 1) Products, 2) Programming, and 3) Processes:

3pdf.usaid.gov/pdf_docs/pnadz842.pdf 4 pdf.usaid.gov/pdf_docs/PA00M9B8.pdf



Products Tufts is examining such mission-critical issues as: how food matrices (“the nutrient and non-nutrient components of foods and their molecular relationship to each other”5) affect bioavailability of nutrients and digestibility of products; the potential for thermal/non-thermal processing technologies to improve food matrices; potential roles for existing products that are rarely used today, as well as new products (which may include fortificant powders) and novel packaging technologies to improve resistance to infestation, shelf life and efficiency of handling; dual-use products for emergency response; and completion of the data collection, analysis and reporting on field studies which assess the effectiveness and cost-effectiveness of various newly formulated food products.

Programming Tufts is focusing on improving cost-effectiveness of various intervention designs. This includes strategy development for pre-positioned special nutrition products, guidance on options for deployment of specialized products, elaboration of a strategy for responding to food needs in the initial stages of a sudden onset emergency and dissemination of cost calculation tools. FAQR is generating improved technical guidance, sharing details on research protocols used in testing new food aid products in the field and making further progress in harmonizing product specifications.

Processes FAQR III is providing recommendations on institutional and industry processes for capacity building, including the institutionalization and strengthening of interagency technical collaborations, mechanisms to ensure greater policy and product harmonization (domestically and internationally), providing recommendations for enhanced supply chain oversight, establishing stronger and more user-friendly quality assurance feedback loops, as well as promoting food safety and quality standards which can also be applied to local and regional food procurement.

FAQR III organizes its activities into the following work streams:

A. Food Matrices B. Food Aid Basket C. Commodity Management System D. Food Aid Safety and Quality Systems E. Cost Tools F. Field Research G. Interagency Communications and Harmonization H. Knowledge Sharing

5Source: United States Department of Agriculture: National Agricultural Library (https://agclass.nal.usda.gov)



II. Activities for the period Oct. 1 – Dec. 31, 2016

For a detailed overview of work stream activities see Annex I

A. Food Matrices Activities related to:

1) Examining the evidence on how the composition and structure of food products influence the bioavailability, absorption, and physiological utilization of nutrients.

2) Exploring innovations in thermal and non-thermal food processing including perspectives on food functionality (quality control), nutrient content and bioavailability, palatability, and digestibility.

Activities for First Quarter, FY 2017:

The FAQR team reviewed the concept note for this work stream and conducted a literature review and landscape analysis of current available information related to food matrices. The team identified gaps in research including enzyme systems, prebiotics, in-vitro lab tests and software to build a food product database. FAQR identified additional stakeholders to interview as part of the literature review. The team also developed recommendations for next steps for research including developing in-vitro models for new matrices.

In addition, the team planned exploratory meetings with Natick Research and Development Laboratories, producers in the pet food industry and animal feed stakeholders, to understand current innovations in these domains.

The team continued to plan a workshop titled “Food and nutrition science for mitigating malnutrition/undernutrition through food aid programs” to be held as a one-day session during a larger conference such as Institute of Food Technologists (IFT) 2017. The purpose of the session will be to vet findings from the work stream activities and identify future priority areas and gaps. The forum will also be used to discuss food matrices and bioavailability of nutrients and methods to improve the overall effectiveness of food aid products as measured through health outcomes. Small group discussions will also be held to identify future priority areas/gaps which could be further researched, possibly with funds from World Food Programme (WFP) or United States Department of Agriculture (USDA).

Finally, the team created protocols for Bostwick testing and analysis of the Fortified Blended Foods (FBFs) and Ready-to-Use Supplementary Food (RUSF) being used in the FAQR field research studies.



B. Food Aid Basket The “food aid basket” refers to the list of products available for programming under Food for Peace.

Activities related to the Food Aid Basket include:

(1) Enhancing the food basket with existing commodities;

(2) Assessing new products for inclusion in the food basket;

(3) Exploring dual-use products for emergency response;

(4) Developing a strategy to introduce new or modified specialized products;

(5) Providing food and ration technical guidance;

(6) Facilitating the institutionalization of an expert-driven periodic review of nutrition evidence; and

(7) Planning to conduct accelerated shelf life trials for fortified rice and high-energy biscuits.


The Food Aid Basket Research Assistant (RA) worked on revising the Concept Note for this work stream. The RA also conducted a desk review on policy-level decisions related to the food aid basket and researched the history of how the U.S. government has developed its food aid activities over time, gaining an understanding of the ways products and programming approaches have evolved. The team began to conceptualize a process for setting up a technical advisory group (TAG), including what might be incorporated into a memorandum of understanding (MOU), what the group’s mandate would be and a central question for the group: “How does each agency make a decision to introduce new products?”

C. Commodity Management System Activities related to:

(1) Updating and streamlining the USAID/FFP commodities resources portal;

(2) Developing and modernizing commodity reference guide fact sheets; and

(3) Harmonizing specifications and templates for food aid commodities.


1. Commodity Reference Guide – USAID FFP Commodities Resource Portal The team is conducting a landscape analysis of current USAID FFP resources available through the FFP website (e.g., Commodity Fact Sheets, Commodity Management information and the Commodity Reference Guide, etc.) in order to assess the structure of materials available online. They also reviewed World Food Programme (WFP), United



Nations Children’s Fund (UNICEF) and food aid suppliers’ websites to identify commonalities. The landscape analysis will also identify new and relevant materials based on the latest product, programming and procurement information, and FFP priorities.

2. Commodity Reference Guide Fact Sheets FAQR reviewed the existing fact sheet templates and created a revised proposed template for fact sheets, which was discussed and approved by USAID. The team also updated the quarterly fact sheets currently available on the FFP Commodities Resource Portal.

3. Harmonized specifications and templates The team reviewed all currently-used documents and processes to create a template for a matrix to highlight discrepancies between all aspects of WFP and USAID/USDA specifications, including nutrient composition, packaging, microbiological tests, food safety, quality, etc. The team gained approval for the template from USAID and populated the matrix for priority products identified by USAID. The team created and submitted draft specifications for Super Cereal Wheat Plus and Wheat-Soy Blend Plus based on the new specifications template used for RUF (effective Dec. 21, 2015).

D. Food Aid Safety and Quality Systems Activities related to:

(1) Exploring the potential for improved food aid packaging;

(2) Reviewing supply chain oversight;

(3) Assessment of the existing food safety and quality feedback loop; and

(4) Quality assurance for local and regional procurement.


1. Food aid packaging FAQR hired a Food Aid Packaging RA who will start part-time in January 2017 and begin full-time in Boston starting in March 2017.

2. Supply chain oversight FAQR conducted a second round of analysis for supply chain data provided by the FFP Program Operations Division (POD). Additionally, they compiled a limited literature review of supply chain analytical models and held a meeting with USAID/FFP’s operations division to gain a better understanding of their operations. The team also developed an initial mathematical model for supply chain optimization.

3. Food safety and quality assurance feedback loop



The team assessed the existing food safety and quality feedback loop developed by FFP’s POD. The team interviewed commodity management, supply chain and food safety experts within USAID FFP and in the larger PVO stakeholder community to gather additional feedback on the current USAID FFP POD food incident feedback loop and survey. This process also included reviewing and identifying best practices from WFP’s food incident protocol and commercial supply chain oversight.

