Tag: RUSF

“Poor Relief” a Book by Heath Henderson, Critiques Cash Handouts

June 22, 2026   In his recent book, Poor Relief:  Why Giving People Money Is Not the Answer to Global Poverty (Harvard University Press, 2025), author Heath Henderson challenges assumptions about the sustainability and effectiveness of cash transfers to remedy poverty.

During the last 20 years, aid agencies have increasingly experimented with giving out cash to poor families around the world, either as loans (microfinance) or as grants, as a new ideal for aid, including to refugees and famine victims.  It supposes two things:  1) that individual choices are more effective than infrastructure or market programs, or provision of health services or food aid;  2) that cash is the binding constraint in overcoming poverty, not jobs, social structures, doctors, food availability, housing, market access, security, or legal rights.

Heath Henderson, Associate Professor of Economics at Drake University (with prior experience at the Inter-American Development Bank, World Bank, and United Nations), examines the actual effectiveness of direct cash transfers, whether unconditional cash transfers (UCTs), conditional cash transfers (CCTs), or universal basic income (UBI)-style programs.

Henderson concludes that “cash transfers are a flawed way to address extreme poverty. Cash programs do not combat the deep, structural issues that serve to keep people poor, such as racism or sexism, lack of access to quality education or health care, and even political exclusion.  In addition, money can’t buy everything a person needs to escape poverty, like a stable climate, clean water, or access to markets. Furthermore, some people can be left behind or outright harmed by cash programs, particularly women and children.”

His evidence includes long-term results of large cash programs as well as surveys of the views of their beneficiaries.  He finds:

“Given the limitations of cash transfers, it is no surprise that people living in poverty often prefer other forms of support.  … impactful and respectful poverty alleviation requires being more responsive to the voices of people in poverty, rather than assuming markets know best. Stated differently, eradicating extreme poverty requires looking beyond one-size-fits-all solutions and toward a truly bottom-up, democratic alternative.”

The poor often say they prefer community-level, longer-term interventions, such as infrastructure, clean water or healthcare.

Henderson traces the bandwagon support for and rapid growth of cash transfer programs.  For example, GiveDirectly’s (a popular non-profit) transfers (and donations) grew from $3 million (2014) to $543 million (2024).  Some experts have called cash handouts “as close as you can come to a magic bullet in development”.  Like microfinance before it, cash transfers have become a very popular fad, with poor evidence to support its efficiency.

Henderson provides a global and historical view of cash schemes, from English Poor Laws through Speenhamland, the New Poor Law, Bismarckian social insurance, negative income tax experiments, the EITC, Alaska Permanent Fund, Mexico’s Progresa/Oportunidades, Brazil’s Bolsa Família, India’s NREGS, South Africa’s child grants, China’s Di Bao, and Indonesia’s programs. By 2013, 76% of developing countries had such programs.

One large example:

The 2017–2018 Direct Benefit Transfer (DBT) pilot in Nagri, Jharkhand, India. The National Food Security Act had long allowed eligible households to buy rice for 1 rupee per kilogram at ration shops. The pilot replaced this with equivalent cash deposited into bank accounts. The architects of this program expected greater autonomy and choice. Recipients, however, protested en masse.  Over 1,000 people marched miles to the governor’s residence in Ranchi in protest.  Practical failures abounded. A woman named Jamna Sanga spent significant time and money (32 rupees on rides + fees to banking correspondents) checking balances, missing work days that paid 150 rupees each, and forcing her daughter to miss school for water collection. A government audit of over 8,000 beneficiaries found the average person claimed only 3.6 of 6 entitled installments.  Famine expert Jean Drèze noted that “the elderly, the disabled, the ailing and the most vulnerable” were least likely to claim benefits.

Surveys reinforced the point.  In nine Indian states (~1,200 poor rural households), over two-thirds preferred in-kind transfers. A 60-year-old tribal widow, Aetwaribhai, explained: “It is very difficult to get rice in the market. I am too old to go and search for rice.” A Bihar poll (~3,800 respondents) found 86% preferring public health investments over cash and 65% preferring improved roads.  Henderson uses this to illustrate broader problems: implementation frictions, exclusion of the vulnerable, preference for public goods over individual cash, and the risk that cash programs can even exacerbate harms (e.g., one Indian program linked to a 1.0–2.3% rise in sex-selective abortions). He notes that even when the old in-kind system had corruption issues, many still preferred it to the cash experiment, which was eventually scaled back in Nagri.

Henderson recounts numerous other experiments in cash transfers with mixed outcomes, and where effects are poor, efficiency from large-money transfers seems particularly poor.  Particularly in regard to malnutrition, he finds that half of cash programs reviewed had negative effects on height-for-age (stunting of children), and the majority had negative effects on weight-for-age.  “The simple conclusion is that cash transfers just aren’t that powerful for fighting malnutrition.”

