U.S. Food Aid (Part 9): Critiques of Recent Development Food Aid (RFSAs)

July 24, 2026     Since 2019, U.S. Food for Peace spent between $1.8 and $2 billion in development programs called RFSAs, for Resilience Food Security Activities.  RFSAs were more than simple food distribution; they combined food or cash transfers with nutrition educaiton, water supply, hygiene, agriculture, savings groups, market links, mentoring, disaster risk reduction, local governance, gender, and behavior change. The complex designs of these programs made them hard to evaluate, to ascertain whether they reduced hunger or malnutrition.  Most of the measurements from these programs were not about nutrition or hunger, but were about NGO activities or skills training, water committees, microfinance organizations or planning.

Making sense of what RFSAs actually accomplished is clouded by all the complex things NGOs sought to do.  In their own reporting aid agencies are more prone to showcase their field activities over their outcomes or impacts.  For instance, much of what has been written in recent years about the Food for Peace RFSAs is about their design, their theory of change, how many people reached, but not as much about what they accomplished.

The numerous US-funded RFSAs showed many promising near-term outputs, but in the end, showed minimal long-term change in nutrition.  In other words, a repeated lesson from RFSAs was that short-term improvements do not prove durable resilience.  Food aid and complementary activities may improve consumption and nutrition while the project is operating, but lasting impact requires stronger local systems, markets, income streams, water access, and shock-responsive safety nets.

 One RFSA evaluation expert had these reflections about RFSAs:

>   “The  kitchen sink approach (many sectors, scattered activities) to a problem (malnutrition) is difficult to implement and merits more prioritization;”

>   “The USAiD strategy of sequencing and layering makes sense conceptually but it may be hard to implement.  It is hard to assess or evaluate, and should not be an after thought;”

>   “Revisiting the project’s theory of change each year represents a big burden on everyone involved;”

>   “Separating the leaning function from the monitoring and evaluation function, i.e. giving roles to different institutions, is unnecessary and reflects too much micro management.  Meanwhile,tThere were too many monitoring and measuring activities;”

>   “The subsidies given out as supplemental income to buy food will not work if amounts are too low or if other non-food needs are so great that funds are diverted by families to other ends than food.”

>    “Project management offices were too far from the areas of implementation.”

Across the evaluation literature, only a minority of RFSAs produced strong causal evidence that malnutrition rates changed because of the RFSA.  One of the larger programs, in Ethiopia, was evaluated by IFPRI:  despite high baseline stunting and wasting, there was no measurable average impact on child anthropometric status from the Ethiopian SPIR program package.  Meanwhile, in Asia, the multi-year SHOUHARDO RFSA in Bangladesh had a rigorous pre-post evaluation that documented improvements in per capita food expenditures (increasing from $2.03 to 22.22) but found no attributable differences in child malnutrition.

Many of the RFSAs provided cash and food to families and then measured whether the families had more wealth (more cash).  In other words, people given money had more money, at least during the project period, and they said they consumed more food.  But 18 months later, while  families said they were better off,  nutrition gains were not sustained.

Several of the RFSAs never published final project reports or impact results. The most sobering evidence comes from Malawi’s WALA long-term evaluation, where positive endline trends in nutrition and food-aid need were not clearly sustained several years later under climate and pest shocks.   Other evaluations included as Niger’s Hamzari/Girma/Wadata, Zimbabwe’s Amalima/Nuyok/Apolou, Madagascar’s Fararano/Maharo/Fiovana, and Malawi’s UBALE/Njira. These could not isolate RFSA effects from broader trends, shocks, or selection.

Other evaluation lessons of RFSAs include:

The graduation model of sequencing each household’s intervention and mentoring appears to have improved livelihoods and food security.  But the sequencing/layering method did not work in other countries.

Nuggets of success can be identified.  For example, mothers’ “Care Groups” is a model of improving nutrition that is  scalable, and cost-effective. Lead mothers (volunteers) reach 10–15 neighboring households with timed, sequenced messages. Evidence from multiple contexts shows strong improvements in young child feeding practices, hygiene, and service utilization.  Greater success was consistently associated with interpersonal nutrition counseling and home visits, population- and community-based Social and Behavior Change Communication (SBCC) strategies, and targeting children under two or three years (the critical window).