4. Quality assurance for local and regional procurement The team worked with Rufino Perez as he plans for a small meeting on food safety and quality with a group of key stakeholders including UNICEF, WFP, Agricultural Marketing Service (AMS), and USAID/FFP. FAQR continues to conceptualize and plan for a focused interagency harmonization session on auditing, sampling and inspection of processing facilities.

E. Cost Tools

Activities related to:

(1) Developing a strategy for assessing cost-effectiveness of new modalities of response to emergencies;

(2) Developing cost-effectiveness tools for food aid programs; and

(3) Developing the cost methodology and cost-effectiveness analysis plan for ongoing field studies.


1. Cost-effectiveness in response to emergencies The FAQR team conducted a second analysis of cost-effectiveness data provided by FFP/ POD. Additionally, they compiled a limited literature review on cost-effectiveness in response to emergencies and held a meeting with USAID/FFP’s operations division to gain a better understanding of their operations. The team also created an initial mathematical model for optimization of the supply chain in emergencies.

2. Cost-effectiveness tools The Cost Specialist conducted an initial analysis of the model input data provided by USAID/USDA and clarified relevant data questions with USAID in order to build the decision support cost tools.

3. Cost Methodology and Cost-effectiveness Analysis Plan The Cost Specialist continued to create and refine cost data collection instruments and to build the cost matrix and cost-effectiveness analysis plan for the Sierra Leone treatment study. The cost specialist visited the study site in Sierra Leone.



F. Field Research

Activities include:

(1) Malawi feasibility and cost-effectiveness study of increasing amount of oil added to corn-soy blend (CSB) porridge prepared by caregivers through changes in Corn-Soy Blend Plus (CSB+) oil ration quantity, packaging and Social and Behavior Change Communication (SBCC) messaging;

(2) Burkina Faso effectiveness and cost-effectiveness study comparing four supplementary foods for prevention of stunting and moderate acute malnutrition (MAM);

(3) Sierra Leone treatment and cost-effectiveness study comparing four supplementary foods used for treatment of MAM; and

(4) Developing guidance and examples to inform future research protocols intended to assess the effectiveness and cost-effectiveness of foods, rations, and programming approaches related to preventing and treating malnutrition.


1. Malawi feasibility studya. Manuscripts

The manuscript reporting the main findings from the Malawi Feasibility Study was accepted for publication in the journal Maternal & Child Nutrition.

The FAQR team completed and submitted two other manuscripts from the Malawi study data: one analyzing the relationship between the SBCC intervention and flow of communication through the Care Group Model in changing behavior/communicating CSB porridge messages; another comparing self-report versus direct measures for assessing corn-soy blend porridge preparation and feeding behavior.

b. Case study

The team completed and submitted a case study to present the qualitative findings from focus group discussions on the perceived positive and negative aspects of repackaging CSB from 25 kilogram sacks to 2 kilogram bags.

c. Data

The team uploaded the data used for the main findings paper to the USAID Development Data Library (DDL).

2. Burkina Faso prevention of MAM and stunting study a. Beneficiary intervention follow-up



Beneficiary intervention follow-up visits did not occur this quarter as the ViM program distribution has finished.

b. Post-intervention follow-up

Between October and December, the field team continued to measure children for their post-intervention follow-ups, which ended in December. Annex 3 and Annex 4 summarize the post-intervention follow-up activities.

c. Surveys and data collection

The team continued field supervision and quality control of data collection and conducted regular meetings with supervisors, in-home observers, enumerators, interviewers and focus group facilitators. The team ensured collaboration between Institut de Recherche en Sciences de la Santé (IRSS) and ViM program promoters and supervisors. Annex 5 summarizes the qualitative data collection activities, which ended in October. During November and December, enumerators continued to collect GPS data from households which had been randomly selected for surveys but whose surveys were not completed due to various reasons such as travel or inaccessibility.

d. Data entry

The field team continuously entered monthly data on anthropometric measurements and morbidities for each child included in the study and already in the database. The database is up to date on entry of monthly anthropometric data. The data entry team completed data entry of all end-line socio-economic forms (5,393), lead mother surveys (265), beneficiary mother interviews (1,463), distribution observations (48), promoter interviews (32) and community questionnaires (199). They have entered 98 in-home observations to date.

e. Porridge samples

The team continued collaborating with Nepal’s National Public Health Laboratory (LNSP) to analyze porridge samples, and ensure that porridge analysis follows the correct procedures. The lab analyzed the remainder of the porridge samples. They analyzed a total of 707 porridge samples throughout the life of the study.

f. “Last Mile” interviews

The team submitted a new data collection instrument to the Tufts University IRB to conduct qualitative interviews with key informants from Save the Children and ACDI/VOCA about their experiences with the “last mile” of food distribution—the final leg of delivery from a storage facility such as a central or satellite field warehouse to the hands of the beneficiaries—and what happens to the commodities after they reach the beneficiaries. Data collected will contribute to the knowledge base surrounding the “last mile” for food aid distribution programs in six areas: losses, food safety, sharing and



leakage, acceptance and use, process barriers to achieving distribution, and beneficiary experiences with and perceptions of the program. The team is currently waiting for IRB approval.

3. Sierra Leone treatment of MAM studya. Study preparation and logistics

The field team set up and opened the main offices for the clinic and survey research teams in Pujehun Town. Project Peanut Butter coordinated the transport of the storage container for the food commodities from the WFP warehouse to Pujehun Town. Caritas Bo began community mobilization activities through weekly radio messaging communicating timeline and activities for study start-up. The team began gathering costing information on start-up expenses for the cost-effectiveness analysis. A list of vendors for sourcing key study materials (such as pharmaceuticals for the clinics and bottles for repackaging the oil) was started along with a price list for materials.

b. Commodity procurement

The team formed a contract with Zura Consulting to serve as freight forwarders/chartering brokers for FAQR’s commodities.

Didion Milling produced all commodities for the treatment study (Corn-Soy-Whey Blend [CSWB], CSB+, Super Cereal Plus with amylase, and fortified vegetable oil [FVO]) and undertook rigorous quality testing. Due to peroxide values outside of the specification level, a second production run was needed. Commodities are anticipated to ship at the beginning of January 2017.

The 37.5 metric tons (MT) of Ready-to-Use Therapeutic Food (RUTF) procured by WFP from Edesia arrived in Sierra Leone safely and will be stored in the WFP warehouse in Kenema until the study begins.

