Food Aid Quality Review Phase III: Technical Report No

Food Aid Quality Review Phase III:

Technical Report No.2 April 2016 – June 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.

Quarterly Technical Report 2 Tufts Friedman School of Nutrition

USAID Food Aid Quality Review Phase III April – June 2016

Acronyms CoP Community of Practice COR Contracting Officer’s Representative CRG Commodity Reference Guide CSB Corn Soy Blend DMAP Data Management and Analysis Plan EB Experimental Biology FAO Food and Agriculture Organization FAQR Food Aid Quality Review FFP Office of Food for Peace (USAID) FPAN Food, Policy and Applied Nutrition GMP Good Manufacturing Practices HACCP Hazard Analysis and Critical Control Points HEB High Energy Biscuit IRB Institutional Review Board IRSS Institut De Recherche En Sciences De Santé LRP Local and Regional Procurement MAM Moderate Acute Malnutrition MNP Micronutrient Powder MSF Médcins Sans Frontières OFDA Office of Foreign Disaster Assistance (USAID) RA Research Assistant REFINE Research Engagement on Food Interventions for Nutritional Effectiveness RUF Ready to Use Food RUSF Ready to Use Supplementary Food SC+ Supercereal Plus TAG Technical Advisory Group TOPS Technical and Operational Performance Support Program ToR Terms of Reference USAID United States Agency for International Development USDA United States Department of Agriculture UN United Nations UNICEF United Nations Children’s Fund ViM Victory Against Malnutrition WFP World Food Programme (United Nations) WHO World Health Organization



Background Information 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 February 1, 2016 to January 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 Improving the Nutritional Quality of U.S. Food Aid: Recommendations for Changes to Products and Programs. 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 are highlighted in the Food Aid Quality Review Phase II Closeout Report (forthcoming, August 2016).

FAQR Phase III will conclude Phase II activities, while also responding to additional (new) FFP priorities. FAQR Phase III will focus on generating links between research on food product formulation with recommendations on cost-effective programming and policy-level action among national and multilateral institutions engaged in food assistance. Tufts will work closely with several key domestic and international collaborators, the USAID, the United States Department of Agriculture (USDA), and with United Nations (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; 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:

Products Tufts will examine such mission-critical issues as: how food matrices 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; completion of the data collection, analysis, and reporting on field studies that assess the effectiveness and cost-effectiveness of various newly formulated food products.

Programming Tufts will focus on program cost-effectiveness of various intervention designs. This will include 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. It will also generate improved technical guidance, share details on research protocols used in testing new food aid products in the field, and further harmonize product specifications.

Processes FAQR III will provide 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 that can also be applied to local and regional food procurement.

Activities for the period April 1 – June 30, 2016

Implementation of Phase III During this quarter, the following activities were undertaken.

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; also includes exploring innovations in thermal and non-thermal food processing including perspectives on food functionality (quality control), nutrient content and bioavailability, palatability, and digestibility.

This quarter, the FAQR team posted the job description for the Food Technology Research Assistant (RA). The RA’s primary focus will be FAQR III activities related to the food matrices for specialized nutritious foods. The team reviewed applicants and began interviewing candidates. In preparation for the new RA, the team completed a key word list and outline for the literature review.

The FAQR team completed developing the work plan and working group for the food matrices work stream. The team also completed a first draft of the concept note outlining



the purpose, scope, objectives, protocol and methodology for this work stream.

B. Food Aid Basket Overview: Activities related to the food aid basket include: (1) enhancing the food basket with existing commodities: Tufts will conduct an assessment of discontinued and rarely used products to establish, past uses, purposes, and why they are no longer called for in programming. As part of this work stream, the FAQR team will (2) assess new products: explore innovations in product development and technologies that 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 will (3) exploring dual-use products for emergency response: study what agencies already use as well as a consultation with partners on desirability of multi-use products for future programming. This stream of work will also develop guidance on the ‘how and when’ of deployment of specialized products in acute phase response, as well as mapping out longer-term strategies. FAQR will assist in (4) developing a strategy to deploy new specialized products: recommended guidance on public announcements of new products, the preparation and distribution of ‘when and how to use’ materials (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 will also (5) provide food and ration technical guidance: As part of developing a strategy for deploying specialized products, Tufts will prepare 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. Finally, the team will (6) conduct accelerated shelf life trials for fortified rice and high-energy biscuits.

The FAQR team posted the job description for the Food Aid Basket RA. The team interviewed candidates, and hired Kristine Caiafa to start next quarter.

The team also began developing the work plan and working group for this work stream and sub-activities.

This quarter, the team developed the study protocol on fortified rice accelerated trials and identified potential labs. This process included communicating with USAID/FFP, harmonizing the protocol with the World Food Programme (WFP) accelerated shelf life protocols, researching the fortified rice products and existing rice trials, drafting a protocol, and communicating with testing laboratories on storage and sampling methods for similar trials to inform an eventual solicitation for laboratories to conduct the fortified rice accelerated shelf life trials.

C. Commodity Management System



Overview: Activities related to (1) updating and streamlining the USAID/FFP commodities resources portal. This involves efforts to raise the profile of the U.S. food aid basket and better share and present commodity information online to PVOs, suppliers, USAID mission representatives and other stakeholders, especially for new products. (2) Developing and modernizing commodity reference guide fact sheets. FAQR will develop and populate modernized fact sheets based on a template and will assist FFP in finalizing a strategy for regular updating of the Commodity Reference Guide (CRG) 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 that 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.

1. CRG – USAID FFP Commodities Resources Portal The FAQR team finalized the work plan and drafted the concept note for this work stream sub-activity. During FAQR Phase III, Tufts will conduct a landscape analysis of USAID FFP resources, focusing on materials relevant to developing an updated, commodities resource portal, available through the FFP website

2. Commodity Reference Guide Fact Sheets The FAQR team finalized the work plan and drafted the concept note for this work stream sub-activity. The team also completed a quarterly update to the commodity fact sheets. The team conducted a quarterly review of the CRG fact sheets, compiled updates to the CRGs, and shared these updates with USAID/FFP.

3. Harmonized specifications and templates The FAQR team finalized the work plan and drafted the concept note for this work stream sub-activity. The team also worked with USAID to identify one product to enter into the matrix, as an example, and hosted a meeting with WFP to discuss the template.

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; 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 will also take 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. There will also be an (3) assessment of the existing food safety and quality feedback loop developed by FFP’s Program



Operations Division. 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 will support these transition from GMP to HACCP and assist in maintaining the same standards of food safety and quality in both U.S.-sourced and internationally sourced food aid commodities.

1. Food aid packaging The FAQR team finalized the work plan for this work stream sub-activity. The team also met with colleagues from MIT to discuss their work on food aid packaging technology.

2. Supply chain oversight This quarter, the FAQR team hosted a brainstorming meeting in Boston. The team finalized the work plan and completed a draft concept note outlining the purpose, objectives and methodology for the work stream sub-activity.

The FAQR team also completed the outline for a literature review and began to populate that review.

