U.S. Food Aid (Part 3): Lessons from Tufts University’s “Food Aid Quality Review”,

July 17, 2026   This is the third in a series of briefs about U.S. Food Aid, recognizing the shift of programming to the U.S. Department of Agriculture.

Every year, for over a half century, the United States has shipped more than a million tons of food to hungry people in dozens of countries.  During this time the underlying products barely changed.  In 2009, USAID’s Office of Food for Peace (FFP) commissioned Tufts University’s School of Nutrition, in Medford (near Boston), Massachuseets to ask basic questions about how effective these foods are.   The resulting twelve-year “Food Aid Quality Review” (FAQR), was anchored by two principal investigators, Patrick Webb, and Beatrice Lorge Rogers, working with a team of Friedman School of nutrition faculty and students, and a stakeholder network spanning dozens of NGOs, implementing partners, and UN agencies across more than 40 countries.

Tuft’s FAQR, in partnership with USDA and the Department of Defense’s Natick food research laboratories, had three phases over twelve years:

Phase I (2009–2011): a diagnostic review of whether U.S. food aid products, programming, and institutional processes reflected current nutrition science.

Phase II (2011–2016): development and field-testing of reformulated products, including a large randomized prevention trial in Burkina Faso.

Phase III (2016–2021): a randomized treatment trial in Sierra Leone, supply-chain and packaging research, bioavailability science, and the institutionalization of the reforms across USAID and USDA.

The flagship Phase I report, “Delivering Improved Nutrition: Recommendations for Changes to U.S. Food Aid Products and Programs” (Webb, Rogers, Rosenberg et al., 2011), was built on a survey of 64 implementing-partner field offices across 40 countries (an 81% response rate), plus expert panels and public comment — the first systematic, evidence-based review of Title II food aid products in the program’s history. It organized its findings around three pillars: product quality, programming quality, and process quality , the idea that better food alone would not fix a broken system unless targeting, procurement, and delivery improved alongside it.

From there, Tufts led two of the largest field trials ever conducted on specialized nutritious foods:

• • • Burkina Faso (2014–2017): a geographically randomized prevention trial with roughly 6,100 children aged 6–23 months, comparing four foods for their effect on stunting and wasting.
    • Sierra Leone “Four Foods” study (2017–2018): a cluster-randomized treatment trial with 2,683 children aged 6–59 months, testing recovery from moderate acute malnutrition, alongside sub-studies on body composition and gut health, and a novel 1.2 kg consumer package.

The headline finding surprised many in the field: the newer, more expensive, reformulated products did not outperform the upgraded standard corn-soy blend. In Burkina Faso, no food fully prevented growth decline, and a novel corn-soy-whey blend actually performed worse than standard CSB+ with oil. In Sierra Leone, recovery rates were statistically similar — around 62–65% — across all four products tested. In both trials, cost, not effectiveness, was what separated the products: CSB+ with oil was consistently the cheapest and therefore the most cost-effective option, at roughly $122 per child in Burkina Faso versus $140–$245 for the alternatives.

Tufts also stood up the REFINE database (Research Engagement on Food Interventions for Nutritional Effectiveness), an open-access knowledge-sharing platform built by Friedman School faculty, staff, and students together with a team from the World Food Programme.

The founding evidence base came from a survey of 64 responding USAID implementing-partner field offices across 40 countries, supplemented by expert panels and a formal public-comment period on the draft report.

• • •  – The institutional-process review that shaped FAQR’s supply-chain and programming recommendations was built on consultations with “US government employees and contractors, academics, industry representatives, donor agency staff, United Nations personnel, and field-level food aid programming technical staff from many countries,” plus a standing Panel of Experts whose members included organizations such as BASF Micronutrient Initiatives and MANA Nutrition.
    •  – The field trials ran through named implementing and research partners rather than Tufts alone: Project Peanut Butter and Caritas Bo in Sierra Leone; Save the Children and ACDI/VOCA in Burkina Faso, which also managed the underlying USAID Title II “Victory against Malnutrition” project; Washington University in St. Louis’s School of Medicine, which led clinical protocol design and implementation for the treatment trials; the Institut de Recherche en Sciences de la Santé, Burkina Faso’s national health-sciences research institute, which ran field data collection; and Global Food & Nutrition Inc., a food-systems consulting firm.
    •  – On harmonization, FAQR worked directly to align product specifications among USAID, USDA, the World Food Programme, UNICEF, and WHO, agencies that had previously maintained differing specifications for functionally similar products, complicating procurement and confusing manufacturers.  REFINE itself was co-built with a WFP team.
    •  – Ongoing consultation ran through the congressionally established Food Aid Consultative Group (FACG), whose membership spans academicians, advocacy organizations, commodity groups, and implementing partners, and which met semiannually throughout the FAQR years to review the evolving food-aid product basket.