WFP conducted a final inspection of and issued the procurement request for 16 MT of RUSF from the local implementing partner, Project Peanut Butter. The contract is expected to be finalized in January and production to begin in late January/early February.

c. Training of enumerators for data collection

Caritas Bo posted the vacancy announcement for 34 enumerators, four field supervisors, and two data clerks. Interviews were held in October and trainings are carried out in November and December. Of the 34 enumerators, 20 will be invited to remain for the duration of the study. Over the course of five weeks, enumerators were trained on the different survey methods (in-depth interview, focus group discussions, in-home observations and enrollment survey/clinic card) for each food as well as ethics of conducting survey research, overview of the study and project, how to use tablets in survey research and other related topics. The time was split between Caritas offices in



Bo and Pujehun.

d. MOU with CAWeC

The team negotiated and signed a memorandum of understanding (MoU) with Community Action for the Welfare of Children (CAWeC), a local NGO coordinating nutrition-specific and sensitive programming in 800+ communities throughout Pujehun District. The agreement will allow CAWeC to communicate and coordinate with the field team on community mobilization activities, integrating the four foods-specific social behavior change communication (SBCC) messages into community-health workers’ training and outreach, and to establish a robust referral system during community screening for MAM cases to peripheral health units (PHUs) enrolled in the study.

e. Study timeline

As noted under Commodity Procurement, the fortified blended flours did not ship to Sierra Leone in 2016 as expected. The foods are expected to ship in January 2017. Allowing for six weeks’ transit time and two weeks to clear the port, the study start date currently is estimated to be March 20. The first three months of 2017 will be used to: pilot field operations; develop, pilot and pre-test the SBCC modules; finalize the list of PHUs that will be enrolled in the study; and engage in community outreach activities in preparation for the roll out of clinics. Annex 6 provides a current study timeline.

f. Sub-Studies

Two research assistants were hired to implement the body composition and environmental enteropathy sub-studies. The research assistants will divide their time between the sub-studies.

a. Body composition

The research assistants drafted the IRB protocol, identified the laboratory where the urine samples will be sent and began compiling the list of required supplies.

b. Environmental enteropathy

The IRB protocol and supplies list was drafted for the sub-study. A laboratory for the dual sugar test was identified. RA Isabel Potani visited Dr. Mark Manary’s environmental enteropathy study sites in Malawi to observe study implementation and generated recommendations for protocol development and logistics for the FAQR III study.

c. Saccadic reaction time

This quarter a contract was finalized between Tufts University and Dr. Jukka Leppänen to serve as the neurocognitive consultant on the Saccadic reaction



time sub-study. Dr. Leppänen worked with the FAQR team to draft a protocol for the sub-study. Additionally, FAQR began to purchase materials for the sub-study including an eye-tracking machine for collection of sub-study measurements.

g. Institutional Review Board (IRB) The FAQR received approval for the main study protocol to the Tufts Institutional Review Board (IRB).

G. Interagency Communications and Harmonization Activities related to institutionalization of interagency consultations (U.S. focused and U.S.-Global).


1. U.S.-focused interagency group The team planned for the semi-annual U.S.-focused interagency meeting to take place in mid-March, 2017. Major agenda items include: Research (FAQR, Packaging, New Products, Specifications), Fortified Rice (Procurement, Shelf Life, Fortified Rice Kernel Specifications), Food Safety (Joint Auditing System, Interagency Committee on Food Safety, Food and Drug Administration [FDA] Food Safety Participating Agency Program Agreement [PAPA], USAID Food Aid Commodity Warehouse Expectations), and the Interagency Approval Process for Innovative/New Products.

2. Globally-focused interagency group

The FAQR team organized a conference call to discuss dates and possible agenda items for the next global interagency harmonization meeting. The next interagency harmonization meeting is planned for June 2017.

Additionally, the team developed a work plan template to track progress toward global interagency group goals semi-annually.

H. Knowledge Sharing

Activities include:

(1) FAQR II “Scorecard Report;”

(2) Evidence Summit;

(3) Research Engagement on Food Innovation for Nutritional Effectiveness (REFINE)—http://www.refinenutrition.org; and



(4) FAQR communications.


1. FAQR II “Scorecard Report” A draft of the “Scorecard Report” was completed and circulated to USAID/FFP for comment in anticipation of negotiations and advocacy activity in the context of the 2018 Farm Bill negotiations. FAQR III team members met with USAID/FFP to discuss uses and dissemination of the “Scorecard Report” in Quarter 2 of FY 2017. The “Scorecard Report” highlights the anticipated sustainable achievements of FAQR including: U.S. food aid products redesigned to be fit-for-purpose and new products introduced, industry-standard product specifications and accelerated shelf-life testing assessments for new products established, global standards set for food aid (aligning UN and U.S. agencies), open access evidence on successful food aid products and programming protocols initiated, innovations in food aid packaging, and cost-effectiveness tools and approaches applied to all food aid programming choices.

2. Evidence Summit

The FAQR team continued to discuss the themes, purpose, audience, output and organization of the Evidence Summit–provisionally planned for late 2018. Additionally, speakers were confirmed and planning continued for two sessions at the 2017 International Congress of Nutrition (ICN).

3. REFINE The updated REFINE website (refinenutrition.org) was publicly launched at the International Food Assistance and Food Security (IFAFSC) conference in Des Moines, IA on Oct. 10, 2016. The updated website features a map which documents current studies going on around the world which involve food aid, a library of studies related to food aid effectiveness and a description of the gaps in the research literature.

The REFINE RA also compiled a resource update and continued ongoing information dissemination through Twitter.

@REFINEnutrition Twitter Analytics for this quarter:

Tweets Retweets Likes New Followers Total Followers October 6 8 16 14 62

November 9 7 11 9 76 December 13 10 13 8 84 TOTAL 28 25 40 31 84



4. FAQR communications

The FAQR Communications RA developed templates for briefs and PowerPoint presentations to be used by all team members and continued to upload approved documents to DEC. The team continued to work on materials and content for the update FAQR website and prepared to launch the updated website in January 2017.



III. Administration and Budget During this quarter, the following activities were undertaken:

A. Work Plan The FAQR team updated sections of the FAQR Phase III work plan, which includes: sub-activities, timelines, milestones/outputs and responsible team members.

B. Budget The FAQR team submitted a request to USAID/FFP for allocation of the second tranche of funding for FAQR III and a budget modification based on actuals from FY 2016.

C. Subcontract and Consultant Contracts FAQR formed a contract with Dr. Jukka Leppänen to serve as consultant for the Sierra Leone neurocognitive sub-study.

Additionally, FAQR formed a contract with Sidie Sahid Sisay to serve as field research coordinator for the Sierra Leone treatment study. Sidie’s scope of work will focus on completing cost data collection for the cost-effectiveness analysis.

D. Staffing Akriti Singh joined the FAQR team as a Senior Field Research Assistant for the body composition and environmental enteropathy sub-studies in Sierra Leone. Akriti is currently pursuing a doctoral degree in food policy and applied nutrition at Tufts University, Friedman School of Nutrition Science and Policy. She holds a Master’s Degree in Public Health (MPH) from Yale University School of Public Health (YSPH) with a specialization in epidemiology of microbial diseases. Prior to attending Tufts, Akriti spent four years working for Suaahara (Phase I), a USAID-funded integrated nutrition project in Nepal. She has also worked as program manager for the Global Health Concentration at YSPH. Akriti is working part-time with FAQR and will join the team full-time in January 2017.

Isabel Potani joined the FAQR team as a Field Research Assistant for the body composition and environmental enteropathy sub-studies in Sierra Leone. Isabel holds a Bachelor’s Degree in Nursing from the University of Malawi as well as a Master’s Degree in Human Nutrition with Public Health specialization from the University of Glasgow. Before coming to Tufts, Isabel was working as Senior Nurse in a Pediatric Ward for severe acute malnourished children. In addition, she has worked as a Senior Research Nurse for clinical studies on Severe Acute Malnutrition and has also worked with the Malawi Ministry of Health in developing the 2016 National Community Management of Malnutrition Guidelines. Additionally, she is a recognized National Trainer on management of malnutrition in Malawi. Isabel is working as a part-time consultant with FAQR and will join the team full-time in January 2017.