The team held a meeting with World Vision to discuss the last mile solutions mobile application.

Finally, the team began reviewing the supply chain data provided by FFP/Personnel Operations Division.

3. Food safety and quality assurance feedback loop The FAQR team finalized the work plan and completed the concept note draft for this work stream sub-activity.

4. Quality assurance for local and regional procurement The FAQR team finalized the work plan and completed the concept note draft for this work stream sub-activity.

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 will be conducted. The goal will be 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 estimate costs of producing and transporting Corn Soy Blend (CSB) and Ready to



Use Supplementary Food (RUSF) products used in USAID/FFP Title II programs and WFP emergency operations.

1. Cost-effectiveness in response to emergencies The FAQR team hosted a kick-off meeting and completed the draft concept note outlining the purpose, objectives and methodology for the work stream. The team also completed consultation meetings with USAID/FFP and finalized the work plan.

2. Cost-effectiveness tools This quarter, the FAQR team hosted a kick-off meeting to finalize the work plan. The team also met with the Technical and Operational Performance Support Program (TOPS) to share FAQR work on cost matrices. The team began to draft a concept note on last mile work in Burkina Faso.

The FAQR team posted a position for a Cost Specialist/Data Analyst to manage the cost data and cost-effectiveness analysis for the field studies assessing the use of food aid products in USAID/FFP Title II programs. The team interviewed candidates, and hired Ye Shen, who started with the team late this quarter.

F. Field Research Overview: Activities include (1) finalization of the Malawi feasibility and cost-effectiveness study of changes in CSB ration quantity, packaging and messaging; (2) continuation of the Burkina Faso cost-effectiveness study on the prevention of stunting and moderate acute malnutrition (MAM) in children who will be followed to the age of 24 months, with follow-up measurements up to three months after completion of the supplementary feeding program; (3) initiation of the Sierra Leone effectiveness and cost- effectiveness study to compare four foods in terms of treatment of MAM. Children six months to five years of age will receive supplementary food 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; and (4) development of research protocols.

1. Malawi feasibility study

a. Work plan and working group This quarter, the FAQR team developed the work plan and working group for this work stream sub-activity. b. Manuscript comments This quarter, the Tufts FAQR team received comments from Maternal & Child Nutrition for the first Malawi study manuscript, Program changes are effective and cost-effective in increasing the amount of oil used in preparing corn soy blend porridge for treatment of moderate acute malnutrition in Malawi. This manuscript addresses the main research objective: change in CSB porridge oil density. c. Additional manuscripts



The team is in the process of drafting additional manuscripts including (1) a methodological paper to compare oil amounts estimated by the mother’s demonstration with the oil amount results from the laboratory analysis; (2) a comparison of observed versus self-reported sharing of porridge to explore mothers’ willingness to say that they share and; and (3) a validation of the Care Group Model in changing behavior/communicating CSB porridge messages. d. Case study The team began drafting a case study to present the qualitative findings from focus group discussions on the perceived positive and negative aspects of repackaged CSB. e. Experimental Biology (EB) 2016 Conference This quarter, the Tufts FAQR team presented a poster titled A Tale of Two Measures: Self-Report and Lab-Assessed Values in Amount of Oil Added to CSB Porridge Prepared by Caregivers of Children with Moderate Acute Malnutrition in Southern Malawi Experimental Biology 2016. The poster is in Annex 1.

2. Burkina Faso prevention of MAM and stunting study a. Work plan and working group This quarter, the FAQR team developed the work plan and working group for this work stream sub-activity. b. Beneficiary follow-up The field team continued follow-up measurements of beneficiary children. The total number of beneficiary children enrolled is 6,101. Annex 2 summarizes the follow-up information and measurements for the quarter. c. Post-intervention follow-up At the end of this quarter, 570 children have exited the Victory Against Malnutrition (ViM) program. Of these, 564 children were measured. Annex 3 summarizes the post-intervention follow-up. The team developed a post-intervention follow-up strategy for children exiting the ViM program at the end of September 2016 when there are no longer distributions. Children are measured monthly for three consecutive months after graduating from the ViM program. This quarter, the field team brought on 16 new enumerators to be focal points for mobilizing women in communities once women exit the program and need to be followed up with at home. d. Surveys and Data Collection The team continued field supervision and quality control of data collection. The field team 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 Santé (IRSS) and ViM program promoters and supervisors. Annex 4 summarizes the qualitative data collection.



e. 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 team recruited two new part-time data entry professionals to assist in data entry. f. Database Templates The data team continued to revise the data entry templates as they became available from IRSS. At the end of the quarter, the remaining template to be revised is the promoter interview. g. Porridge Samples The team continued collaborating with the National Public Health Lab to analyze porridge samples. To date, 638 porridge samples have been successfully analyzed. h. Cost effectiveness The field team made visits to the product warehouse to better understand the storage process and to monitor documentation involved in the storage and transport of program goods. The information will be used in estimating program costs for the cost-effectiveness analysis. The FAQR team completed the cost effectiveness matrix for the collection of all costing data. The team continued working on gathering information about the “last mile.”

3. Sierra Leone treatment of MAM study a. Work plan and working group The FAQR team developed the work plan and working group for this work stream sub-activity. b. Data analysis (terminated study) This quarter, the FAQR Tufts team finalized all clinic analysis for Sierra Leone research. c. Manuscript preparation (terminated study) The team continued revising the manuscript reporting the Sierra Leone findings. This included discussion of how to frame the manuscript and how to interpret findings pre- and during the Ebola virus outbreak. d. New treatment study This quarter, the FAQR team selected the implementation site for the Sierra Leone treatment of MAM study: Pujehun district (southeast province of the country). This will allow the team the opportunity to complete this research in full and conclude findings with the appropriate sample size. The team continued with planning the treatment study, which included updating the study design, discussing the study arms and planning the sub-studies. e. Treatment Study Sub-studies The FAQR team completed a literature review on body composition, environmental enteropathy and neurocognitive development in preparation for the three sub-studies planned for the treatment study.



f. Field Research Manager This quarter, the FAQR team posted the Field Research Manager position and hired Stacy Griswold to manager the new treatment of MAM study in Pujehun district, Sierra Leone. g. Commodity procurement Terms of Reference (ToR) The FAQR team began drafting the commodity procurement ToRs for Supercereal plus (SC+) with amylase, CSWB, CSB plus and FVO. The team drafted specifications for the SC+ with amylase. The team also drafted a ToR for freight forwarders. h. Institutional Review Board (IRB) The FAQR team prepared and submitted an application for exemption for recipe development and taste tests for CSB porridge in Sierra Leone with the Tufts IRB.

4. Research protocols a. Data management This quarter, the FAQR data manager continued updating the Data Management and Analysis Plans (DMAPs) for the Burkina Faso field study. The data manager reviewed the Burkina Faso data entry templates with the Burkina Faso field research coordinator. The data manager also edited the DMAP for Malawi so that it is ready for wider dissemination.

