Emergency Health and Nutrition Program

Emergency Health and Nutrition Program is sponsored by U.S. Agency for International Development (USAID). This opportunity supports mission-aligned projects and measurable outcomes.

This report describes the food commodities that are used in U.S. emergency food aid programs and outlines issues in their distribution, selection and formulation that may limit their ability to meet the nutrition needs of recipients. Issues are being raised at this time because the U.S. Congress plans to renew the authorizing legislation by the end of 2002.

The author summarizes quantity and quality problems with food aid contributions and the difficulties experienced with the coordination of food aid with related needs of disaster victims. He identifies the foods supplied for emergency feeding by the U.S. Government and the World Food Program, and describes the limited applications of nutrition science to the formulation of the processed foods provided through U.S. food programs.

The core of the report outlines the dominant nonnutritional priorities, stemming from the linkages to U.S. agricultural supply markets, U.S. commercial food interests, food aid pledging customs and difficulties in U.S. Government humanitarian response coordination.

The presentation concludes with a review of issues, emphasizing the need for further studies, and some suggestions for shaping future food aid programs and policy with a strengthened capacity for protecting and promoting the nutritional status of disaster victims. J. Nutr.

132: 2104S–2111S, 2002. Human nutrition is nowhere more critically important than in those situations where the normal channels of food access have been disrupted or cut off because of natural or man-made disasters. A fair amount of inferential evidence exists to show that in the second part of the 20th century U.S. food assistance has probably saved the lives of millions people see ([115281-8/fulltext#) McClelland, D.

G. (2000) Complex Humanitarian Emergencies and USAID’s Response. USAID Program and Operations Assessment Report no. 27.

Center for Development Information and Evaluation, U.S. Agency for International Development, Washington, DC. )], although food assistance in emergencies is widely alleged to be not as effective as it could be.

Experienced field nutritionists and some limited field research point to serious nutritional and health problems in emergency victims because of food shortages, untimely food delivery and inappropriate types of food being supplied.

The U.S. Government, as the largest provider of food aid, carries a special responsibility to explore the extent to which these problems exist; if its policies and practices may be contributing to them, it must make the necessary remedies.

## Reports of field-level problems Reported difficulties with emergency food aid fall roughly into three categories: _1_) the quantity of rations provided; _2_) the quality of rations, particularly their micronutrient content and the appropriateness of foods in the ration; and _3_) the coordination of food aid programming with the health and personal care components required to protect the nutrition of people affected by emergencies.

### Problems with ration quantities After decades of inadequate ration provision, minimum international standards were set for average daily energy needs of disaster victims 2100 kcal/person/d; see ([1-315281-8/fulltext#) McClelland, D. G. (2000) Complex Humanitarian Emergencies and USAID’s Response.

USAID Program and Operations Assessment Report no. 27. Center for Development Information and Evaluation, U.S. Agency for International Development, Washington, DC. Committee on International Nutrition, Institute of Medicine, National Academy of Sciences.

(1995) Estimated Mean Per Capita Energy Requirements for Planning Emergency Food Aid. National Academies Press, Washington, DC. WFP/UNHCR.

(1999) Guidelines for Estimating Food and Nutritional Needs in Emergencies. World Food Program, Rome, Italy/United Nations High Commission for Refugees, Geneva, Switzerland. )].

Serious health consequences have been observed where dietary energy supplies have fallen short of this standard.

For instance, in the Horn of Africa in the 1990s, the UN Agency Committee on Coordination/Sub-Committee on Nutrition (ACC/SCN) analyses reveal that rations providing under 1500 kcal/person/d (a standard employed by some donors at the time) were associated with much higher crude mortality rates than those providing over 2000 kcal/person/d (415281-8/fulltext#) ACC/SCN. (1994) Update on the Nutrition Situation.

Agency Committee on Coordination/Sub-Committee on Nutrition, Geneva, Switzerland. Shoham, J. , O’Reilly, F.

& Wallace, J. (2000) Humanitarian crisis and conflict: food assistance and nutritional security issues. In: Food Aid and Human Security (Clay, E.

& Stokke, O. , eds.) Frank Cass, London, UK.