The FAQR team hired one student RA:



French Translation RA Marisa Tsai is pursuing an Master’s Degree in the Food Policy and Applied Nutrition program at Tufts Friedman School of Nutrition. She holds a Bachelor’s Degree in International Relations from the University of Southern California.



IV. Plans for the Coming Quarter (January-March 2017)

A. Food Matrices

a. Complete work stream concept note outlining purpose/scope, objectives, protocol and methodology for work stream.

b. Continue to conduct literature review/landscape analysis on current food matrices and gaps in data and develop recommendations for next steps.

c. Continue to identify additional stakeholders to interview and create interview guide. d. Complete all interviews and analyze results e. Meet with Natick Labs and animal feed stakeholders to understand ongoing work and

to review the scope of the concept note. f. Create protocols for CaCo2 testing of porridges used in the Sierra Leone treatment

study, conduct tests, analyze result) and write recommendations for possible inclusion of future in vivo or in vitro testing.

B. Food Aid Basket

a. Finalize work stream concept note. b. Food Basket with Existing Commodities:

i. Create a data collection plan, including a list of stakeholders to interview from NGOs and industry representatives.

ii. Continue to conduct a desk review - Collect and review reports on discontinued/never-used products, and document/compile lessons learned. (In addition, compile gray literature and acceptability and use reports on foods, which may be field reports from PVOs).

iii. Conduct a qualitative review - Develop the interview guide and complete data collection to quantify use of products in food aid basket (amounts, frequencies, use).

c. New Products, Technologies and Formulations and Deployment of New Specialized Products:

i. Create a data collection plan, including the list of stakeholders to interview (NGOs, industry reps, etc.).

ii. Conduct information-gathering activities (i.e., Packaging Innovation workshop at MIT, FAQR Supplier Side Meeting at International Food Assistance and Food Security Conference) - Collect information to quantify use of new products (amounts, frequencies, use).

iii. Conduct a desk review - Collect and review reports on new products and compile lessons learned.

iv. Conduct a qualitative review - Develop the interview guide and complete data collection to quantify use of products in food aid basket (amounts, frequencies, use).

v. Hold Workshop I: "What is the process for accepting food aid products?" to gather input on new product decision criteria.

d. Technical Advisory Group (TAG) i. Define the TAG (e.g., Terms of Reference [TOR]).



e. Fortified Rice Accelerated Shelf Life Trial i. Develop study protocol and review with USAID FFP.

f. Accelerated High Energy Biscuits (HEB) Shelf-Life Trials i. Assist US HEB supplier in developing protocol for accelerated shelf-life.

g. Dual Use Products for Emergency Response i. Collect and review reports use of SQ-LNS and MQ-LNS, MNPs, FBFs, RUSF,

HEB, and other relevant products used in emergencies, school feeding, and development programs, and document/compile lessons learned (using REFINE to assist with gathering research on these products).

h. Food and Ration Technical Guidance i. Complete literature review on all research related to policy-level decisions.

C. Commodity Management System

a. Commodity Reference Guide i. Conduct a landscape analysis of current USAID FFP resources available

through the FFP website (e.g., Commodity Fact Sheets, Commodity Management Information, and the Commodity Reference Guide, etc.) in order to assess structure of materials available online; review WFP, UNICEF, NGOs and food aid producers’ websites to identify commonalities. Will include identifying new and relevant materials based on the latest product, programming and procurement information, and FFP priorities.

ii. Review findings from the landscape analysis with USAID and develop joint recommendations for USAID FFP portal.

b. Commodity Reference Guide Fact Sheets i. Hold expert consultations/distribute to key stakeholders (USAID, USDA,

NGOs) to discuss templates and solicit feedback. (Will include creation of questionnaire guide for interviews.)

ii. In parallel, continue to update the Commodity Reference Guide, the Commodity Fact Sheets for new and modified products and other tools for programming new specialized products.

c. Harmonized Specifications and Templates i. Review all currently-used documents and processes to create and have USAID

approve template for Matrix to highlight discrepancies/differences between WFP and USAID/USDA specs (all aspects) - nutrient composition, packaging, microbiological tests, food safety, quality, etc.

ii. Create harmonized commodity specifications templates for new and updated products, in consultation with industry (U.S. suppliers) and international partners (WFP, UNICEF).

D. Food Aid Safety and Quality Systems

a. Food Protection i. Onboard an RA to focus on packaging/food protection

b. Supply Chain Oversight i. Complete a limited review of analytical tools framing data analytics work and

the Supply Chain decision tool.



ii. Revise the concept notes as needed and finalize the concept note and share widely to gain buy-in. (This will include meeting with FFP POD to identify staff to assist with this work.)

iii. Analyze the FFP data 2011-2016 for all operations (answering question received January 2017 from USAID/FFP POD).

iv. Analyze and understand use and distribution of commodities from Preposition Warehouses (after receiving data from USAID/FFP POD).

v. Analyze and understand in country supply chains for Ethiopia and Uganda. c. Food Safety and Quality Assurance Feedback Loop

i. Review key aspects of supply chain oversight. Tufts will also assess the existing food safety and quality feedback loop developed by FFP’s Program Operations Division.

ii. Review of other systems being used to track incidents (including commercial companies).

E. Cost Tools

a. Cost-effectiveness in Response to Emergencies i. Revise the concept notes as needed, finalize the concept note and share widely

with relevant stakeholders. ii. Identify and hold expert consultations or workshop with key stakeholders (e.g.

USAID, USDA, NGOs, WFP, UNICEF) to present our proposed work. iii. Analyze and understand emergency response operations. iv. Obtain and prepare data from past emergency operations.

b. Cost-effectiveness Tools i. Review new documents (with particular focus on product-specific

recommended product dosages and on expected health/nutrition outcomes). ii. Update Phase II model. iii. Develop time series data on USAID product procurement costs,

transportation cost and on macro ingredient costs. iv. Seek more data from sources suggested by other work streams. v. Develop the Phase III Decision Support Cost Tool.

c. Cost Methodology i. Cost Matrix and User Manual-Malawi (share details on “last mile” with

Technical and Operational Program Support [TOPS] group). ii. Develop Cost Matrix for Sierra Leone 2.0. iii. Cost Matrix and User Manual-Sierra Leone (share details on “last mile” with

TOPS group) F. Field Research

a. Malawi Feasibility Study

i. Complete and submit remaining manuscripts and case studies for publication. b. Burkina Faso Prevention Study

i. Field data cleaning: send enumerators back into the field to gather any missing data or correct any implausible values.

ii. Continue data entry.



iii. Begin close-out of the field operations and determine plan for disposition of materials.

iv. Continue cost-effectiveness analysis. v. Work with labs to finalize lab data. vi. Preliminary data analysis. vii. Plan for data dissemination workshops. viii. Discuss potential manuscripts and reports with the FAQR and IRSS teams.

c. Sierra Leone Treatment Study i. Ship research food commodities. ii. Continue study preparation. iii. Distribute foods for study. iv. Finalize protocols for three sub-studies and submit to IRB. v. Finalize logistics for three sub-studies.

d. Research Protocols i. Use the REFINE platform to develop a list of research ongoing or completed

whose protocol FAQR III would like to learn more details about. ii. Create an outline for a research protocol guidance document.