G. Interagency Communications and Harmonization Overview: Activities related to institutionalization of interagency consultations (U.S. focused and U.S.-Global). FAQR will engage 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 will continue to provide support to the two main interagency technical groups (U.S. focused and U.S.-global focused) that currently meet, and promote these groups as modalities for ongoing discussion of product modifications, as well as the review and approval of new products and/or ingredients, and harmonization of policies, standard and specification-setting, and engagement with industry.

1. U.S. focused interagency The team completed the work plan and working group for this work stream sub-activity.

2. U.S.-Global focused interagency International Food Aid Inter-Agency Harmonization Meeting: The 9th meeting of the inter-agency working group took place in Rome, Italy at WFP headquarters from May 31st to June 1st 2016. The overarching goal of the inter-agency group is to ensure that specialized nutritious food aid products are prepared and programmed in a manner consistent with advances in science, operational needs of agencies, and empirical understanding of costs and effectiveness.

Representatives from USAID/FFP, USAID/Office of Foreign Disaster Assistance (OFDA), Médcins Sans Frontières (MSF), WFP, and the United Nations Children’s Fund (UNICEF)



participated in the meeting. A representative from Food and Agriculture Organization (FAO) joined for part of the meeting to provide an update on the Ready to Use Food (RUF) expert microbiological criteria report, as well as on a proposed Codex guideline for RUF for acute malnutrition. The FAQR team from Tufts University acted as secretariat, as well as participated in the discussions when appropriate.

The main outputs of this meeting included: • Finalized a Terms of Reference for the interagency group • Finalized an interagency work plan template • Harmonized RUF specifications • Programmatic harmonization • Identified inter-agency research interests • Discussed CODEX updates • Food aid safety and quality audits • Discussed status of micronutrient powders (MNPs) as food aid product

H. Knowledge Sharing Overview: Activities include (1) FAQR II “Scorecard Report”: Tufts will prepare 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 the results of implementation of FAQR recommendations on products, processes, and programming. Finally, as part of this work stream the FAQR team will continue their work on the consultative processes: (3) Research Engagement on Food Innovation for Nutritional Effectiveness (REFINE): Tufts will continue to engage with the broad food aid community during FAQR III, through live consultations via the FAQR website and the REFINE website (http://refinenutrition.org/index.htm). REFINE’s goal is to enhance accessibility 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.

1. FAQR II “Scorecard Report” This quarter, the FAQR team incorporated feedback from FFP into the revised FAQR Phase II Close-Out report, and continued updating the report to finalize next quarter. The team hosted several meetings in DC to discuss findings from FAQR Phase II and plans for FAQR Phase III. The FAQR team consulted with USAID/FFP to develop a Summary of Accomplishments/Scorecard. The team also began planning a meeting with stakeholders to disseminate the “Scorecard” at the next International Food Aid & Development Conference.

2. Evidence Summit This quarter, the FAQR team submitted proposals to International Congress of Nutrition



2017 for a body composition and environmental enteropathy colloquium and a food aid research update colloquium.

3. REFINE This quarter, the FAQR team continued work on the REFINE website by updating the field research matrix, updating the publications library and highlighting current research gaps. The team updated the ongoing study inclusion criteria based on feedback from the International Inter-agency Harmonization meeting also held this quarter. The intent is to be more proactive in updating this website and adding additional analytical insights, not just summaries of protocols.

The FAQR team also compiled recent publications and research studies into two resource updates, and shared the updates with list serve members. The team shares highlights from the resource updates on the @REFINEnutrition Twitter. @REFINEnutrition Twitter Analytics for this quarter:

Tweets Retweets Likes New followers Total Followers 13 2 4 9 40

4. FAQR communications This quarter, the FAQR team hired two student research assistants to work on FAQR communications. The team reviewed communication strategies from other organizations and projects with similar missions and goals. The team engaged with the Tufts website development team to outline the new FAQR project website, and began to build the website content. The team also prepared a media kit and project briefs to engage a wider audience in FAQR activities.

5. The role of dairy in supplementary foods This quarter, the Tufts FAQR team presented a poster titled The role of dairy in the comparative effectiveness and cost of fortified blended foods versus ready-to-use foods in treatment of children with moderate acute malnutrition at EB 2016. The poster is in Annex 5.

Meetings and Events during the period April 1 – June 30, 2016 The team continued to hold working group meetings throughout the quarter to plan FAQR Phase III activities. Selected specific meetings included the following:

• EB 2016 Conference in San Diego, CA April 2-6, 2016 The FAQR team presented two posters at EB 2016: (1) A Tale of Two Measures: Self-Report and Lab-Assessed Values in Amount of Oil Added to CSB Porridge Prepared by Caregivers of Children with Moderate Acute Malnutrition in Southern Malawi, and(2) The role of dairy in the comparative effectiveness and cost of fortified blended foods versus ready-to-use foods in treatment



of children with moderate acute malnutrition. The posters are in Annex 1 and 5.

• International Association of Operative Millers Conference in Columbus, OH April 5-7, 2016 FAQR Food Technologist, Quentin Johnson, attended the International Association of Operative Millers Conference and Expo.

• Workplan work sessions with USAID in Washington, DC April 7, 2016 The FAQR team met with USAID to work on the FAQR Phase III work plan.

• Supply Chain and Costing Workplan Meeting in Boston, MA May 23-24, 2016 Global Food and Nutrition, Northeastern University and Senior Cost Specialist, Dr. Steve Vosti, met at Tufts to discuss the FAQR Phase III Work Plan related to supply chain oversight: finalize the work plan, begin to draft a concept note, and review documents related to the work stream.Annex 6 details the meeting agenda.

• Field Staff Meeting in Burkina Faso May 28, 2016 The FAQR Field Research Director in Burkina Faso, Ilana Cliffer, together with IRSS, held an all field staff meeting to discuss plans for post-intervention follow-up.

• International Food Aid Inter-Agency Harmonization Meeting in Rome, Italy May 31-June 1, 2016 This quarter, Dr. Patrick Webb, Shelley Walton and Jocelyn Boiteau participated in the ninth International Inter-agency Harmonization meeting. The purpose of the meeting was to review accomplishments since the April 2015 meeting; to discuss the Terms of Reference of the food aid Inter-agency working group to define the main goals, objectives, outputs, criteria for organization membership and working rules; to discuss the harmonization of programming guidance around food aid and nutrition delivery; to discuss inter-agency involvement in research harmonization; to discuss CODEX and World Health Organization (WHO) updates; and to discuss MNP updates. Annex 7 summarizes the meeting outcomes.

• Working Meeting with USAID and WFP in Rome, Italy May 30 and June 2, 2016 FAQR acted as secretariat for working meetings with USAID and WFP to identify overlapping work streams and activities between agencies. Annex 8 summarizes the discussion topics, the joint point (s) of collaboration, points of contact, and next steps.

• Humanitarian Technology 2016 Conference in Boston, MA June 7-9, 2016 Shelley Walton attended the Humanitarian Technology conference, which brings together



scientists, engineers, technologists and policymakers from across academic, government, industry and non-government organizations to discuss, share and promote current research and recent accomplishments across all aspects of technology, from science to systems, that have a global humanitarian impact. The FAQR team followed-up with a number of contacts made during the conference, including: MIT colleagues working on packaging technologies, ProvisionGARD, GrainPro, WFP and USAID procurement division and SurveyCTO.