In the Philippines, the Pantawid conditional cash transfer program increased the local price of protein-rich perishable foods by 6-8% and had spillover effects for families not in the program.  Ineligible neighboring children showed increases in wasting malnutrition and stunting.

Many of the problems with cash, he details, come from blunt approaches to targeting, that do not reach those most in need.  For instance “most of Africa’s nutritionally deprived women and children were not…found in the most economically disadvantaged households.  .. roughly 75% of underweight women and undernourished children were not in the 20% of households with the lowest wealth levels.”

He explains “Cash transfers rely heavily on markets for poverty alleviation, but this approach is only effective to the extent that people can buy what they need to pull themselves out of poverty.  In short, cash transfers inherit the limits of markets, and we’ve seen that markets fail to deliver many goods that are vital to human well-being.  Safe blood, clean air, clean water, quality education and quality healthcare are just a few leading examples.”

He points to some positive examples, including programs that promote complementary feeding education, zinc supplementation, small-quantity lipid-based nutrients, ready to use supplementary food, family planning and insecticide-treated bednets to prevent malaria.

Overall, Henderson distinguishes between the individualist and the structuralist approaches to fighting poverty.  Cash transfers follow the individualist approach, which often perpetuates the status quo.  Henderson calls for decentralized structural change. He reminds readers of how Amartya Sen argued that famines do not occur in democracies because democracy creates channels for local knowledge to be passed on to policy-makers.

Since its publication, Henderson says

“I’ve been quite pleased with the reception of the book. The book has generated a fair amount of interest within the targeted audience, and I’ve also seen several positive reviews of it. Beyond that, I’ve had many conversations with people expressing to me that the book provides a much-needed reality check on the hype around cash transfers. All in all, the reception has definitely exceeded my expectations.”

Henderson has created a nonprofit, JustGive.  In place of paternalism, Just-Give uses democratic methods to identify the causes that people in need themselves judge to be valuable and impactful.  Its flagship initiative is the Iowa Food Security Forum, planned in partnership with the Des Moines Area Religious Council (DMARC) and scheduled for Des Moines in fall 2026. The forum is built around a “deliberative poll,” a methodology associated with Stanford’s Deliberative Democracy Lab (James Fishkin’s work).

The program in Iowa recruits a large sample of food-insecure Iowans, gives them briefing materials, expert plenary sessions, and small-group discussions, then surveys them before and after; the shift in informed opinion is meant to feed into how local policymakers and nonprofits respond to food insecurity.  It tests an approach to deliberative democracy, believing that lay participants, once informed and allowed to deliberate, produce more considered and legitimate preferences than a raw opinion poll would capture.

Interview with Edesia’s Maria Kasparian about Anti-Hunger Foods

April 20, 2026      Plumpy’Nut has become one of the most recognizable tools in the fight against severe acute malnutrition among young children around the world.  Plumpy’Nut is one brand of the broader food type called “Ready to Use Therapeutic Food”, or “RUTF.”  RUTFs have been a key topic in recent articles in Hunger Notes; nonprofits have used RUTFs in the Sudan, Gaza, Haiti, Afghanistan and in other countries in need.

In the United States, one of the leading producers is Edesia, the Rhode Island–based nonprofit that manufactures Plumpy’Nut and related products for UNICEF,  the World Food Programme, and NGO partners, while also participating in a wider global network of therapeutic food producers.
Following are selections from WHES’ interview with Ms. Maria Kasparian, Edesia’s Executive Director in 2023, about Edesia and now head of Strategic Partnerships.  The interview highlights several of these trends: rising interest in alternative formulations using ingredients such as soy, corn, chickpea, or millet; debate over procurement rules; the slow pace of agency adoption; and growing recognition that the challenge is not only making therapeutic food, but also building efficient supply chains that can deliver it where children need it most.

WHES: Thank you so much for taking time out to talk with us today. What should our readers know about Edesia?

Kasparian:  One of Edesia’s mandates is to educate and advocate global nutrition. We have school field trips, work with senators, channel our programming through Scouting America, and we do advocacy work in DC.
We produce in the US, taking with PL 480 (Food Aid) funds. We are producing 1.2 million packets of Plumpy’Nut each day. Edesia has had a ticker of how many children that our products have reached since we started producing in March 2010 – and distributing through partners. Today we are at 19.9 M children reached with full treatments. Our goal is to reach a total of at least 10 M more children within 2023 and 2024.

We’re also part of the “PlumpyField network” of partners in ten partners, spanning Madagascar, India, and other countries. We work to help these producers in other countries, such as Ethiopia and Haiti. For instance, we support Meds and Foods for Kids in Haiti. There are now 22 producers worldwide of RUTF, and each uses slightly different formulations.