G. Interagency Communications and Harmonization

a. U.S. Interagency i. Based on findings from meeting with Food Aid Consultative Group (FACG)

organizers, determine next steps for institutionalizing this effort. ii. Plan and host U.S. Interagency meeting.

b. U.S.-Global Interagency (Harmonization) i. Update Interagency Harmonization workplan. ii. Plan for the next Harmonization meeting (June 2017).

H. Knowledge Sharing

a. FAQR II “Scorecard Report”

i. Consult with Contracting Officer’s Representative (COR) to develop Summary of Accomplishments/Scorecard.

ii. Complete Summary and Full Scorecard. b. Evidence Summit

i. Prepare a Proposal and Themes (Purpose, Organization of the Summit, Audience, Outputs).

c. Plan for two accepted symposium presentations at ICN 2017 (Body Composition/Environmental Enteropathy and New Research Frontiers).

d. REFINE i. Disseminate quarterly REFINE resource updates. ii. Compile Quarterly Report (quantified updates-cumulative and quarterly). iii. Conduct Research Gap Analysis. iv. Develop Research Uptake Strategy. v. Develop Research Design Protocol and Data Management and Analysis Plan. vi. Develop recommendations for future REFINE outputs: policy briefs, research



briefs, etc. e. FAQR Communications

i. Develop FAQR III brief documents as needed. ii. Collect target audience's contact information (website, Twitter) for future use. iii. Work with Friedman website team on website layout, aesthetics, widgets and

uploading Mendeley Library. iv. Conduct focus group with FAQR team members to gather ideas to tweak

website design and content. v. Seek approval from USAID/FFP on website design. vi. Launch FAQR project website. vii. Publicize FAQR website launch.

viii. Twitter: follow target audiences in FAQR III Strategic Communications Plan.

ix. Collect website revamp statistics. x. Troubleshoot new website as needed.

I. Administration and Budget

a. Work Plan i. Build out the Project Year 2 (February 1, 2017 to January 31, 2018) work plan

with work stream facilitators. b. Organogram

i. Create a detailed organogram of all FAQR team members. c. Budget

i. Second tranche of funding allocated from USAID. d. Consultant Contracts and Subcontracts

i. Finalize amendments to all subcontract and consultant contracts after allocation of second tranche of funding from USAID.

e. Staff Hiring and Onboarding i. Communications Student RA. ii. Food Aid Packaging RA. iii. Tufts Global Operations/Safeguard set-up for International Staff.

f. Annual Report Submitted to USAID



Annex 1. Detailed overview of work stream activities

A. Food Matrices Overview: Activities related to examining the evidence on how the composition and structure of food products influence the bioavailability, absorption and physiological utilization of nutrients. This also encompasses exploring innovations in thermal and non-thermal food processing including perspectives on food functionality (quality control), nutrient content and bioavailability, palatability and digestibility.

B. Food Aid Basket Overview: Activities related to the food aid basket include:

(1) Enhancing the food basket with existing commodities: Tufts is conducting an assessment of currently used, rarely used and discontinued products to establish past uses, purposes and why they are no longer called forward for programming.

As part of this work stream, the FAQR team is (2) assessing new products: exploring innovations in product development and technologies which could enhance food aid baskets, and help FFP define a process by which products should (or should not) be added to an improved basket, bearing in mind the need for streamlining and/or updating existing processes.

The FAQR team is (3) exploring dual-use products for emergency response: by studying what agencies already use, as well as a consultation with partners on desirability of multi-use products for future programming. This stream of work is also developing guidance on how and when to deploy specialized products in acute phase response, as well as mapping out longer-term strategies.

FAQR is assisting in (4) developing a strategy to deploy new specialized products: including recommended guidance on public announcements of new products, the preparation and distribution materials explaining when and how to use these products (including topics such as appropriate warehousing, shelf life, etc., as well as appropriate uses in the field) and recommendations regarding monitoring and evaluation of the effectiveness of such products in the context of emergency and non-emergency operations.

The FAQR team is also (5) providing food and ration technical guidance: As part of developing a strategy for deploying specialized products, Tufts is preparing updated food product and ration (food basket) technical guidance that includes both value-added and other foods for use in the design of both multi-year development projects and annual program statements for emergency and non-emergency activities.



In addition, the FAQR team is also (6) facilitating the institutionalization of an expert-driven periodic review of nutrition evidence. The goal of this process is to inform the evolution of food products, programs and processes.

Finally, the team is planning to (7) conduct accelerated shelf life trials for fortified rice and high energy biscuits

C. Commodity Management System Overview: Activities related to:

(1) Updating and streamlining the USAID/FFP commodities resources portal. This involves efforts to publicize products available in the U.S. food aid basket and better share and present commodity information online to private voluntary organizations (PVOs), suppliers, USAID mission representatives and other stakeholders, especially for new products.

(2) Developing and modernizing commodity reference guide fact sheets. FAQR is developing and populating modernized fact sheets based on a template and is assisting FFP in finalizing a strategy for regular updating of the Commodity Reference Guide Fact Sheets and other tools for programming new specialized products.

(3) Harmonized specifications and templates for food aid commodities. This includes developing commodity specification templates which are aligned with general industry practice standards, harmonizing U.S. product specifications with international product specifications, and standardizing and enhancing interaction between USAID and USDA, and between government and the private sector about these matters.

D. Food Aid Safety and Quality Systems

Overview: Activities related to:

(1) Exploring the potential for improved food aid packaging in enhancing/retaining nutrients in food aid products, extending product shelf life, improving transportability, resisting pest infestation, and messaging in addition to assessing issues of packaging and storage, including pest infestation, mold contamination, food wastage, as well as environmental concerns relating to container disposal.

The work stream also includes (2) reviewing supply chain oversight: analyzing decision making along the entire supply chain in order to optimize processes and identify efficiencies and choke points. The supply chain assessment also takes into account potential threats to food safety, nutrient stability, product quality, and cost-effectiveness, where “effectiveness” is defined in terms of timely delivery of products to their final destination in good condition.

FAQR Phase III is also conducting an (3) assessment of the existing food safety and quality feedback loop which was developed by FFP’s Program Operations Division (POD).



Lastly, this work stream includes (4) quality assurance for local and regional procurement. USAID FFP is transitioning from Good Manufacturing Practices (GMP) to a Hazard Analysis and Critical Control Points (HACCP) approach to food safety and USAID food aid procurement is adapting to include more local and regional procurement (LRP). FAQR III is supporting this transition from GMP to HACCP and assisting in maintaining the same standards of food safety and quality in both U.S.-sourced and internationally-sourced food aid commodities.

E. Cost Tools Overview: Activities related to:

(1) Developing a strategy for assessing cost-effectiveness of new modalities of response to emergencies: modeling of the entire value-chain as a “system” (including product mix, transfer modality, regional and local procurement, storage location and amounts, transport and delivery options), a total cost-effectiveness analysis is being conducted. The goal is to move beyond sequential and siloed decision making without proper visibility of each decision’s impact on others to consider the entire value chain as an interacting system.

This work stream also involves (2) developing of cost-effectiveness tools designed to facilitate optimal decision making for food aid programming. It aims to estimate and compare costs and cost-effectiveness of producing and transporting specialized nutritious food aid commodities such as Corn-Soy Blend (CSB) and Ready-to-Use Supplementary Food (RUSF) products used in USAID/FFP Title II programs and WFP emergency operations.