). In complex emergencies, such as those in the Horn, shortages of food rations often result from the inherent risks of relief operations, national sovereignty constraints and diversions of rations for political and military purposes. Nonetheless, authors strongly suggest that specific food aid policies and practices of donors and their partners carry some of the responsibility for shortages (515281-8/fulltext#) Shoham, J.

, O’Reilly, F. & Wallace, J. (2000) Humanitarian crisis and conflict: food assistance and nutritional security issues.

In: Food Aid and Human Security (Clay, E. & Stokke, O. , eds.)

Frank Cass, London, UK. ). Among the problems are shortfalls in meeting international food aid appeals, planning amounts too close to minimum food requirements and logistic gaps in the arrival of food aid shipments.

These problems are traced to donor assistance policies requiring that food aid must be procured from its domestic market for each specific emergency rather than advance funding of contingency accounts, such as the World Food Program's (WFP) immediate response (cash) account (IRA) or international emergency food reserve (IEFR).

4 All these problems are magnified in the instances of rapid-onset emergencies that require large quantities of food in a short period of time from a variety of donors. ### Problems of ration quality Providing a diverse diet, with culturally appropriate foods that are rich in micronutrients, is a persistent food aid quality problem reported in emergencies.

Classic dietary deficiencies in emergency victims, such as scurvy, night blindness and pellagra, have been well documented in refugee situations in the late 1980s (615281-8/fulltext#) Toole, M. J. (1994) Preventing Micronutrient Deficiency Diseases.

In: University of Nairobi (1995). Report of a Workshop on the Improvement of the Nutrition of Refugees and Displaced People in Africa. Machakos, Kenya, December 5–7, 1994.

), and continue to some degree in refugee feeding programs with serious consequences for health and growth in many food aid-dependent populations (515281-8/fulltext#) Shoham, J. , O’Reilly, F. & Wallace, J.

(2000) Humanitarian crisis and conflict: food assistance and nutritional security issues. In: Food Aid and Human Security (Clay, E. & Stokke, O.

, eds.) Frank Cass, London, UK. ).

A related difficulty is that micronutrient-rich food aid commodities, such as the U.S. blended food corn soy blend (CSB), have been limited to supplementary and targeted feeding programs and not provided in sufficient quantities for general feeding. When they are provided, the micronutrient levels in them have been unreliable until quite recently because of the lack of quality control standards (715281-8/fulltext#) Marchione, T. J.

(2000) Title II food aid and the nutrition of children in Latin America and the Caribbean. Food Nutr. Bull.

21. ). Micronutrient problems have also been related to poor ration planning and wrong assumptions about the capacity of the recipients to provision themselves.

Donated food is particularly singled out when refugees, largely dependent on food aid, exhibit micronutrient deficiencies after many months in camp settings (515281-8/fulltext#) Shoham, J. , O’Reilly, F. & Wallace, J.

(2000) Humanitarian crisis and conflict: food assistance and nutritional security issues. In: Food Aid and Human Security (Clay, E. & Stokke, O.

, eds.) Frank Cass, London, UK. ### Problems of coordinating food aid with health, care, and livelihood needs The isolation of the food aid supply from other inputs needed for good nutrition is a well-recognized problem.

Food is too often the overwhelming and reflexive initial response to all disasters, whether food is or is not the most appropriate response to the problems being faced by the disaster victim, who may be in more need of water, medicine or shelter. Once programs are in operation, there may be little understanding of other human needs critical to nutrition and livelihood.

Oversupply should be avoided because of the possibility of unintended diversion for military or commercial purposes, although concerns about oversupply can be exaggerated.

Common misunderstandings include the following: overly strict opposition to the sale of ration commodities by recipients, severe reactions to overregistration in refugee camps and inflated expectations of self-sufficiency of food aid recipient communities (515281-8/fulltext#) Shoham, J. , O’Reilly, F. & Wallace, J.

(2000) Humanitarian crisis and conflict: food assistance and nutritional security issues. In: Food Aid and Human Security (Clay, E. & Stokke, O.

, eds.) Frank Cass, London, UK. ).