WHES: Do all the producers of Ready to Use foods follow the same formulae?

Kasparian: Across the 22 suppliers of foods, there are no two formulas that are identical. But as long as we meet the robust recommendation, we’re okay.
Even within the PlumpyField Network, there are tweaks. There are differences, depending on what’s available locally. For example, you have to achieve certain omega-3 to omega-6 balance with the fats. You need to do that. The vegetable oils are important. You can get different kinds of vegetable oils depending where you are. There might be some variety there. You might have different forms of milk powder available. You might have different forms of whey available that have different amounts of protein. You’ve got to balance the formulas, depending on what ingredients you have available. But they’re very similar. We’ve actually done taste tests where we meet and have everybody’s and we blindly try to guess whose is who. So, they’re a little different, but the difference is small. But the formulations do vary a little bit. There will be a greater degree of difference with those outside the network formulations are.

WHES: Thank you. So, how do donors specify what they want or accept new ideas for specialty foods to address malnutrition?

Kasparian: Well, the Interagency oversight group (UNICEF and WFP) have discussed for many years, having a common standard. It’s the long game. Over time, things do get accepted. Governments and the U.N. don’t move quickly. So generally, though, progress does happen. It just happens slowly. You keep pushing, and over time, things do improve. So you must continue innovating.
The Tufts Food Aid Quality Review study comparing the effectiveness of different foods looked at RUTF (compared Corn Soy Blend or CSB+ with fortified vegetable oil (CSB+ w/oil), Corn soy whey blend (CSWB) with fortified vegetable oil (CSWB w/oil), and Super Cereal Plus with amylase (SC+A)) for the treatment of moderate malnutrition.  The cost-effectiveness was similar between the products, and caregivers had a slightly lower of their own opportunity costs when using RUTF.  The main conclusion was that NGOs/programmers should pick the products that would be most appropriate for their contexts.

WHES: Is it only about the formula of the food composition?

Kasparian: The ecosystem is not only about making RUTF, but also about improving the supply chain. Customs fees for incoming fees mean that local production is not necessarily cheaper. You know, it’s cheaper to get our foods from here to South Sudan than it is from Khartoum to South Sudan. As well, we’re shipping a lot to Somalia right now.

WHES:  Has demand grown for your RUTF?

Kasparian: We have doubled the numbers of kids getting treatment. Most of it goes to Africa, over 70%. Our main goal is to reach more kids. The price of RUTF was going down significantly before the Covid-19 pandemic. As background, 70% is the cost of the ingredients. In 2005 a box of RUTF cost $55 but we brought that down to $35 a box in 2019.

WHES: How is it working with UNICEF and WFP?

Kasparian: One of the barriers we face is the way that Unicef and WFP work together. They work differently and in different places.

WHES: How do you relate to other producers in other countries?

Kasparian: We are a U.S.-based producer. We’re a non-profit U.S.-based producer, and that we care a lot about having a good balance of what’s coming from the U.S. and what is coming from local and regional procurers, and that balance is really important. And we do various things to support these
suppliers in other countries. We work particularly closely with Meds and Food for Kids in Haiti. We help them with their formulations. We just help them to get their codex, upgraded codex specification in order. We help them with procurement of raw materials. We help them troubleshoot from a maintenance engineering perspective.

WHES:   Edesia has a history going back to Tanzania, right?

Kasparian: Yes.  Before we set up a factory in the U.S., we established one in Tanzania, which, unfortunately, is no longer operational, but was, for about five years.  Thus, our experience kind of went that way. Our founder, Navyn Salem, has family roots in Tanzania.  Her father and three generations of the family are Indians who lived in Tanzania for a period of time. Ms. Salem’s father was born and raised in Tanzania before he came to the U.S. on a USAID scholarship for college.  This leads me to another interesting part of the story: USAID is really responsible for Edesia’s existence. Her father, and therefore she, would not be in the U.S. if not for USAID. The U.S. factory, Edesia, was an afterthought to Tanzania because, at the time, USAID’s Food for Peace, was looking to have RUTF and RUSF suppliers in the U.S. because they wanted to be able to use the Title II PL-480 funds for nutrition-specific commodities like RUTF, RUSF. Which, at the time, this is 2008, 2009, at the time, no one was making in the U.S. And there was a push to improve the food aid basket of what was coming out of the U.S. And to take more vulnerable groups into account and to add these nutrition-specific commodities. So, they kind of approached us and others to say, hey, can you do this in the U.S.?

WHES: Do you engage much with the public here in the U.S.?

Kasparian: Our factory doors are open. We have school field trips come through. We have senators and congresspeople whenever we can. We have Scouting America, Rotary Clubs, and the like. And then we also do advocacy work in D.C. around global nutrition.