In addition, this work stream involves (3) developing the cost methodology and cost-effectiveness analysis plan for the field research. This work serves one of the main objectives for each field study which aims to examine and compare the cost-effectiveness of specialized food aid commodities in prevention of moderate acute malnutrition and stunting and treatment of moderate acute malnutrition.

F. Field Research Overview: Activities include: (1) Finalization of the Malawi feasibility and cost-effectiveness study of increasing amount of oil added to CSB porridge prepared by caregivers through changes in CSB + oil ration quantity, packaging and Social and Behavior Change Communication (SBCC) messaging. (2) Continuation of the Burkina Faso effectiveness and cost-effectiveness study comparing four supplementary foods for prevention of stunting and moderate acute malnutrition (MAM) in children who are followed to the age of 24 months, with follow-up measurements up to three months after completion of the supplementary feeding program. (3) Start of the Sierra Leone treatment and cost- effectiveness study comparing four supplementary foods used for treatment of MAM in children 6 months to 5 years of age for up to 12 weeks,



with follow-up thereafter to assess relapse. Three sub-studies are planned in the following areas: body composition, environmental enteropathy and neurocognitive development. (4) Development of guidance and examples to inform future research protocols intended to assess the effectiveness and cost-effectiveness of foods, rations and programming approaches related to preventing and treating malnutrition.

G. Interagency Communications and Harmonization Overview: Activities related to institutionalization of interagency consultations (U.S.-focused and U.S.-Global). FAQR is engaging industry, USAID, USDA and the Food Aid Consultative Group in developing a strategy to institutionalize these interagency interactions relating to food aid products, quality assurance and policy positions. Tufts continues to provide support to the two main interagency technical groups (U.S.-focused and U.S. global-focused) that currently meet. It promotes these groups as modalities for ongoing discussion of product modifications, as well as for the review and approval of new products and/or ingredients, and harmonization of policies, standard and specification-setting, and engagement with industry.

H. Knowledge Sharing Overview: Activities include:

(1) FAQR II “Close-Out Report:” Tufts is preparing a report on lessons learned from each of the main activity streams of FAQR II.

The FAQR team will host an (2) Evidence Summit to share evidence with a wide audience on the cost-effectiveness of specialized foods in the context of implementation of the results of FAQR recommendations on products, processes, and programming.

Finally, as part of this work stream the FAQR team is continuing their work on the consultative processes: (3) Research Engagement on Food Innovation for Nutritional Effectiveness (REFINE).Tufts continues to engage with the broad food aid community during FAQR III, through the REFINE website (http://refinenutrition.org/). REFINE’s goal is to enhance access to, and exchange of, operational and policy-relevant research on food-supported interventions that improve nutrition.

During FAQR Phase III, (4) FAQR communications will be strengthened through increased information sharing and an improved and more user-friendly FAQR website.



Annex 2. Meetings and Events during the period Oct. 1-Dec. 31, 2016 The team continued to hold meetings and attend events throughout the quarter in line with FAQR Phase III activities. Selected specific meetings included the following:

• International Food Assistance and Food Security Conference (Oct. 10-12, 2016)

FAQR team members Patrick Webb, Beatrice Lorge Rogers, Shelley Walton, Lindsey Ellis Green, Kristine Caiafa, Nina Schlossman, Leah Koeppel and Sajid Alavi attended the International Food Assistance and Food Security Conference (IFAFSC) in Des Moines, IA.

In a breakout session, Patrick Webb and Rufino Perez provided an overview of main outcomes of previous phases (FAQR I & II), key objectives of the current phase (FAQR III) and offered a look at specific contributions in the attempt to make food aid more cost-effective and of longer-lasting positive impact. A specific example of research on fortified rice was also provided in the session.

The FAQR team also set up a table at two afternoon networking sessions to provide conference participants with the opportunity to learn more about FAQR.

Finally, the team organized a side meeting for suppliers and U.S. government representatives from USDA and USAID. The purpose of the meeting was to hold an open discussion to highlight progress and elicit input on product innovations, share perspectives on directions for product innovations and address pathways and opportunities to translate research findings into product innovations. Kansas State University (KSU) FAQR Food Engineer Sajid Alavi gave a short presentation on extrusion technology and its link to product innovation.

• Project Administrator trip to Sierra Leone (Oct. 17-31, 2016)

FAQR Project Administrator Lindsey Ellis Green traveled to Sierra Leone to conduct financial and award management training with local research firm, Caritas Bo. Additionally, she assisted the Field Research Manager in negotiating and drafting a Memorandum of Understanding (MOU) with Community Action for the Welfare of Children (CAWeC), provided logistical and procurement support for study startup, clarified contract terms with Project Peanut Butter (PPB) and met with local USAID representatives.

• Burkina Faso Field Research Director visit to Boston, MA (Oct. 15-Nov. 1, 2016)

Ilana Cliffer, the Burkina Faso Field Research Director, visited Boston, MA to meet with the FAQR team to discuss the Burkina Faso prevention study.

The objectives of her visit were as follows:



1. Discuss next steps in data entry, cleaning, and analyses. 2. Discuss ideas for results dissemination. 3. Familiarize data team with the datasets and begin formulating data analyses plans. 4. Write and submit abstract for Experimental Biology conference. 5. Meet with new FAQR partners in other work streams. 6. Discuss next steps in cost analyses.

• Supplier Visits (Oct. 31-Nov. 3, 2016)

From Oct. 31 to Nov. 3, 2016, FAQR Senior Food Technologist Quentin Johnson and USAID/FFP’s Rufino Perez visited food aid commodity suppliers in the Midwestern United States to discuss food quality and safety challenges, packaging technologies, supply chain and existing feedback systems for issues that occur along the supply chain. Vendors visited were Didion Milling in Cambria and Markesan, WI, Incobrasa Industries, Ltd. in Gilman IL, Columbus Vegetable Oils in Des Plains, IL and Bunge Milling in Danville, IL.

• PACK EXPO International Trade Show (Nov. 7-8, 2016)

Quentin Johnson, FAQR Senior Food Technologist, attended the PACK EXPO International Trade Show in Chicago, IL on Nov. 7 and 8. The exposition provided an opportunity to connect with vendors and identify current trends in packaging technology useful to the activities and deliverables of the food aid protection/packaging work stream.

• MIT Tech Conference (Nov. 10-12, 2016) FAQR Co-Principal Investigator (PI) Beatrice Lorge Rogers participated in a panel presentation at the MIT Technology and Development Conference focused on bringing technology and innovation to work in the developing world. The presentation focused on FAQR’s work on analyzing the cost-effectiveness of specialized nutritious food aid products for treating and preventing MAM and why this analysis is crucial to assessing the overall effectiveness of these foods.

• Burkina Faso Brown Bag Presentation at ACDI/VOCA (Nov. 16, 2016)

Burkina Faso FAQR Field Research Director Ilana Cliffer and Co-PI Beatrice Lorge Rogers gave a brown bag presentation to colleagues from ACDI/VOCA and Save the Children on the status of the prevention research study in Burkina Faso. The presentation focused on the study objectives, collaboration with ACDI/VOCA and Save the Children, and discussion about how the results will be useful to future programming.