This thinking fails to recognize that in emergencies food aid becomes a valuable part of the coping strategies of disaster victims, allowing them to barter for local foods or other goods necessary for their families' survival (815281-8/fulltext#) Reed, B. ∙ Habicht, J. -P.

**Sales of food aid as a sign of distress, not excess** _Lancet. _ 1998; **351**:128-130 ). Food aid can be used to buy fresh and nutritious local foods from local markets or, in contrast, good-quality food aid might be traded for fuel or other survival necessities, degrading an otherwise nutritious ration, but for good reason.

When gaps in food supplies occur, recipient households may be forced to sell assets, sacrificing their long-term livelihood and nutritional well-being for the sake of short-term food needs, and these assets can be permanently lost when donors are reluctant to replace shortfalls retrospectively once the shortage period is past (915281-8/fulltext#) Payne, L. (1997) Impact of food delays on refugees. Field Exchange 2.

## Foods supplied by the United States for emergency assistance The current U.S. international food assistance programs began after World War II in an environment of U.S. agricultural surpluses and the looming Cold War challenge to win over emerging nations (1015281-8/fulltext#) Marchione, T. J. (1996) The right to food in the post-Cold War era.

Food Policy 21. ). Two specific programs started during that period continue to provide much of the world's emergency food aid: Title II of Public Law 480 of 1954 (P.

L. 480), administered by the U.S. Agency for International Development (USAID), commonly known as the Food for Peace Program; and Section 416(b) of the Agricultural Act of 1949, administered by the U.S. Department of Agriculture (USDA).

Despite the declining global contribution of food aid to overall development assistance, and the declining overall budget of the U.S. for foreign assistance, the United States continues to be the largest donor of both emergency and nonemergency food aid. In 1999 global food aid shipments were 13. 3 million metric tons, whereas food aid shipped from the United States was 8.

3 million metric tons. The WFP managed 3. 2 million metric tons, but nearly half of that was food aid pledged to WFP by the U.S. Government and purchased from U.S. producers.

Emergency food aid shipments have grown markedly since the end of the Cold War because of the proliferation of civil conflicts and internal wars, whereas other forms of food aid have markedly declined. Since the later 1980s, the WFP budget for emergency food aid rose from 30% of all its assistance to approximately 66% (1115281-8/fulltext#) WFP. (2001) Online Statistical Reports.

World Food Program, Rome, Italy. ), although the P. L.

480 Title II program has remained constant at approximately 2 million metric tons, valued at $800 million to $1 billion a year. The expenditures for emergency P. L.

480 Title II had risen from approximately 47 to 54% of the total dollar budget, purchasing a tonnage ranging from 780,000 to one million metric tons at a cost of $350–550 million annually, whereas the balance of the budget was mandated for use in nonemergency, development contexts.

In contrast, over the same period the USAID government-to-government food aid program dropped from nearly $300 million annually to $116 million and was virtually zero in 2001 (1215281-8/fulltext#) U.S. Agency for International Development/Food for Peace Information System. (1999) FY 1999 Approved Budget Summary Report, December 28. Office of Food for Peace, Washington, DC.

Although the P. L. 480 Title II program procures its food with an annual congressional appropriation, the quantity of emergency food aid available through the Section 416 authority is totally dependent on U.S. agricultural surpluses.

For instance, after a period of abundant surpluses during the 1980s, subsidies to U.S. farmers dropped and Section 416 assistance fell to zero. This happened just as emergency crises were proliferating in the mid-1990s. Surpluses did not revive until 1999 when food commodity prices were plunging and President Clinton, by means of a presidential initiative, reintroduced price supports.

As a result, Section 416 assistance soared to 5. 2 million metric tons at a cost of $740 million, much for emergency relief (1315281-8/fulltext#) U.S. Department of Agriculture. (2000) Online reports of Section 416: http://www.

usda. gov. Accessed June 30, 2001. ).

When one excludes assistance that was provided for economic crises rather than natural or man-made disasters (e.g., countries in the former Soviet Union), Section 416 emergency food aid climbed to 2. 8 million metric tons in 1999 and _total_ U.S. emergency food aid was approximately 3. 7 million metric tons.