• Supply Chain Meeting in Boston, MA June 8, 2016 Dr. Ozlem Ergun, Northeastern University, and Greg Olson, USDA, met with members of the Tufts team to discuss the supply chain work stream and determine USDA/USAID needs.

• Meetings with USAID/FFP in Washington, DC June 20-22, 2016 The FAQR team presented FAQR Phase I and Phase II accomplishments and ongoing/planned FAQR Phase III activities to USAID/FFP Senior Management, FFP staff and USDA. The FAQR team also took this opportunity to work with USAID/FFP on the Phase III work streams.

• Small Business Summit in Washington, DC June 23, 2016 Shelley Walton represented FAQR at the Small Business Summit to explore potential small businesses that can provide services to FAQR and to learn about new small business regulations.

• Food Matrices Meeting in Washington, DC June 27-29, 2016 Quentin Johnson, Food Technologist, and Sajid Alavi, Food Engineer, met with Rufino Perez and Shelley Walton to discuss the FAQR Phase III Work Plan related to food matrices including finalizing the work plan, beginning to draft a concept note, and reviewing documents related to the work stream.

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

A. Work Plan The FAQR team completed all sections of the FAQR Phase III work plan, which includes: grouped work streams (based on FAQR Phase III proposal), sub-activities, timelines, milestones/outputs and responsible team members. The team received approval from the Contracting Officer’s Representative (COR).



B. Comprehensive Management Plan The FAQR team completed all sections of the FAQR Phase III Comprehensive Management Plan, which includes the following sections: Project Description, Comprehensive Management Plan Purpose, Project Deliverables and Milestones, Project Roles and Responsibilities, Timeline Management, Project Cost Management, and Project Communications Management. The COR provided comments and feedback on the Comprehensive Management Plan.

C. Budget The FAQR team continued to monitor the budget and make projections based on real-time expenditures and assessments of fiscal realities.

D. Staffing The FAQR team hired Kristine Caiafa as the Food Aid RA. Kristine recently graduated from the Friedman School of Food Policy and Nutrition at Tufts University with a MS in Food Policy, studying development and nutrition security. She holds a BS in Nutrition and Food Science from University of Maryland, College Park, and a dietetic certificate from Rutgers University. Before coming to Tufts, she was in clinical practice as a Registered Dietitian specializing in pediatrics and neonatology. She has also worked with USAID's Power Africa Initiative within the Africa Bureau, spent time building health capacities, and has been involved in development projects in Burkina Faso as a member of Engineers Without Borders.

The FAQR team hired Ye Shen as the Cost-Specialist/Data Analyst. Ye recently graduated from Johns Hopkins Bloomberg School of Public Health with a MSPH degree in International Health – Human Nutrition and a certificate in Public Health Economics. She received her BA degree in International Relations concentrating on Global Health, Nutrition and the Environment from Tufts University. Ye completed her MSPH practicum at WHO working on issues related to breast-milk substitutes for the NetCode. She also worked with GAIN as a GIS intern. At Hopkins, Ye contributed to research related to food environment and Native American reservations.

The FAQR team also hired Stacy Griswold as the Field Research Manager for the Treatment of MAM study in Sierra Leone. Stacy is a recent graduate from the Harvard School of Public Health where she earned her M.S. in Global Health and Population and concentrated in nutrition. Her graduate thesis explored the relationship between household food insecurity, maternal nutrition and childhood development. She received her B.A. in Economics and African Studies from Boston University where she focused her studies on famine-affected economic outcomes in West Africa. Prior to joining the FAQR team, she worked with various organizations in different contexts, most recently in Washington, DC with the USAID-funded TRAction Project, a maternal health focused implementation research project.

The FAQR team hired three student RAs:

French Translation RA for the Burkina Faso Prevention Study



Maddy Bennett is a first year MS student in the Food Policy and Nutrition (FPAN) at the Friedman School of Nutrition Science and Policy, with concentrations in interventions and economics.

FAQR Communication RAs Gloria Guevara Alvarez is a current doctoral student in FPAN at the Friedman School of Nutrition Science and Policy, focusing on sustainable agriculture, smallholders, food systems and regional distribution systems.

Yue Huang is a second year MS student in FPAN at the Friedman School of Nutrition Science and Policy, with a specialization in agricultural science and policy.

Plans for the coming quarter (July – September 2016) July-September 2016 represents the third quarter of implementation for FAQR Phase III.

A. Food Matrices a. Host a meeting with Natick and animal feed stakeholders to understand ongoing work

and to review the scope of the concept note b. Conduct a literature review/landscape analysis on current food matrices and gaps in

data. Identify additional stakeholders to interview. c. Create an interview guide for stakeholder interviews.

B. Food Aid Basket a. Food basket with existing commodities

i. Create a data collection plan, including the list of stakeholders to interview for the food basket with existing commodities

ii. Collect and review reports on discontinued/never used products and document/compile lessons learned

b. New products, technologies and formulation and development of new specialized products, and Technical Advisory Group (TAG) Community of Practice (CoP)

i. Consult with USAID and USDA on the introduction of new products, and define a process for setting up a TAG

ii. Create a data collection plan based on input from stakeholders iii. Begin creating a repository of all products developed that are new and obtain

prototypes c. Fortified rice accelerated shelf life trials

i. Issue a Request for Proposal and select testing laboratory for the fortified rice accelerated shelf life trials.

ii. Begin managing trial results d. Accelerated High Energy Biscuit (HEB) shelf life trials

i. Visit an international HEB manufacturer e. Dual-use products for emergency response



i. Create a data collection plan ii. Collect and review reports use food aid products used in emergencies, school

feeding, development programs and document/compile lessons learned iii. Complete accelerated shelf-life studies iv. Complete case studies highlighting examples of dual-use product situations

f. Food and ration technical guidance i. Complete literature review on all research related to policy level decisions

C. Commodity Management Systems a. CRG

i. Conduct a landscape analysis of current resources available through the FFP website

b. CRG fact sheets i. Begin reviewing existing fact sheet templates to create a revised proposed

template for fact sheets ii. Discuss templates with USAID and gain approval iii. Hold expert consultations/distribute to key stakeholders to discuss template

and solicit feedback iv. Continue to update the CRG, Commodity Fact Sheets for new and modified

products, and tools for programming new or modified specialized products c. Harmonized specifications and templates

i. Begin reviewing all currently used documents and processes for harmonized specifications and templates among U.S. and non-U.S agencies

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

iii. Facilitate adoption/update, effective use, and process for easy and timely updating, which will include standardizing formats that enhance interaction between USAID and USDA, and between government and the private sector

iv. Monitor adoption and undertake a review of experience with these new processes based on qualitative interviews with the range of stakeholders affected by these changes via consultation during the harmonization meetings