• Cost Specialist/Data Analyst Trip to Sierra Leone (Nov. 3-26, 2016) Ye Shen, Cost Specialist/Data Analyst, visited Sierra Leone where she developed the start-up cost data collection guide, collected some initial start-up costs with implementing partners and fine-tuned cost data collection protocols in the following cost categories: start-up, storage, and transportation. She also visited PHUs and met with WFP officers at the Freetown Port and Kenema warehouse to prepare for storage and transportation costing.

• Co-PI Trip to Burkina Faso (Nov. 26-Dec. 16, 2016) The Co-PI Beatrice Lorge Rogers traveled to the prevention study in Burkina Faso. The objectives of this trip were as follows: 1. Meet with local ViM program partners, Save the Children and ACDI/VOCA about close-

out of the study and next steps. 2. Meet with local research implementation partner about close-out procedures and next

steps for data entry and analyses. 3. Begin planning process for results dissemination. 4. Provide FFP with study updates.

• Food Aid Consultative Group (FACG) Meeting (Dec. 12, 2016)

Leah Koeppel and Shelley Walton attended the fall FACG Meeting at the National Press Building in Washington, D.C. Dina Esposito shared parting remarks on FFP’s progress, growth and the changing nature of humanitarian assistance due to conflicts and displacement. The FAQR team learned how USAID will be introducing a supply chain management team into its office.

• Supply Chain Meeting with USAID/FFP (Dec. 13, 2016) Ozlem Ergun, Keziban Tasci, Shelley Walton, Quentin Johnson, Patrick Webb, Lindsey Ellis Green and Leah Koeppel met with Greg Olson and other USAID/FFP staff to review currently-available supply chain data and to discuss the supply chain model, country context, current data needs and FFP tools and resources useful for framing the supply chain data. The meeting started with an update on progress made as part of the FAQR Supply Chain work stream. John Lamm from USAID/Emergency Food Security Program (EFSP) shared their tools and experiences with data. USAID Country Bureau Officers (CBOs) for Uganda and Ethiopia gave general information about the process in-country related to procurement and supply chain management. Additionally, commodity prepositioning logistics were discussed briefly.


Annex 3. Summary of Follow-up Measurements in Burkina Faso

Summaryofpost-interventionfollow-upmeasurements,BurkinaFasoFAQR,October-December2016

Oct.2016 Nov.2016 Dec.2016To

bemeasured

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Group1 843 709 33 742 4% 88% 694 597 28 625 4% 90% 526 416 45 461 10% 88%Group2 799 652 48 700 7% 88% 681 550 41 591 7% 87% 512 404 34 438 8% 86%Group3 631 522 25 547 5% 87% 495 401 23 424 5% 86% 311 241 28 269 10% 86%Group4 617 505 36 541 7% 88% 471 386 31 417 7% 89% 295 230 27 257 11% 87%Total 2890 2388 142 2530 6% 88% 2341 1934 123 2057 6% 88% 1644 1291 134 1425 9% 87%


70%

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tchildrenmeasured

Percentofstudychildrenmeasuredeachmonth,bystudybranch,BurkinaFasoFAQR,Nov.2014-Dec.2016*

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*The graph on the previous page shows the percentage of children enrolled in the study who were successfully measured each month from November 2014-December 2016. Though the percentage of children measured in the beginning months is slightly higher than in the later months, this can likely be explained by chronic absences, or children who moved away from the study zone, but are still considered part of the study, as we must conduct analyses with intention to treat.


Annex 4. Summary of Post-intervention Follow-up in Burkina Faso

SummaryofPost-InterventionFollow-UpPlan,BurkinaFasoFAQR

ChildrenremaininginOctober ChildrenremaininginNovember ChildrenremaininginDecember*

NumberofVillages

Group1 843 694 526 32

Group2 799 681 512 42

Group3 631 495 311 72

Group4 617 471 295 51

TOTAL 2890 2341 1644 197*AllchildrenremainingtheinstudyinDecemberweremeasuredfortheirlasttimeinDecember2016,andsubsequentlyexitedthestudy.



Annex 5. Summary of Qualitative Data Collection in Burkina Faso

Instrument Attempted Completed Percentcompleted

In-depthInterviewofBeneficiaryMothers 1780 1463 82%In-homeObservationofBeneficiaryMothers 224 208 93%ObservationofDistribution 48 48 100%FocusGroupofBeneficiaryMothers 24 24 100%FocusGroupofDistributionCommittee 24 24 100%LeadMotherInterview 320 265 83%PromoterInterview 35 32 91%CommunityQuestionnaire 199 199 100%

*This graph helps us understand our progress on different aspects of data collection. It gives an idea of the success rate of attempted interviews and surveys of different types. The blue columns show the success rate based on the percentage of interviews conducted out of those attempted. The red column shows the percentage of the total number of interviews to be conducted in the study, to date.

0%10%20%30%40%50%60%70%80%90%

100%

Qualita5veDataCollec5onSummary,BurkinaFasoFAQR,December2016

SuccessrateofaMempted

Percentoftotalinterviewscompleted


Annex 6. Sierra Leone Study Timeline



Annex 7. IFAFSC Presentation



Annex 8. IFAFSC Side Meeting Notes

FOOD AID QUALITY REVIEW SIDE MEETING PROCEEDINGS Side Meeting: Food Aid Product Innovations 2016 USDA-USAID International Food Assistance & Security Conference

On Oct. 10, 2016, the Food Aid Quality Review (FAQR) held a meeting alongside the International Food Assistance & Security Conference, bringing together 32 participants representing 24 organizations, including commodity suppliers, U.S. government, non-governmental organizations, consulting firms, shipbrokers and research institutions. The goal of this meeting was to highlight progress and on food aid product innovations, share perspectives on directions for product innovations, and address opportunities to translate research findings into product innovations. Members of FAQR facilitated the meeting. The following questions guided the discussion:

- What challenges do suppliers face in meeting USAID’s requirements related to food safety, quality, and packaging?

- What new product innovations and research are you interested in? Where do you see the industry moving in terms of innovations?

- What are the challenges suppliers face related to new product innovations? - What information gaps are there in terms of how research influences new product, packaging

or safety specifications? - What are the pathways for translating research—like FAQR’s—into new product innovation? - What future collaboration is needed between food assistance stakeholders?

MAJOR TAKEAWAYS

§ The business risks of producing specialized food aid products must be reduced. § Strict product specifications and inadequate packaging pose critical challenges to suppliers. § Supplier motivation to create new products can be stimulated through funding partnerships. § Suppliers need improved guidance, especially regarding product market potential and how

research influences the food aid agenda. § Better communication or branding of the intended use and cost-effectiveness of products is

needed. § There are many opportunities for stakeholder collaboration that are yet to be fully harnessed.



WHAT CHALLENGES DO SUPPLIERS FACE IN MEETING USAID’S REQUIREMENTS RELATED TO FOOD SAFETY, QUALITY AND PACKAGING?

Production

§ Ingredient availability—especially since premix needs to be imported § Food safety requirements are strict and possibly unrealistic.

- yeast and mold requirements for product are even more strict than baby food à drives up costs.

§ Supplier facilities outside of the U.S. and Europe need production improvements.

