For more than 50 years, the United States–which accounts for about half of global food aid supplies–has played an important role in alleviating malnutrition and hunger, especially during emergencies. In fiscal year 2010, the United States spent about $1.5 billion on emergency food aid that reached about 46.5 million beneficiaries. To preserve the nutritional value of food aid, quality controls are in place throughout the supply chain. GAO was asked to assess U.S. efforts to (1) meet the nutritional needs of intended recipients and (2) maintain the quality of commodities throughout the food aid supply chain. GAO analyzed program data, interviewed agency officials and their implementing partners, and conducted fieldwork in the United States and four countries in Africa. U.S. food aid provides crucial life-saving calories and nutrients to vulnerable populations during short-term emergencies, but food rations designed to address short-term food insecurity may not provide adequate nutrition during long-term food emergencies if the recipients rely solely on food aid. Furthermore, specialized food products designed for the most vulnerable groups are costly and difficult to target to the intended recipients. U.S. food aid provides essential calories and nutrients during short-term emergencies, but many food emergencies extend beyond 1 year, with multiyear feeding programs now accounting for more than half of U.S emergency food aid funding. To address the nutritional needs of vulnerable groups, including young children and pregnant and lactating women, specialized food products can be used in addition to the commodities normally used for general distribution. However, these products are also more costly than the commodities used for general distribution. As a result, U.S. agencies and implementing partners face challenges with the costliness of specialized food products and the trade-off between reaching more beneficiaries and improving nutritional outcomes for some. Within a fixed budget, distributing the more costly specialized products would reduce the overall number of beneficiaries served. The relatively higher cost of specialized food accentuates the importance of targeting efforts to ensure that the food reaches its intended recipients. However, USAID provided implementing partners with limited guidance on how to target the specialized food products to ensure they reach intended recipients. The quality of blended and fortified U.S. food aid procured has generally improved; however, problems still occasionally arise, and vulnerabilities in quality controls–such as data collection and food packaging–make it difficult to ensure that the quality of commodities is maintained throughout the supply chain. In 2007, GAO found long-standing concerns about food aid quality, specifically with corn soy blend (CSB), a nutritionally enhanced product intended for vulnerable populations. To mitigate such quality problems, in September 2009, the U.S. Department of Agriculture (USDA) resumed quality assurance activities for CSB and wheat soy blend, including vendor facility inspections and commodity sampling and testing. According to FGIS officials, virtually all (approximately 99.5 percent) of CSB lots procured by KCCO in the first quarter of fiscal year 2011 met acceptable specifications and discount ranges. Even with testing, quality problems may still arise due to ineffective quality controls within the supply chain, particularly in data tracking and food packaging. U.S. agencies and implementing partners track data only on food aid damage and losses, even though they are an imperfect indicator for quality. Without systematically tracking key quality indicators, such as elapsed time between major points within the food aid supply chain, agencies and implementing partners may not be aware of the full extent of quality problems. Furthermore, quality problems and losses have resulted from food packaging that is not sufficiently durable for the rugged conditions encountered throughout the food aid supply chain. GAO recommends that the Administrator of the U.S. Agency for International Development (USAID) and the Secretary of Agriculture issue guidance on how to address nutritional deficiencies that may emerge during protracted emergencies, evaluate the performance and cost-effectiveness of specialized food products, issue guidance on the use of these products, identify and systematically track key quality indicators, and evaluate food packaging specifications for durability. Both USAID and USDA generally concurred with our recommendations and provided examples of recent efforts to address them.