In 1999 most of this food was provided for emergencies in Africa and Asia. There were 16 foods provided by the United States for foreign emergencies in fiscal 1999. These foods reflect abundant U.S. cereal and soy production that have dominated food aid programs for 50 y including the fortified and blended foods that were introduced in 1966.

USDA customarily classifies food aid into five categories: _1_) wheat and wheat products (five commodities), _2_) feed grains 5 (six commodities), _3_) pulses (three commodities), _4_) vegetable oil and _5_) other (in this instance, rice) (Table 115281-8/fulltext#t1)).

Because the United States is the most generous donor of food aid globally and is the largest contributor to the World Food Program, the cross section of foods provided worldwide closely reflects U.S. donations (see Table 215281-8/fulltext#t2)). U.S. emergency food aid distributed in fiscal year 1999 Excludes Russia and assistance to other countries of the former Soviet Union.

* Open table in a new tab Foods supplied by the World Food Program in 1999 (all programs) * Open table in a new tab The foods more frequently provided in emergency situations are unprocessed grains, although processed foods are critical for meeting micronutrient needs and helping in situations where local processing capability is absent.

Processed foods distributed in substantial quantities were wheat flour, bulgur wheat, cornmeal, vegetable oil (usually from soy beans) and various forms of soy-fortified cereals and cereal blends. The widespread use of soy protein in U.S. food aid commodities reflects the thinking about protein calorie deficiency in the 1950s and 1960s, when these fortified foods were designed and introduced.

All these processed grains are fortified with micronutrients. At a minimum, the micronutrient fortification for all the processed grains consists of elemental iron and B vitamins, a package of nutrients identified >40 y ago for enrichment of U.S. wheat flour, plus vitamin A (required to be a minimum level of 8800 iu per pound or 1900iu per 100 g).

6 Of particular interest are foods especially designed for young children, the blended foods, corn soya blend (CSB) and wheat soya blend (WSB). These are the richest sources of micronutrients of particular importance in emergency feeding programs, although not specifically designed for them (see Table 315281-8/fulltext#t3)).

The micronutrient premixes (3% by weight) consist of 17 minerals and vitamins important to the growth and health of young children and other physiologically vulnerable groups, such as pregnant and lactating women.

Nutritional characteristics of wheat soy blend and corn soy blend per 100 g of dry product115281-8/fulltext#note2) Key ingredients (in descending order): 53% bulgur flour; 20% wheat protein concentrate; 20% soy flour, defatted; 4% soybean oil, stabilized; 3% vitamins and minerals added as premixes. Key ingredients (in descending order): 69. 5% cornmeal, processed and gelatinized; 21.

8% soy flour, defatted and toasted; 5. 5% soybean oil, refined, deodorized and stabilized; 3. 0% vitamins and minerals added as premixes.

0. 17 mg added as pyridoxine HCl. 0.

2 mg added as pyridoxine HCl. * Open table in a new tab ## The application of nutrition science to U.S. food aid commodities In fact, the best illustration of the use of nutritional science to food aid commodities is in the blended foods developed for feeding young children. The U.S. Department of Agriculture and USAID developed these foods with assistance from the National Institutes of Health (1415281-8/fulltext#) Senti, F.

R. (1972) Guidelines of the nutrient composition of processed foods. Cereal Science Today, 17 June.

). When introduced in 1966, the blended foods contained nonfat dry milk and were corn soy milk (CSM) and wheat soy milk (WSM). These were intended to complement the supply and acceptance of dry milk as a protein source, which was widely distributed and a common U.S. agricultural surplus.

The nutrient profile of these blends was designed for the needs of growing children, emphasizing the need for a large proportion of protein in the diet, a prevalent view of child nutritional deficiency at that time. As milk surpluses became exhausted in the later 1980s, milk was dropped from the blends, which were replaced by CSB and WSB with a similar nutrient profile.

In 2001 nonfat dry milk surpluses have reemerged with expansion of the USDA price-support programs and abundant milk surpluses. In 2001 the P. L.