D. Food Quality and Safety in the Supply Chain a. Food packaging

i. Create a task force to help lead this process and reach out to partners. ii. Complete literature review on packaging technology iii. Task force members to complete site visits to suppliers or industry iv. Interview selected individuals to gather information on issues regarding

packaging, storage, pest infestation, mold and food wastage. b. Supply chain oversight



i. Complete a structured literature review for supply chain oversight ii. Develop a supply chain model and create a list of ‘ideal data’ needed from

various stakeholders. iii. Obtain and prepare data (this may include site visits or other forms of data

collection as needed) c. Food safety and quality assurance feedback loop

i. Review key aspects of supply chain oversight d. Quality assurance for local and regional procurement

i. Coordinate a small working group with a focus on quality assurance and communication on field issues

E. Cost Tools a. Cost-effectiveness in response to emergencies

i. Complete a structured literature review on cost-effectiveness in response to emergencies (documents, grey literature and reports)

ii. Model development and create a list of ‘ideal’ data needed from various stakeholders related to emergency

iii. Obtain and prepare data on cost-effectiveness in response to emergencies (this may include site visits or other forms of data collection as needed)

b. Cost-effectiveness tools i. Review new documents (product dose and duration documents) in order to

update the cost projection tool ii. Cost out adding barcodes to commodities iii. Test the cost projection tool with internal FAQR team to understand how this

tool would be used in a decision-making process iv. Share cost matrix and user manual detail on last mile with TOPS group

c. Cost tool collaboration i. Hold initial sharing meeting on the cost tool (e.g. Save the Children’s Cost of

Diet tool)

F. Field Research a. Malawi Feasibility Study

i. Complete all manuscripts and case studies for the Malawi feasibility study b. Burkina Faso Prevention Study

i. Complete food distribution ii. Field Research Director attend hostile environment awareness training iii. Continue quantitative and qualitative data collection iv. Continue data entry v. Determine plan for disposition of eventual excess commodities post-

intervention and research vi. Continue cost-effectiveness analysis



vii. Analyze lab data quality viii. Preliminary data analysis ix. Begin planning for data dissemination workshops x. Discuss potential manuscripts and reports with the FAQR team

c. Sierra Leone Treatment Study i. Procure and ship research food commodities ii. Complete the study protocol for main research and sub-studies. Develop a

detailed work plan for all treatment study activities (to include: logistics, acceptability tests, ethical approval, selection of study sites, etc.)

iii. Attend conferences and trainings as needed

G. Interagency and Harmonization a. U.S. Interagency

i. Review MOU between USAID and USDA and consider ‘regernerate’ ii. Review ToR for the U.S. focused interagency group and consider incorporating

the MOU iii. Review the FAC mandate/legal framework iv. Plan for next U.S. Interagency meeting

b. U.S. – Global Interagency (Harmonization) i. Disseminate notes and next steps from the June 2016 Harmonization meeting ii. Update and disseminate ToR to the group iii. Plan for the next Harmonization meeting

H. Knowledge Sharing a. FAQR II “Scorecard Report”

i. Consult with COR to develop Summary of Accomplishments/Scorecard ii. Plan a meeting with stakeholders to disseminate “Scorecard” iii. Add feedback or other results from meeting to the Annex section of the

master report b. Evidence Summit

i. Prepare a Concept Paper and Focal Questions c. REFINE

i. Continue disseminating REFINE resource updates every other month ii. Continue sending REFINE tweets iii. Continue REFINE website update iv. Complete REFINE Landscape Analysis v. Continue REFINE Research Uptake Guide

d. FAQR communications i. Continue updating FAQR project website ii. Finalize FAQR communication strategy iii. Continue FAQR communication dissemination



I. Administration and Budget a. Work Plan

i. Continue to draft remaining sections of the Work Plan via conference calls and in-person meetings with working group team members

ii. Seek approval from the COR for updated work plan b. Comprehensive Management Plan

i. Finalize comprehensive management plan and submit to COR for approval c. Consultant Contracts and Subcontracts

i. Submit FAQR Phase III contract modification request to USAID for Save the Children subcontract

ii. Finalize contract with neurocognitive sub-study design consultant iii. Finalize subcontracts with: Save the Children/U.S. iv. Release Request for Proposal for Local Research Firm in Sierra Leone and

formalize subcontract


Annex 1. Malawi EB 2016 poster

ATaleofTwoMeasures:Self-ReportandLab-AssessedValuesinAmountofOilAddedtoCSBPorridgePreparedbyCaregiversofChildrenwithModerateAcuteMalnutriDoninSouthernMalawi

BreanneLanglois1,BeatriceRogers1,LaurenWilner1,DevikaSuri1,KwanHoKennethChui2,GrayMaganga1,ShelleyWalton1,

JocelynBoiteau1,IrwinRosenberg1andPatrickWebb11FriedmanSchoolofNutriJonScienceandPolicy,TuLsUniversity,Boston,MA

2DepartmentofPublicHealthandCommunityMedicine,SchoolofMedicine,TuLsUniversity,Boston,MA

BACKGROUND&PURPOSETuLsUniversityisconducJngtheFoodAidQualityReview--PhaseI

recommendedthatCorn-SoyBlend(CSB)porridgefortreatmentofmoderateacutemalnutriJonbepreparedandconsumedwithforJfiedvegetableoilintheraJoof30goilto100gCSB(targetraJo=30:100).A2014studyconductedbyTuLsUniversityexaminedthefeasibilityofincreasingtheraJoofoiltoCSBinporridgepreparedbycaregiversofchildrenwithmoderateacutemalnutriJon,inordertoincreasecaloricdensityandimprovetheabsorpJonoffatsolublevitamins.

ThissecondaryanalysiscomparedtheamountofoiladdedtoCSBporridgefromcaregivers’self-reporttotheamountdeterminedbylaboratoryanalysisofporridgesamplescollectedduringtheinterviews.TheobjecJvewastoassesswhethercaregivers’reportsappearedtobeconsistentwithresultsofthelabanalysis,bydeterminingwhethertheyoverorunderreportedtheamountofoiladded.

METHODSStudyDesign:WeassessedtheeffecJvenessoftwointervenJonscomparedtostandardprogrammingin3cross-secJonalgroups(Figure2)

StudyparDcipants:CaregiverswhowerereceivingCSBwithoilastreatmentfortheirchildren(age<5years)withmoderateacutemalnutriJon

Outcomemeasures:1)AmountofaddedoilinpreparedCSBporridgefrombothself-reportandlabanalysis(expressedastheraJoofgramsoiltogramsCSB),and2)thedifferencebetweentheself-reportedandlabraJos

DatacollecDon:

Ø Self-reportmeasureàCollectedthroughstructuredinterviewswithcaregivers,throughwhichtheydemonstratedCSBporridgepreparaJon,andusedriceandwatertomodelCSBandoilquanJJesintheirownlocalmeasuringtools

Ø LabmeasureàCollectedthroughporridgesamplescollectedinthehomethatwereanalyzedforfatcontentbyalocallaboratory

Dataanalysis:

Ø Pairedsamplet-tests(Wilcoxonwhenappropriate)comparedthequanJtyofoiladdedtoCSBporridgefromself-reportandlabanalysiswithineachgroup;

Ø ANOVAtestassessedthemeandifference(self-report–labvalue)betweengroups;

Ø Bland-Altmanplotsdisplaythediscrepancybetweenthe2measures

CONCLUSIONS CaregiversintheintervenDongroupsreportedquanDDesofoilclosertowhat

theywereinstructedtouse,regardlessofwhetherlabanalysisreflectedthetargetedbehaviorchange.Whileself-reportwasnotasreliableasthelabmeasure,bothconveyedthatintervenDongroupcaregiversaddedmoreoiltoporridgethanthecontrolgroup.LaboratoryanalysiswascriDcaltodeterminethepreciseamountofaddedoiltoCSBporridge.