Packaging

§ Rigid, cost-intensive requirements - So different for USAID products that it takes years of dedication to

comply - Introducing new packaging often requires a costly change in

equipment. - This can be a decision point for suppliers to decide if they want to

stay in the market. § Inadequacies

- Packaging material is not sturdy enough for long-term or heavy use. - Cumbersome size - Susceptible to infestation

In-Country Storage

§ Theft and spoilage between destination port and end point

Distribution

§ Theft § Contamination of product once it leaves the strict controls of the

factory § There is no quality control over product distribution/use in the last

mile.

WHAT NEW PRODUCT INNOVATIONS AND RESEARCH ARE YOU INTERESTED IN?

WHERE DO YOU SEE THE INDUSTRY MOVING IN TERMS OF INNOVATIONS?

Products

- Easier to prepare - Inexpensive - Ongoing studies in four

countries to improve grain protection

- Creation of more locally available options

- Aflatoxin prevention - New FBF blends & types

Packaging - Hermetic storage - Hermetic options

Shipping - Bulk shipping using super sacks/container liners

- Eliminating fumigation



- Fumigation of the entire ship before it reaches port

WHAT ARE THE CHALLENGES SUPPLIERS FACE RELATED TO NEW PRODUCT INNOVATIONS?

§ There is little incentive for suppliers to create or change products. - Suppliers are not really focused on innovation. They leave the research up to

universities and comply with specs given to them. - These are specialized foods with specialized market, so suppliers can’t really make

something new. They only make a product after someone asks for it. § In general, producing food aid is a high-investment enterprise (for which there is

no external funding support) … - New ideas for food aid products require extensive testing, development, and

assessment, but there are no good funding sources to do so. - The budget needed to bring a product into a market is prohibitively high. - Producers also need seed funding to tailor existing products for food aid use. - “Product sophistication” comes with many associated cost increases, such as

increased costs to meet packaging requirements or to buy special equipment. § …that is also high risk because demand is not guaranteed, demand volumes are

typically low and PVO interest in new products is lukewarm. - There is no assurance anyone, including USAID, will buy a new product. - Specialized products that are considered “innovations,” like fortified rice, are only for

food aid, so demand can’t be guaranteed, and when it is demanded it’s in small volumes.

- Suppliers need a guaranteed volume that will be purchased; without this it is difficult to forge agreements with packagers.

- Suppliers need to know the market potential of a product (i.e., what countries and regions has it been tested in?).

- Even if a supplier does invest in R&D of a new product, they don’t know who will use it.

- When a contract for a specialized product comes out, commercial mills can’t stop their current product line to shift to food aid products.

- Creating a new product supply chain is hard for PVOs. § So, the economic equation doesn’t balance.

- Suppliers have to decide if they want to participate in the food assistance market and if they can make it economically viable.

§ Overall, commodities need to be offered at an affordable price and marketed by affordability (taking all aspects of product lifespan into account).



WHAT INFORMATION GAPS ARE THERE IN TERMS OF HOW RESEARCH INFLUENCES NEW PRODUCT, PACKAGING, OR SAFETY SPECIFICATIONS?

§ Suppliers have no way of knowing if a product innovation is needed. § There is no standardized pathway for translating ideas into research or research into

practice. § It is not obvious to suppliers:

- What government shelf life requirements are; - What the cost-benefit in impact per dollar of each product is; - What the needs, finances, and programming landscape of the PVO community are; - What role different products play in addressing PVO programming needs; - Why certain products are not used; - How USAID uses these research findings on products; and - How LRP fits into the supplier equation.

WHAT ARE THE PATHWAYS FOR TRANSLATING RESEARCH—LIKE FAQR’S—INTO NEW PRODUCT INNOVATION?

§ Translating product costs into cost/beneficiary and cost/impact, rather than cost/ton § Presenting research findings in a way that allows suppliers to build on existing products while

staying close to those products

WHAT FUTURE COLLABORATION IS NEEDED BETWEEN FOOD ASSISTANCE STAKEHOLDERS?

§ Supplier Industry + U.S. Government (USG) - USG can provide seed funding for new product proof of concept.

§ PVOs + Suppliers + USG - Research by PVOs can inform more effective product advertising. - Research by PVOs can help suppliers understand the product market. - PVOs can assist in the roll-out of new products.

§ Academia + USG - Can work with the USG to issue “Grand Challenges” for food aid innovations. - Can do research for USG. - Can work as an information surrogate to educate governments on products. - Can help ensure stakeholders are aware of the research findings and are connected. - Can help suppliers and packagers understand the conditions, constraints, or

opportunities involved with handling food aid products. § Commercial Market + Suppliers

- Are there supply opportunities within the commercial market? What would that process be?

- If a product were commercially viable, it could play a role in regulating demand. - But there could be constraints, such as high costs of commercial-scale marketing and

high tariffs commercial entities may pay on micronutrient premixes.



- The commercial industry can be a source of valuable information regarding food safety, quality, and packaging.

§ Commercial Industry + Suppliers - Can work together on large-scale food aid campaigns, like the Hershey-funded

Project Peanut Butter factory and accompanying national-level school feeding program in Ghana.

§ USG + partners - USG can work better with implementing partners to identify supply needs in advance

of when they are needed to allow suppliers to respond.

Contact Patrick Webb, Principal Investigator: [email protected] Beatrice Rogers, Co-Principal Investigator: [email protected] Shelley Walton, Project Manager: [email protected] Kristine Caiafa, Food Basket Research Assistant: [email protected] Leah Koeppel, Project Associate: [email protected]

APPENDIX I. SIDE MEETING ATTENDEE LIST

Attendee Organization/Agency Email Franklin Moore Africare [email protected] Bruce Schactler Alaska Seafood Marketing Institute [email protected] Chris Goldthwait American Peanut Council [email protected] Jordan Teague Bread for the World [email protected] Hope Floeck Breedlove Foods, Inc. [email protected] Julie Cerenzia Bryant Christie, Inc. [email protected] Eric Rasgorshek Bunge Milling, Inc. [email protected]

John Whetten Challenge Dairy Products, Inc. [email protected]/ [email protected]

Coral Didion Didion Milling [email protected] David Silver Didion Milling [email protected] Jennifer Esterle Edesia [email protected] Tom Stehl Edesia [email protected] Marilyn Shapley InterAction [email protected] Brian Lindshield Kansas State University [email protected] Paul Green North American Millers’ Assoc. [email protected] Kelle Horn Pacific Rim Shipbrokers, Inc. [email protected] Nelson Randall Randall Consulting [email protected] Reid Christopherson South Dakota Wheat Commission [email protected] Trevor White Combest, Sell & Associates [email protected] Cade Fields-Gardner TCE Consulting Group [email protected]



Rebecca Bratt USA Dry Bean Council [email protected] Peter Bahmer USA Rice [email protected] Sarah Moran USA Rice [email protected] Rob Bertram USAID [email protected] Greg Olson USAID FFP [email protected] Ingrid Ardjosoediro USDA [email protected] Melvin Smith USDA [email protected] Diane DeBernardo USDA FAS [email protected]

Alan Grote USDA Kansas City Commodity Office [email protected]

Dan Webber USDA Kansas City Commodity Office [email protected]

Wentzel Mitchell USDA Kansas City Commodity Office [email protected]

Food Aid Quality Review Phase III: Technical Report No. 4...Food Aid Quality Review Phase III:...

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