480 and Section 416 programs have begun to reintroduce CSM and WSM and other uses of nonfat dry milk. Since the protein-fortified and blended foods were introduced, formulation and fortification of processed foods have been changed infrequently and only slightly to reflect new scientific knowledge. Most have been in response to the discovery of the broader child survival and health significance of vitamin A deficiency.

In 1988 vitamin A levels were nearly doubled in all processed cereal foods. In 1998 magnesium was added, zinc levels were significantly increased and vitamin B-12 was decreased in the two blended foods (1515281-8/fulltext#) Combs, G. F.

et al. (1994) Micronutrient Fortification and Enrichment of P. L.

480 Commodities: Recommendations for Improvement. USAID Opportunities for Micronutrient Interventions (OMNI) Project. U.S. Agency for International Development, Washington, DC.

). Vitamin A was introduced into refined vegetable oil in 1998 (1615281-8/fulltext#) Sharing Untied States Technology to Aid in the Improvement of Nutrition (SUSTAIN). (1999) The Micronutrient Assessment Project, Final Report.

SUSTAIN Project, U.S. Agency for International Development, Washington, DC. Furthermore, manufacturing standards have not been rigorous. Unlike the products made for the U.S. commercial market, U.S. commercial food suppliers to the P.

L. 480 program were not required by USAID or USDA—which procures P. L.

480 foods for USAID—to meet product standards until 1999, one-third of a century after blended products were introduced. USAID-sponsored research, conducted in cooperation with the USDA, eventually led to the establishment of micronutrient standards and a product monitoring program as part of the USDA Total Quality Systems Audit (TQSA) program; enforcement began in February 2000 (1715281-8/fulltext#) USAID.

(1999) Enhancing the Quality of Blended Food Aid Commodities. Internal memorandum. Office of Program, Planning, and Evaluation, Bureau for Humanitarian Response, U.S. Agency for International Development, Washington, DC.

Other than these steps, little work has been done over the past three and a half decades to incorporate scientific and technical knowledge into the development of new and improved products for food aid.

There has been limited incorporation of new technical knowledge about efficient production processes, nutrient absorbability and responses to the special requirements and diets of disaster victims see recent recommendations from the conference, Enhancing Refugee Diets ([1815281-8/fulltext#) Food Aid Management (FAM)/Food and Nutrition Technical Assistance Project (FANTA)/SUSTAIN Project.

(1999) Enhancing Refugee Diets: Proceedings of the USAID-funded workshop. U.S. Agency for International Development, Washington, DC. )], for instance, the need for more stable micronutrients, supplying foods requiring less cooking time, tailoring fortification to local needs and the like.

In general, the formulation and variety of foods provided is more dependent on U.S. agricultural food supply policy and food supplier interests. In summary, many of the distribution and nutrition issues surrounding emergency food aid are the outgrowth of U.S. Government policy and legislation, to which we now turn.

## Issues of emergency food aid policy and programming It is timely to reexamine the issues surrounding U.S. food aid, which is part of the international trade section of the U.S. farm legislation that will be renewed by the end of 2002. The emergency purposes of P.

L 480 Title II food aid are to provide U.S. agricultural commodities _1_) to address famine or other urgent and extraordinary relief requirements; _2_) to combat malnutrition, especially in children and mothers; and _3_) to carry out feeding programs (see Article XV: Agricultural Trade in Public Law 101-624, the Food, Agriculture and Conservation, and Trade Act of 1990). In the 1990 P. L.

480 legislation, the U.S. Government mandated the current policy to “…use [our] abundant agricultural productivity to promote the foreign policy of the United States by enhancing the food security of the developing world through the use of agricultural commodities…under this Act.

” This represented a substantial refocusing away from the international trade development emphasis that dominated U.S. food aid policy in the post-WWII period, but the trade development purpose has not been eliminated and the stricture to purchase foods exclusively from U.S. sources was maintained. This is related to several issues influencing the selection and distribution of U.S. emergency food aid.

### Delays and gaps in shipment resulting from the need to procure foods from U.S. suppliers Delays and pipeline breaks in delivery of foods from U.S. suppliers to distant emergency sites have been a common problem faced by USAID programmers.