Figure1.StudyAreainSouthernMalawi

Figure2.Cross-secDonaldesignassessing2programmaDcchanges

Atotalof584caregiversparJcipated(n=192inIntervenJonGroup1;n=196inIntervenJonGroup2;n=196intheControlGroup).Ofthese,atotalof144hadmissingvaluesforeithertheself-reportorlabmeasureandwereexcludedfromanalysis.NostaJsJcaldifferenceswerenotedbetweentheomijedandincludedcaregiverswithregardtodemographicandhouseholdcharacterisJcs.AddiJonally,weobservedaclusterofoutlierswithveryhighlabvaluesfortheoil:CSBraJointheintervenJongroupsthatcamefromthesamefooddistribuJonpoints(n=95),raisingconcernsabouttheaccuracyofthoseanalyses.Therefore,weperformedsensiJvityanalyseswiththoseobservaJonsexcludedinaddiJontotheanalysesofthefullsample.Displayedhereareanalyseswiththeoutliersremoved.

Meanoil:CSBraJofromself-reportandlabanalysisisdisplayedinFigure3.Withineachgroup,thereportedamountofaddedoilwassignificantlyhigherthanlabanalysiswithineachstudygroup.Amongthe3studygroups,themeandifferencesbetweenthemeasuresofaddedoil(reported–lab)werenotsignificant(p=0.56),butsensiJvityanalysisexcludingoutliersreducedthemeanlabvaluesofaddedoilinbothintervenJongroups,causingdifferencesinself-reportversuslabtobecomesignificantlylargerintheintervenJongroupscomparedtocontrol(Table1).

Bland-Altmanplotsrevealedabiasbetweenthe2measuresintheintervenJongroups(Figure4):parJcipantstendedtoover-reporttheamountofoilused,butasthelab-assessedamountincreased(i.e.astheirbehaviorchangedtowardsusingmoreoil)therewasashiLtowardsunder-reporJng.Nosuchbiaswasclearlyevidentinthecontrolgroup.Bothself–reportandlab-assessedvaluesshowedthesamerelaJonshipsamongthestudygroups,withGroups1and2havingmoreaddedoilthantheControlbyeithermeasure.

ThisresearchwasperformedundertheextensionoftheFoodAidQualityReview(FAQRII)projectimplementedfortheUSAIDOfficeofFoodforPeacebytheTuFsUniversityFriedmanSchoolofNutriHonScienceandPolicy.ThisposterismadepossiblebythegeneroussupportoftheAmericanpeoplethroughtheUnitedStatesAgencyforInternaHonalDevelopment(USAID).ThecontentsaretheresponsibilityofTuFsUniversityunderthetermsofContractAFP-C-00-09-00016-00anddonotnecessarilyreflecttheviewsofUSAIDortheUnitedStatesGovernment.ThepartnerTitleIIprogram,WellnessandAgricultureforLifeAdvancementoperatedinMalawiunderthemanagementofCatholicReliefServices,andwasimplementedbyseveralprivatevoluntaryorganizaHons,includingthethreethatparHcipatedinthisstudy:ProjectConcernInternaHonal,SavetheChildren,andAfricare.TheCenterforSocialResearch,aresearchinsHtuHonwithintheFacultyofSocialScienceoftheUniversityofMalawiinZomba,wasinchargeofdatacollecHon.

RESULTS

Figure3.Reported&labmeasuresdifferedwithineachgroup

OilSBCC(n=129)

OilSBCC+Repackaging(n=164)

Control(n=196)

Mean±SD,MedianDifference

(reported-lab) .09±.14,.10a .08±.15,.09a .04±.12,.04b

*P-value=0.002fortheoveralldifferencebetweengroups†MeanswiththesamesuperscriptarenotsignificantlydifferentbasedonBonferronimethod

Figure4.Biasbetweenreported&labmeasuresintheintervenDongroups

Table1.Differencesbetweenreported&labraDoswerehigherintheintervenDongroups*†

ACKNOWLEDGEMENTS


Annex 2. Summary of follow-up measurements in Burkina Faso

Summary of follow-up measurements, Burkina Faso FAQR, April-June 2016 Apr-16 May-16 Jun-16

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Group 1 1487 1199 80 1279 6% 86% 1486 1210 103 1313 8% 88% 1484 1278 59 1337 4% 90% Group 2 1502 1268 54 1322 4% 88% 1499 1217 111 1328 8% 89% 1488 1250 65 1315 5% 88% Group 3 1547 1189 147 1336 11% 86% 1547 1186 154 1340 11% 87% 1383 1077 129 1206 11% 87% Group 4 1458 1070 199 1269 16% 87% 1450 1055 223 1278 17% 88% 1316 986 182 1168 16% 89% Total 5994 4726 480 5206 9% 87% 5982 4668 591 5259 11% 88% 5671 4591 435 5026 9% 89%

70%75%80%85%90%95%

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Nov-14

Jan-15

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Percent of study children measured each month, by study branch, Burkina Faso FAQR, Nov 2014-June 2016*

Group 1

Group 2

Group 3

Group 4

*This graph shows the percentage of children enrolled in the study who are successfully measured each month from November 2014-June 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 3. Summary of post-intervention follow-up in Burkina Faso

Cumulative post-intervention follow-up summary, Burkina Faso FAQR, June 2016

Number of children in study at beginning of month

Number of children at ViM program exit this month

Number of exiting children measured this month

Number of children measured for month 1- month 3 follow-up

Number of children at their last post-intervention follow-up (month 3)

Children that will remain in study for next month

Group 1 1484 142 142 427 175 1309 Group 2 1488 109 105 438 175 1313 Group 3 1383 160 160 456 214 1169 Group 4 1316 159 157 451 192 1124 TOTAL 5671 570 564 1772 756 4915



Annex 4. Summary of qualitative data collection in Burkina Faso

Qualitative Data Collection Summary, Burkina Faso FAQR, June 2016

Instrument Attempted to Date

Completed to Date Remaining

Percent of those

attempted completed

Percent of total

interviews completed

In-depth Interview of Beneficiary Mothers 1632 1351 127 83% 76%

In-home obs of Beneficiary Mothers 211 198 12 94% 88%

Observation of Distribution 38 37 11 97% 77% Focus Group of Beneficiary mothers 23 23 1 100% 96%

Focus Group of Distribution Committee 22 22 2 100% 92%

Lead Mother Interview 252 209 72 83% 65% Promoter Interview 8 8 12 100% 23% Community Questionnaire 199 199 0 100% 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.