Programs providing preventive supplementary feeding achieved twice the rate of stunting reduction, an average annual decline of 1.69 percentage points, compared to recuperative-only or no-ration programs.  (Less successful programs often relied on stand-alone Positive Deviance/Hearth (PD/H) approaches focused narrowly on recuperation rather than prevention, or failed to integrate services.)

The RFSA model was most effective when it gave poor households a real consumption floor through food, cash, or vouchers and it layered a credible economic pathway: assets, savings, coaching, agricultural or livestock support, market access.

Photo credit:  from CARE’s SHOUHARDO III Plus Program page at https://www.facebook.com/groups/2195296804116047/

“Essentials of Public Health Communication”: Valuable Curricula

February 22, 2026    A round the world, a key shift during the past few decades in combatting malnutrition has been the adoption of social marketing, communications and “behavior change” to improve diets, caretaker behavior,  and recognition of failures in child growth.  The technical book, “Essentials of Public Health Communication” summarizes the state of the art in applying these tools in public health and nutrition.  Written by Claudia Fishman Parvanta, David Nelson, Sarah Parvanta, and Richard Warner.

Chapters walk the reader through implementation, with examples.  One example is the “Folic Acid First Campaign,” convincing women to take a multivitamin with folic acid (or a folic supplement) before they get pregnant.  Television, radio and print messaging should convey a sense of good health, warmth and energy to reduce the chances of birth defects in newborns.

Claudia Parvanta’s background in designing and evaluating health and nutrition social marketing programs in over 20 countries informs the text’s emphasis on using communication to influence dietary behaviors and address hunger-related issues.  The book references other nutrition-related initiatives, such as the Bangladesh Nutrition Education Project, to illustrate how strategic communication plans are developed and implemented in real-world settings.  It walks the reader through formative research methods, such as focus groups, to understand barriers to diet choices.

This 416-page text (published by Jones & Bartlett Learning) is divided into four major sections: Section One: Overview. Chapters 1, 2, and 3 provide an overview of public health communications, the planning, and informatics. Section Two: Informing and Educating People about Health Issues. Chapters 4 through 7 describe communication challenges and methods to provide information in a clear and unbiased manner.

The book analyzes how anti-vaccine content thrives online using emotive narratives and false expertise. It then contrasts this with proactive, empathetic communication strategies from health agencies, such as “pre-bunking” (inoculation theory) and engaging trusted community influencers (e.g., pediatricians, local mothers) as messengers.

The authors frame communication as a core public health function essential for prevention, behavior change, and policy advocacy.  Introduces behavioral and social science theories that guide message design (e.g., risk perception, social norms, diffusion of innovations).  The book includes discussion of media and channel selection and emphases  the 4 “P”s of Social Marketing, namely Product (the idea of being active), Price (reducing social/access barriers), Place (where tweens gather), Promotion (cool, aspirational ads).

Other case examples include the 2009 H1N1 Influenza Pandemic, the 2014 Ebola scare, and tobacco.  The “Truth” Campaign is described as an anti-tobacco campaign to illustrate audience segmentation and theory application. It didn’t target smokers with health warnings but segmented a new audience  i.e., teenagers, and used the Theory of Reasoned Action/Planned Behavior and empowerment models. The campaign framed tobacco use as a manipulation by big corporations, making rebellion synonymous with not smoking. This showcases moving from “knowledge-attitude-practice” to more sophisticated socio-ecological models.  A full chapter is dedicated to public health informatics which highlights how data systems, surveillance, and digital tools support communication planning and evaluation.

Apropos to its subject, the book reads easily for students and professionals and communicates its messages very well, using a mix of steps, examples, cautions and context.  The book has received very positive reviews, with a 4.5 out of 5-star rating on Amazon.  Reviewers praised it as an excellent resource for nutrition communications and for various types of public health communication work.  It remains the best learning resource in its category.  It is particularly required reading for anyone planning a public health campaign anywhere in the world.