The Special Supplemental Food Program for Women, Infants, and Children (WIC)--How Can It Work Better?

CED-79-55: Published: Feb 27, 1979. Publicly Released: Feb 27, 1979.

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A follow-on review of the Department of Agriculture's (USDA) Special Supplemental Food Program for Women, Infants, and Children (WIC) was conducted.

Several WIC programs did not provide needed health services as requested by Congress. Many of the programs were affected by the following: (1) required professional assessments of applicants' nutritional status were not being made in some locations; (2) states used different criteria for judging whether applicants were nutritional risks and eligible for the program and supplemental food packages seldom were tailored to participants' individual nutritional needs; (3) nutrition education and program evaluation have not received the priority and attention they deserve; and (4) program regulations contain provisions hindering effective evaluations.

Matters for Congressional Consideration

  1. Status: Closed - Not Implemented

    Comments: Congress does not expect to take any action on this recommendation in the near future.

    Matter: Congress should address the problem of whether benefits of the food supplement part of WIC alone warrant its expansion to areas where needed health services cannot be delivered.

  2. Status: Closed - Not Implemented

    Comments: Congress does not expect to take any action on this recommendation in the near future.

    Matter: Congress should monitor USDA actions on the GAO recommendation that USDA work with the states and local agencies and with the Department of Health, Education, and Welfare (HEW) to provide needed services in those present and planned program areas where adequate health services are not available, accessible, and acceptable.

  3. Status: Closed - Not Implemented

    Comments: Congress does not expect to take any action on this recommendation in the near future.

    Matter: Congress should revise authorizing WIC legislation to clearly require that participants receive needed health services where such services are available, accessible, and acceptable, with possible exceptions based on participants' religious beliefs.

Recommendations for Executive Action

  1. Status: Closed - Implemented

    Comments: When we confirm what actions the agency has taken in response to this recommendation, we will provide updated information.

    Recommendation: The Secretary of Agriculture should ensure that all states, especially Illinois and Washington, are properly interpreting federal program regulations as requiring that needed health services, including prenatal and pediatric care, be made available to WIC participants.

    Agency Affected: Department of Agriculture

  2. Status: Closed - Not Implemented

    Comments: USDA decided not to evaluate this issue in the near future.

    Recommendation: The Secretary of Agriculture should require that USDA evaluate and report on state monitoring of the content and overall effectivenesss of nutritional education given to participants at the local level.

    Agency Affected: Department of Agriculture

  3. Status: Closed - Implemented

    Comments: When we confirm what actions the agency has taken in response to this recommendation, we will provide updated information.

    Recommendation: The Secretary of Agriculture should arrange for USDA and HEW to jointly determine whether sufficient acceptable health services will be available for an expanded WIC program to operate as an adjunct to good health care. If problems appear likely in this regard, the executive branch should consult Congress and, within the framework of the government's overall budget policy, consider various alternative solutions geared to maximizing the effectiveness of available health resources.

    Agency Affected: Department of Agriculture

  4. Status: Closed - Not Implemented

    Comments: FNS officials do not consider this recommendation to be of high priority.

    Recommendation: The Secretary of Agriculture should preclude disincentives to food package tailoring by specifically prohibiting states from considering food costs in distributing administrative funds to local agencies.

    Agency Affected: Department of Agriculture

  5. Status: Closed - Implemented

    Comments: When we confirm what actions the agency has taken in response to this recommendation, we will provide updated information.

    Recommendation: The Secretary of Agriculture should require that nutritional risk assessments be made at specified intervals by competent professionals in accordance with established uniform criteria, and that the results of all such assessments, including assessments by outside providers, be made available to clinic staff for program purposes.

    Agency Affected: Department of Agriculture

  6. Status: Closed - Implemented

    Comments: When we confirm what actions the agency has taken in response to this recommendation, we will provide updated information.

    Recommendation: The Secretary of Agriculture should direct that research be started to obtain the needed information to enable USDA to effectively implement the legislative provision in the newly enacted Child Nutrition Amendments.

    Agency Affected: Department of Agriculture

  7. Status: Closed - Not Implemented

    Comments: FNS officials do not consider this recommendation to be of high priority.

    Recommendation: The Secretary of Agriculture should make certain that USDA regional offices and its internal audit staff systematically evaluate and report on state management controls over: (1) the nature, extent, and frequency of the nutritional risk assessments of program participants, and (2) the basis for, and extent of, food package prescriptions made to enable individual participant's nutritional/health needs to be met.