KEY INSIGHTS and CONCLUSIONS

Regarding commodity quality, FAQR concluded that U.S. foods used in aid had “barely changed in decades” and were out of step with modern nutrition science, and (among other things) recommended adding a dairy-protein source (whey protein concentrate, WPC80) to fortified blended foods, upgrading micronutrient premixes, and adding lipid-based ready-to-use foods to the approved product list. USAID adopted uniform micronutrient specifications across 21 products, upgraded the micronutrient content of 8 products, developed 4 entirely new products, and set the first global minimum nutrient premix standard for ready-to-use foods.

  •  About programming quality, FAQR found that programs were commonly judged by tonnage shipped or numbers of people “fed,” not by nutrition outcomes achieved, and that a single “one-size-fits-all” ration could not meet the very different needs of infants, pregnant and lactating women, wasted children, and people on HIV treatment. It developed decision trees to match specific products to specific purposes and emphasized the first 1,000 days of a child’s life (conception to age two) as the priority window for specialized nutrition programming.

  •   When looking at process quality, FAQR found that the many hand-offs of food from procurement to delivery were poorly coordinated across agencies, and it recommended a standing interagency committee, stronger quality-assurance feedback loops, and later, in a 2021 review of 26 commodity incidents between 2018 and 2020, a formal Commodity Incident Management System with real-time, end-to-end traceability “from producer to consumer.”

FAQR‘s most durable legacy may be less about any single product than about how Food for Peace (today, USDA) should make decisions. Several implications carry directly into current and future food-aid policy:

  •   Cost-effectiveness, not unit cost, should drive product choice.  The central empirical finding,  that the cheapest option (CSB+ with oil) matched or beat costlier, more sophisticated products in both prevention and treatment trials, to treat moderate malnutrition is a standing rebuke to the assumption that newer and more expensive automatically means better.  USG programs should keep asking “cost per case of malnutrition averted,” not “dollars per ton shipped,” when choosing among products.

  •   Freight and procurement costs, not formulation, usually decide the winner. Because product price and international freight, not nutritional efficacy, drove most of the cost differences observed in the field trials, decisions about where to source, how to package, and how to ship deserve as much scrutiny as decisions about what goes in the bag.

  •   “Fit for purpose” should stay the organizing principle, not a slogan. No single food worked for every beneficiary group in FAQR’s trials. Continued investment in decision tools that match a specific product to a specific nutritional objective, context, and beneficiary,  rather than defaulting to one flagship commodity, is what the evidence actually supports.

  •   Interagency and international harmonization needs active maintenance, not a one-time fix. The alignment FAQR achieved among USAID, USDA, WFP, UNICEF, and WHO specifications reduced confusion for manufacturers and implementers, but harmonized standards drift apart again without a standing mechanism (like the FACG or an interagency committee) to keep revisiting them as new evidence and new products emerge.

  •   Supply-chain quality control deserves the same rigor as nutrition science. FAQR’s 2021 finding that losses are rare (under 1% of U.S.-sourced food) but that the health risk from what does slip through is high,  combined with weak, uncoordinated incident tracking, points to unfinished business: a real-time, end-to-end traceability system was recommended but not fully built out before the project closed in 2021.

  •   Evidence infrastructure needs a permanent home. REFINE was built specifically because, before FAQR, a lack of evidence on which foods to use and how to deliver them was a genuine gap, not a rhetorical one. Sustaining REFINE, or something like it, as a living, continuously updated evidence base, rather than letting it lapse once grant funding ends,  is the clearest way to keep future USG food-aid decisions grounded in current science rather than institutional habit.

The main FAQR finding that upended conventional wisdom was not that U.S. food aid needed fancier, costlier products; it was that a smarter, evidence-driven version of what USAID already had,  better targeted, better formulated, and more honestly costed, outperformed the alternatives. That is the standard FAQR leaves behind for whatever comes next in U.S. government food assistance.