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Qualitative data collection summary, Burkina Faso FAQR, June 2016*

Success rate of attempted

Percent of total interviewscompleted


Annex 5: Role of Dairy EB 2016 poster



Annex 6: FAQR Phase III Supply Chain Meeting Agenda

FAQRPhaseIIISupplyChainMeeting

May23,9AM(EST)-5:30PM(EST)AND

May24,8:15AM(EST)-4PM(EST)Attendees:SteveVosti,OzlemErgun,KezibanTasci,NinaSchlossman,LeahKoeppel,BreeLanglois,JocelynBoiteau,ShelleyWalton,QuentinJohnson(possibleskypein?)Purpose:DiscusstheFAQRPhaseIIIWorkPlanrelatedtosupplychainoversight:finalizetheworkplan,begintodraftaconceptnote,andreviewdocumentsrelatedtotheworkstream.

Monday,May23rd,JaharisRoom1339AM-9:15AM CoffeeandGreetings9:15AM-9:45AM ReviewofLanguageinFARQPhaseIIISOW,WorkPlanTemplate,and

ConceptNoteTemplate-Shelley9:45AM-10:15AM ProductRoll-OutReportOverview-NinaandLeah

• Highlightmainpartsoftheproductroll-outreportthatarerelevanttothesupplychaindiscussion

10:15AM-10:45AM OptimizationModelandCostProjectionTool-SteveandBree• Steve’spublicationsontheoptimizationmodel• Brieflygooverthecostprojectiontoolandreport

10:45AM-11AM Break11AM-12:15PM ReviewofdocumentsOzlemShared-KezibanandOzlem

• CAREReport• WFPSupplyChainOptimization• UNHCRReport• ManagingBottlenecksPaper

12:15PM-1PM Lunch1PM-2PM SupplyChainDocuments

• JointUSAID-WFPSupplyChainReportSOWandMissionReport• USAIDDeliverProject-LastMile• VisualssentoverfromKyle• ReviewofUSAIDdecisiontreemodels

2PM-5:30PM WorkPlanDevelopmentandConceptNoteDevelopment

• StakeholderContactList• ListofNeeded‘IdealData’• ‘InterviewQuestions’forSupplyChainStakeholders• QuestionsforWFP



**6PMTeamDinner-Masa,439TremontSt,Boston,MA02116**

Tuesday,May24th,JaharisRoom1568:15AM-8:30AM Coffee8:30AM-9:30AM GuineaBissauResearch(NOTE:thisisnotrelatedtosupplychainwork.

ourcolleagueProf.RobertswantedtofindsometimetodiscussherfoodaidworkinGBandthiswasthebesttime:OzlemandKeziban,feelfreetojoinornotjoin)

9:30AM-12PM Cont.WorkonWorkPlanandConceptNote


12PM-1PM Lunch 1PM-4PM Cont.WorkonWorkPlanandConceptNote




Annex 7: International Inter-agency Harmonization Meeting Summary

Food Aid Inter-Agency Meeting Summary Rome, May 31 – June 1, 2016

The 9th meeting of the inter-agency working group took place in Rome, Italy at the World

Food Programme (WFP) headquarters from 31 May to 1 June 2016. The overarching goal of the

inter-agency group is to ensure that specialized nutritious food aid products are prepared and

programmed in a manner consistent with advances in science, operational needs of agencies, and

empirical understanding of costs and effectiveness.

Representatives from United States Agency for International Development (USAID)/Food for Peace

(FFP), USAID/Office of Foreign Disaster Assistance (OFDA), Médcins Sans Frontières (MSF), WFP,

and the United Nations Children’s Fund (UNICEF) participated in the meeting. A representative

from Food and Agriculture Organization (FAO) joined for part of the meeting to provide an update

on the Ready to Use Food (RUF) expert microbiological criteria report, as well as on a proposed

Codex guideline for RUF for acute malnutrition. The Food Aid Quality Review (FAQR) team from

Tufts University (funded by USAID/FFP) acted as secretariat, as well as participated in the

discussions when appropriate.

The main outputs of this meeting included:

• Finalized a Terms of Reference for the inter-agency group: including laying out overarching goal, objectives, criteria for organization membership, and working rules for the

group. • Finalized an Inter-agency work plan template that will allow the secretariat to more

effectively track work stream topics, points of contact, output/deliverables, timeline, and priority levels. The work plan will be updated by the secretariat and shared with all members of the groups at least every 6 months to track inter-agency progress.

• Harmonized RUF Specifications: agreement to combine specification and packaging feedback. Agencies presented an update on RUF harmonized specification implementation, including specific feedback from suppliers and how to move forward. The inter-agency group will create a summary paper on, evidence, scientific and programmatic basis behind the specification harmonization process, to share and inform stakeholders.

• Programmatic harmonization: Identified a need for structured partner level consultation to understand field issues and to increase feedback from implementing partners relevant to product challenges, improvement and delivery.



• Identified Inter-agency research interests: dosage amounts for RUF for moderate acute malnutrition (MAM) treatment, MAM and stunting prevention linkages, pregnant lactating women (PLW) supplementation, integrated MAM treatment protocols, operations research linked to product formulation research, new/innovative markers to measure growth status, e.g. Environmental Enteric Dysfunction (EED), body composition, cognitive development

• Discussed CODEX updates: A joint FAO/WHO Food Standards Programme Codex

Committee on Nutrition and Foods for Special Dietary Uses (CCNFDU) will meet in

Germany at the end of 2016 to discuss a proposed RUF Guideline, which will include revised

microbiological criteria as well as more diverse sources of raw materials, to facilitate local

production of these products. • Food aid safety and quality audits: A food safety and quality auditing tool was presented,

emphasizing the need for preventive control systems and its applicability in local, regional and international food aid procurement

• Discussed status of micronutrient powders (MNPs) as food aid product: On- going activities on MNPs were discussed.

The Inter-agency group made the decision to hold the next meeting in Washington, DC (or

possibly Boston) in May or June of 2017. Additional sub-group meetings will be scheduled on

an ad hoc basis (in-person or electronically), and/or through side meetings at other major related

events. Tufts University and the FAQR Team will serve as Group Secretariat until May 2018.

For additional documentation on the 9th inter-agency working group meeting, please contact

Jocelyn Boiteau: [email protected] or Shelley Walton: [email protected].