For example, private voluntary organizations are told by USAID's Office of Food for Peace to allow a 4- to 5-mo lead time before shipments can be expected to reach the field, although shorter delivery times are possible for WFP-sponsored programs. In the case of rapid-onset emergencies, diversions of foods in the pipeline for development purposes can substantially shorten this lead time.

Delays have also been offset in the last few years by more prepositioning of food aid stocks at U.S. ports (1915281-8/fulltext#) USAID. (2000) Annual Food Assistance Report—1999. U.S. Agency for International Development, Washington, DC.

). Furthermore, when emergency foods are needed immediately, USAID can purchase from foreign sources and deliver small quantities of foods for a short time with cash resource provided to its Office of Foreign Disaster Assistance.

### Uncertainties because of the overall availability of foods depend on U.S. agricultural surplus policies Section 416(b) of the Agricultural Act of 1949 provides for overseas donations of surplus commodities owned by the Commodity Credit Corporation (CCC). The CCC is the U.S. Government purchaser of farm commodities, which supports farm prices and supplies U.S. Government food distribution programs at home and abroad.

Surplus commodities acquired by the CCC as a result of price support operations may be made available under Section 416(b) if these surplus commodities cannot be sold or otherwise disposed of without disruption of price-support programs or sold at competitive world prices. Clearly, the Section 416(b) program is not designed to subordinate U.S. domestic agricultural policy to the emergency nutrition uses in the choices of commodities.

Eligible commodities include dairy products, rice, feed grains and products, oilseeds and other commodities acquired by the CCC through price support operations. Commodities may not be made available in amounts that will reduce amounts traditionally used for domestic feeding programs. On the other hand, food aid under P.

L. 480 is better coordinated to emergency demand. Appropriated dollars will buy marginally less tonnage in years when agricultural prices are high and vice versa; however, when unanticipated emergency demand is great and especially if the emergency has a high political profile (i.e., “CNN effect”), it is possible to borrow from other legislative authorities, such as Title I P.

L. 480, receive supplemental Congressional appropriations and draw from emergency commodity reserves. 8 P.

L. 480 again has more flexibility in choice of commodity. For P.

L. 480, no agricultural commodity is made available if its disposition would reduce the domestic supply below domestic requirements and provide adequate carryover, unless the Secretary of Agriculture determines that some part of the supply should be used for urgent humanitarian purposes. The availability of surpluses also affects the quality of formulated food aid commodities.

For instance, as pointed out previously, the availability of dry milk powder drives the formulation of the blended foods CSB or CSM and WSB or WSM, as well as their instantized forms (Instant, Corn Soy Blend/Milk and Instant Wheat Soy Blend/Milk), not the need for high quality protein in the formulation.

### Distortions in foods developed and supplied because of U.S. commercial food and shipping interests Domestic food commodity interests along with nongovernmental organizations are a formidable constituency supporting the continuation of a substantial U.S. global food aid commitment.

However, in the current policy environment, the pursuit of self-interest by U.S. producers and food processors, the ingredient industries, shippers and other interests represents a major influence on the commodities and conduct of the program. Not only do lobbies for these groups actively shape appropriations and authorization bills, they are also involved in program operations on a day-to-day basis.

Agricultural producers promote their foods for use in specific situations and are quick to intervene if their commercial markets are threatened. Processors seek to increase the value-added (processed) foods included in food aid shipments, and mineral and vitamin manufacturers want more additives included in processed products (2015281-8/fulltext#) Committee on International Nutrition, Institute of Medicine, National Academy of Sciences.

(1997) Vitamin C Fortification of Food Aid Commodities. National Academies Press, Washington, DC. Influences have increased since 1996 when, under pressure from agricultural lobbies, the P.

L. 480 food aid consultative group—where P. L.

480 Title II program guidance is debated and shaped—was expanded to include representatives from commodity groups such as the U.S. Dry Bean Council, the Potato Board, the North American Millers Association and the Food Additives Council. It is not uncommon for producers of specific foods to seek to extend their markets by approaching their congressional representatives or otherwise influencing the food aid procurement process.

Rarely does the food aid program and its partners research and define food needs and seek private sector support in procuring a new food aid commodity. Ironically, because of the domestic purchase requirement, P. L.