    Agency Affected: Department of Agriculture

  8. Status: Closed - Not Implemented

    Comments: This issue was discussed at congressional hearings at which GAO testified. The recommendation was supported in GAO testimony and in a recently issued GAO report, RCED-85-105. USDA will not agree to act on this recommendation. It says that there is no need for the development and use of uniform standards and criteria. This issue will be tracked in the follow up to RCED-85-105.

    Recommendation: The Secretary of Agriculture should work with HEW and recognized professional groups, such as the American College of Obstetricians and Gynecologists and the American Academy of Pediatrics, to develop uniform standards and criteria for determining what constitutes bona fide nutritional/health risks for the different classes of WIC program participants. Such criteria should be uniformly applied across the board to ensure equitable and consistent treatment of the program's target population.

    Agency Affected: Department of Agriculture

  9. Status: Closed - Implemented

    Comments: When we confirm what actions the agency has taken in response to this recommendation, we will provide updated information.

    Recommendation: The Secretary of Agriculture should require that individual food packages be prescribed to provide the kinds and quantities of foods needed to meet the specific nutritional needs of each recipient. Such prescriptions should be based on systematic feedback from nutritional risk assessments make by competent professionals and should specifically provide that greater or lesser amounts of food than contained in the current standard package be authorized and prescribed in accordance with case-by-case professional determinations of need.

    Agency Affected: Department of Agriculture

  10. Status: Closed - Implemented

    Comments: When we confirm what actions the agency has taken in response to this recommendation, we will provide updated information.

    Recommendation: The Secretary of Agriculture should require that states and other authorized grantees take more effective measures to ensure that health services will be available to all potential participants in WIC before approving new local programs or major program expansions. Such measures should include a requirement that specified documentation from sponsor applicants show detailed information about public and private health service capacity in the target area, including firm agreements with private doctors and other health providers that would ensure needed care for low income WIC participants.

    Agency Affected: Department of Agriculture

  11. Status: Closed - Implemented

    Comments: When we confirm what actions the agency has taken in response to this recommendation, we will provide updated information.

    Recommendation: The Secretary of Agriculture should provide more specific guidance and direction to the states, and through the states to the local programs, as to how to structure and implement an effective nutrition education program for WIC participants. Part of this effort should entail designating a Service headquarters official responsible for the nutrition education component of the WIC program. It also should involve close coordination with HEW to develop and implement an appropriate nutrition education policy and to prepare, distribute, and update related teaching materials for the WIC program.

    Agency Affected: Department of Agriculture

  12. Status: Closed - Not Implemented

    Comments: USDA will not act on this recommendation. It takes the view that confidentiality of participant medical information must be preserved.

    Recommendation: The Secretary of Agriculture should, to ensure that future legitimate program evaluators have access to needed information on participants' health status, direct FNS to revise its regulations to give USDA and GAO personnel access to participants' medical information, but require that these personnel protect the privacy of the participants.

    Agency Affected: Department of Agriculture

  13. Status: Closed - Implemented

    Comments: When we confirm what actions the agency has taken in response to this recommendation, we will provide updated information.

    Recommendation: The Secretary of Agriculture should make certain that USDA reviewers keep close watch on state efforts to arrange for appropriate health services for WIC program participants and to ensure that such services are actually available to participants as needed.

    Agency Affected: Department of Agriculture

  14. Status: Closed - Implemented

    Comments: When we confirm what actions the agency has taken in response to this recommendation, we will provide updated information.

    Recommendation: The Secretary of Agriculture should, where adequate health services are not available, accessible, and acceptable in present and planned WIC program areas, direct that USDA work with the states and local public and private agencies, and with HEW, to provide the needed services.

    Agency Affected: Department of Agriculture

  15. Status: Closed - Not Implemented

    Comments: USDA will not act on this recommendation. It believes that WIC participants should be encouraged, but not required, to receive nutrition education.

    Recommendation: The Secretary of Agriculture should drop from program regulations the proposed provision that participants not be denied supplemental food for failure to attend or participate in nutrition education activities. In light of the need for local WIC programs to fully integrate nutrition education into WIC program regulations, such restrictions on methods by which this can be effectively accomplished would be counterproductive and at odds with program goals.

    Agency Affected: Department of Agriculture

 

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