Annex 8. Summary of meeting with USAID and WFP

WFP-USAIDMeetingSummary

May30andJune2,2016

ThepurposeofthismeetingbetweenUSAIDandWFPwastoidentifyoverlappingworkstreamsandactivitiesbetweenagencies.TheFoodAidQualityReview(FAQR)teamfromTuftsUniversity(fundedbyUSAID/FFP)actedassecretariat,aswellasparticipatinginthediscussionswhenappropriate.Foreachtopiclistedbelow,thejointpoint(s)ofcollaboration,pointsofcontact,andnextstepsarelisted.

o FoodMatrices:compositionandstructureoffoodproductsinfluencethebioavailability,absorption,andphysiologicalutilizationofnutrients

§ JointPointofCollaboration:bioavailabilityofmineralsinLNSproducts,considerfortifiedrice

• WFPworkonfoodmatricesincludeSC+withamylase,fortifiedrice(acceptability,bioavailabilityandretention)

• HireFoodMatricesRA(Tufts)• RevisitIAEAconsortiumandpotentialsupport

§ PointsofContact• Sajid,Irv,Quentin,Saskia,Ruffo

§ Nextsteps• LookatlistofquestionsfromAndréBriendpaperfromVienna

meeting(ThisrelatedtodiscussiononpotentialcontributionsbyIAEAandisotopestudiesofbodymass)

• DiscussionwithSajidandIrv

o FoodAidBasket:assessmentofnewproductsandtechnologiestoexploreinnovationsinproductdevelopmentandtechnologiesthatcouldenhancethefoodaidbaskets,andhelpdefineaprocessbywhichproductsshould(orshouldnot)beaddedtoanimprovedbasket

§ JointpointsofCollaboration:• Exploringdualuseproducts(exploringthepotentialforusing

foodsusuallyusedinemergencyfortreatmentorotherprograms)



o HighEnergyBiscuits–dualuse(maybedifficultduetopoorshelf-life).Agreementtoexplorethepotentialofcompletingacceleratedshelf-lifestudiesonHEBs

o MNPs-dualuse• Evidencesummit

o Focusonoutstandingquestionsandimplicationsofproductsforprogrammingandviceversa

§ PointsofContact• Bea,Quentin,Nina,Ruffo,PaulAlberghine(USDA)

§ Nextsteps• FoodAidBasket

o HireFoodBasketRA(Tufts)o ReviewHEBspeco LoopinUSDAandconsideroptionsforsupplyingschoolso HEBshelf-lifestudieso Developrecommendationsondualuseproducts

• EvidenceSummito LookintoACFmeetinginNovembero Lookintothewastingandstuntinginterestgroup

(understandtheirdirectionofresearch)

o Research:effectivenessandcosteffectivenessoffourfoodproductsinMAMtreatment(SierraLeonestudy)andevidencesurroundingcashandvouchers

§ JointpointsofCollaboration• SierraLeonestudy

o WFPsupporttotheTufts-ledstudy,includingsupplyingSC+withamylase

o Theamylaseisaddedatthetimeofthepremix(butseparatefromthepremix)

o FAQRplanstodotastetestingandpictogramtestinginSierraLeonemid-July

• Cashandvoucherso WFPFilltheNutrientGap(withUCDavis,IFPRIand

Epicentre).Thisismoreofamethodology/frameworkratherthanatool

o ForFAQR,lookingforamodel/toolthattakesintoaccountdifferentmodalities

§ Pointsofcontact



• Saskia,Quentin§ Nextsteps

• SierraLeonestudyo SaskiatoaskBrittaboutwheretogettheSC+withamylase

(fromRwandaorEurope)tosendtoSierraLeonefortastetesting(require1case)

o QuentintodeveloptheSC+withamylasespecfortheFAQRcommodityTOR

o Producttestingbygovernmentincountry:ingeneral,Shaneisnotfamiliarwithneedforadditionalsamples

• Cashandvoucherso Saskiatosharemethodology/reportonceavailableo Needforfurtherdiscussion

o ContinuedcollaborationviaREFINE(iftimepermits)

§ JointPointsofCollaboration:Gapswithingoodaidresearch(ongoingandplanned/upcomingresearch)

§ PointsofContact• Saskia,Patrick,Jocelyn,Kristine

§ NextStep• FAQRtoupdateREFINEstudyinclusioncriteria(toexpand

inclusionofrigorouspapers).• NewwebsitetobelaunchedbeforeendFY16.• SomediscussionofusingREFINEwebsiteaspotentialhostofa

proposedCommunityofPractice.Willbeexplored.

o Improvedpackagingtechnologies:onenhancing/retainingnutrientsinfoodaidproducts,aswellasinextendingproductshelflife,improvingtransportability,resistingpestinfestation,andasavehicleformessaging.

§ JointPointsofCollaboration:Packagingtechnology• Developaconceptnote• CreateaTaskForce(headedbyRuffoandShane)• DataCollection,LiteratureReviews,SiteVisits• Conveneaworkshoptoidentifymajorissuesandprioritiesand

developrecommendations• Disseminateresults

§ PointsofContact• Shane,WFPheadofsupplychain(CorinMitchell?),headof

nutrition(LaurenLandis)



§ NextStep:• ShareconceptnotewithShaneandCharles• Convenefirstworkinggroup

o Supplychainanalysis:fieldchallengestocommodityproduction,shipment,

storage,andhandling,includingthe“lastmile”ofdistributiontobeneficiaries

§ JointsPointsofCollaboration:• UnderstandingWFPsLESS(whatisthemetricofefficiencygain?)• DiscussWFP‘corridorapproach’forprepo• Discussthebarcodingsystem• Understandthedemandforecastingoptimizationdetails

§ PointsofContact:• Barcodingpersonis:[email protected]• BarcodingfromtheUSside:RobertPorter,[email protected]• RMBP(Betty,Ally-RazaQureshi)• Ms.KAVELJMirjana,ChiefOSLD,1301-2187[2187],Rome,5_R_36

[email protected]• Mr.SILVASergio,SupplyChainOfficer(R&D)OSLD,1301-2972

[2972],Rome,5_R_22a,[email protected]§ NextSteps

• Sharedataandworkonlastmile• Discussions/interviewstounderstandwhatWFPisdoingin

relationtobar-coding;willreachouttotheircontacts.• FAQRtocostouthowmuchfordevelopingbarcodingsystemand

SAPsoftwarefortracking;FAQRwillattendthehumanitariantechnologyconferenceinBostoninearlyJunetoassesspotentialtechnologiesinthisspace.

o CommodityManagementSystem:Developmentofharmonizedcommodity

specificationsandtemplates§ JointPointsofCollaboration:

• Developmatrixtohighlightdiscrepancies/differencesbetweenWFPandUSAID/USDAspecs

• Addindetailstoexplainrationaleondiscrepancies§ PointsofContact:

• Nina,Ruffo,Shane,Quentin,Nina§ NextSteps:

• Completecomparisons



• Developrationalefordifferences

o Foodsafetyandqualityassuranceforlocalandregionalprocurement:auditing,sampling,andinspectionofprocessingfacilities.

§ JointPointsofCollaboration:• Convenethefoodsafetysub-groupwithintheinter-agency

harmonizationframework§ PointsofContact:

• Ruffo,Shane,Quentin,UNICEF,MSF§ NextSteps:

• Completecomparisons• Developrationalefordifferences

Food Aid Quality Review Phase III: Technical Report No

Documents

Transcript of Food Aid Quality Review Phase III: Technical Report No