480 appropriations must _not_ be used to purchase special emergency foods produced in other countries, such as high energy therapeutic milk or high energy biscuits (although limited quantities are purchased by USAID's Office of Foreign Disaster Assistance). Two legal requirements are especially illustrative of commercial interests that influence the programs, the “value-added” mandate and the Cargo Preference Act. ### 1.

Value-added mandate Under Title II, nonemergency, the P. L. 480 law mandates that 75% of all foods shipped are to be “value-added,” that is, they must be processed, fortified or bagged.

This is a provision, originally supported by USAID and the private voluntary organizations, that is now supported and defended by the interests of U.S. food processors and packaging interests. The list of commonly used value-added commodities is determined internally at the highest levels of USDA and USAID, with little or no consultation with nutritionists.

At present, the blended foods, refined vegetable oil, but not unrefined vegetable oil, powdered milk and formula milk, and many other processed or bagged cereals or legumes are on the list (Table 415281-8/fulltext#t4)).

Although this mandate explicitly does not apply to emergency food aid, it has a bearing on the commodity mix in emergencies, because donors and field agencies are accustomed to requesting them, know how to handle them and U.S. suppliers are likely to have them available. To shorten the supply delays for rapid-onset emergencies, limited quantities of the commonly used commodities are being stockpiled or “prepositioned” at U.S. ports.

Field agencies can request any commodity and, if approved by program authorities (e.g., yams), USDA would procure it for shipment by USAID under Title II (provided it was not explicitly excluded because of U.S. domestic needs). However, in practice this would probably involve longer delays if it was not one of the commonly used value-added or bulk commodities. Adequate manufacturing capacity and supplies might not exist.

Costs, availability, packaging, handling, and shelf-life issues would be under greater scrutiny because of the limited experience the programs have with such foods. Food aid programmers claim to be always responsive to field requests; however, field agencies faced with longer waits for the preferred foods are likely to chose the less-preferred commodity.

Corn, bagged Fortified non-fat dried milk Cornmeal Butter oil 55-gal drum Corn soy blend Corn, bulk with BNT Instant corn soy milk Wheat hard durum, bagged Corn soy milk Wheat soft red winter, bagged Sorghum, bagged Wheat northern spring dark, bagged Nonfat dried milk Wheat hard red winter, bagged Rice, bagged Wheat soft white, bagged Rice, bulk with BNT315281-8/fulltext#note9)Wheat hard durum with BNT Soy fortified bulgur Wheat soft red winter with BNT Soy fortified rolled oats Wheat hard red winter with BNT Soy fortified sorghum grits Wheat soft white with BNT Vegetable oil 4 L Beans, navy Wheat flour Corn soy masa flour Wheat soy blend Beans, black Beans, pinto Beans, Great Northern Vegetable oil 20 L Beans, kidney Peas, yellow Peas, green split Butter Peas, yellow split Wheat soy milk Infant formula Processed and fortified cereal grains: commonly used value-added commodities115281-8/fulltext#note7)215281-8/fulltext#note8) USAID, Office of Food for Peace 2002 Guidance.

Determined to be processed, fortified, or bagged. BNT, bags, needles, and twine. * Open table in a new tab It seems that if the processed and fortified foods were supplied on the basis of nutritional and food needs, the value-added mandate would apply to emergency food aid.

Emergency feeding recipients have difficulty preparing unprocessed grains and have a greater need of a complete diet from food aid, including micronutrient fortificants. Fortified commodities may also be less likely to be shipped because either requesting governments or inexperienced requesting agencies may view emergency nutrition problems strictly in terms of calorie supply.

Larger numbers of persons can meet basic energy needs with a commodity such as wheat or corn at approximately $150/metric ton than can be satisfied with corn soya blend at $350/metric ton or higher.

Moreover, because of the orientation of the program toward domestic food processing and value-added commodities, little interest can be generated in policy circles to process and fortify foods near emergency food distribution sites overseas or to export vitamin premix under food aid budgetary authority. ### 2. The Cargo Preference Act Another constituent for the food aid programs is U.S. shippers.

Under the Merchant Marine Act of 1936, as amended, 75% of all food aid must be