Farm-to-Hospital Procurement in NC

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Executive Summary

Hospitals in the U.S. procure large volumes of food to feed millions of people each year. Due to the current structure of our food system, hospitals and other institutional purchasers often rely on large, national food distributors to ensure consistency and availability of food products at the lowest price. These structural inequities disadvantage smaller farms in their ability to sell to hospitals and in turn stimulate the local economy. By shifting purchases away from traditional procurement sources to local sources, these same institutions have the power to anchor their community's economy and provide increased access to high-quality foods.

In partnership with the Food Insight Group (FIG), a team of graduate students at the University of North Carolina assessed farm-to-hospital practices in North Carolina in an attempt to understand the current state of local food procurement in hospitals, barriers to increasing local food procurement, and potential opportunities to increase local food procurement. The ultimate goal of this project is to provide justification for local food purchasing in hospitals, promote local economic development, and foster the growth of small- and mid-size farms.

We identified three main goals to guide this work:

Project Goals


Our work began with a literature review of institutional food procurement practices and existing FTH initiatives in the United States. Then, to understand the state of local food procurement in hospitals in North Carolina, we conducted interviews with producers, distributors, hospitals, and researchers in the state. Informed by our qualitative analysis findings, we created and disseminated a survey to capture current local food procurement practices, barriers, and leverage points to increasing local food procurement in North Carolina.

We identified several key findings from our background research and qualitative analysis:

  • Individual changemakers rely on limited, non-institutionalized relationships, and often leverage their own resources to initiate FTH system.

  • Variation, complexity, and lack of transparency within the FTH system makes it difficult for existing stakeholders to recognize their role in the system and for potential stakeholders to enter the system.

  • The position of stakeholders in the FTH system are determined by their power, motivations, values, relationships and access to knowledge and resources.

  • Market forces have tremendous influence in promoting or dampening community-driven FTH system initiatives.

  • External environmental, political, and social factors greatly influence the FTH system.

From this research, we can conclude that, in general, hospitals in North Carolina are positioned to strengthen local food supply chains, but there are disconnects between supply chain stakeholders that prevent the flow of information and exchange of goods. For sustainable FTH sourcing to occur, those working with these systems will need to intervene at multiple points of the supply chain. Educating stakeholders in the FTH supply chain about the social and economic value of local food can result in improved health outcomes and stronger local economies.

Report Sections

Access the overview of institutional food procurement practices, including farm-to-institution systems.

Access the findings from stakeholder interviews, including gaps to a sustainable farm-to-hospital (FTH) system in North Carolina.

Access the discussion of survey development to quantify the current market and demonstrate opportunity for increased FTH procurement.

Full Report

If you would like to download the survey, please click here.