Barriers and Facilitators to the Development and Implementation of Public Policies Addressing Food Systems in Five Sub-Saharan African Countries and Five of Their Cities

Burgaz, Celia; Van Dam, Iris; Diouf, Adama; Kouakou, Kouakou Philipps; Mama, Olouwafemi M.; Kou’santa Amouzou, Sabiba; Assa Yao, Rebecca Rachel; Atwine, Blessing; Guloba, Madina M.; Lamboni, Lallepak; Nakitende, Pauline; Manga, Julien S.; Metonnou, Clémence; Koffi N’dri, Célestin; Santos, Reynald; Sossa, Charles; Sylla, Papa M.D.D.; Souho, Tiatou; Vandevijvere, Stefanie

doi:10.34172/ijhpm.8592

Barriers and Facilitators to the Development and Implementation of Public Policies Addressing Food Systems in Five Sub-Saharan African Countries and Five of Their Cities

Document Type : Original Article

Authors

Celia Burgaz ¹^{, 2}

Iris Van Dam ¹

Adama Diouf ³

Kouakou Philipps Kouakou ⁴

Olouwafemi M. Mama ³

Sabiba Kou’santa Amouzou ⁵

Rebecca Rachel Assa Yao ⁴

Blessing Atwine ⁶

Madina M. Guloba ⁶

Lallepak Lamboni ⁵

Pauline Nakitende ⁶

Julien S. Manga ⁷

Clémence Metonnou ⁸

Célestin Koffi N’dri ⁴

Reynald Santos ⁸

Charles Sossa ⁸

Papa M.D.D. Sylla ⁹

Tiatou Souho ⁵

Stefanie Vandevijvere ¹

¹ Department of Epidemiology and Public Health, Sciensano, Brussels, Belgium

² Department of geosciences, environment and society, Université libre de Bruxelles (ULB), Brussels, Belgium

³ Laboratoire de Recherche en Nutrition et Alimentation Humaine (LARNAH), Université Cheikh Anta Diop, Dakar, Senegal

⁴ Université Alassane Ouattara (UAO), Bouaké, Côte d’Ivoire

⁵ Laboratoire de Biochimie des Aliments et Nutrition, University of Kara, Kara, Togo

⁶ Economic Policy Research Centre (EPRC), Kampala, Uganda

⁷ Department of Nutrition, University of Montreal, Montreal, QC, Canada

⁸ Regional Institute of Public Health, Université of Abomey-Calavi (UAC), Ouidah, Benin

⁹ Laboratoire des Sciences Biologiques, Agronomiques, Alimentaires et de Modélisation des Systèmes Complexes (LABAAM), Université Gaston Berger de Saint-Louis, Saint-Louis, Senegal

10.34172/ijhpm.8592

Abstract

Background
There is increasing recognition of the role governments play in addressing the health and environmental sustainability challenges within current food systems. This study seeks to understand food system policies designed and/or implemented by selected national and local governments in Africa, and the barriers and facilitators faced when designing or implementing policies to create healthy and environmentally sustainable food systems.

Methods
From an evidence-based list of proposed policies with double- or triple-duty potential to achieve healthy and environmentally sustainable food systems, a policy mapping was performed in five African countries (Benin, Côte d’Ivoire, Senegal, Togo, and Uganda) and one city in each of these countries (Ouidah, Bouaké, Saint-Louis, Sokodé, and Mbale). Semi-structured interviews were then conducted with policy stakeholders. The interview data were analysed in NVivo 14 using the thematic framework analysis approach, informed by the Health Policy Triangle (HPT).

Results
The mapping showed that African countries have designed and implemented policies that simultaneously address food insecurity and climate change, mainly through food production policies. Within food environments, countries are focussing on interventions to prevent obesity, mainly food provision or food pricing policies. However, many policy gaps remain. Several technical and political barriers were commonly experienced when designing and implementing food system policies, regardless of the jurisdiction, context or region, such as insufficient financial resources, lack of political will, limited data, and inadequate monitoring and enforcement mechanisms. The major facilitators perceived were supportive public opinion and awareness, international agreements, sound agenda-setting, multi-sector and multistakeholder consultations and partnerships, availability of both financial resources and data, and solid political will.

Conclusion
This article gives an overview of policies designed and implemented to achieve sustainable food systems, highlighting a strong focus through agriculture on undernutrition and climate change objectives. It also identifies their potential legislative, financial, and practical barriers and facilitators.

Keywords

Food Systems

Global Syndemic

Policy

Sub-Saharan Africa

Araújo RG, Chavez-Santoscoy RA, Parra-Saldívar R, Melchor-Martínez EM, Iqbal HM. Agro-food systems and environment: sustaining the unsustainable. Curr Opin Environ Sci Health. 2023;31:100413. doi:1016/j.coesh.2022.100413
Willett W, Rockström J, Loken B, et al. Food in the Anthropocene: the EAT-Lancet Commission on healthy diets from sustainable food systems. Lancet. 2019;393(10170):447-492. doi:1016/s0140-6736(18)31788-4
Campbell BM, Hansen J, Rioux J, Stirling CM, Twomlow S, Wollenberg E. Urgent action to combat climate change and its impacts (SDG 13): transforming agriculture and food systems. Curr Opin Environ Sustain. 2018;34:13-20. doi:1016/j.cosust.2018.06.005
Swinburn BA, Kraak VI, Allender S, et al. The global syndemic of obesity, undernutrition, and climate change: the Lancet Commission report. Lancet. 2019;393(10173):791-846. doi:1016/s0140-6736(18)32822-8
World Health Organization (WHO). UN Report: Global Hunger Numbers Rose to As Many As 828 Million in 2021. WHO; 2021. https://www.who.int/news/item/06-07-2022-un-report--global-hunger-numbers-rose-to-as-many-as-828-million-in-2021. Accessed October 11, 2024.
World Obesity Federation. World Obesity Atlas 2023. World Obesity Federation; 2023. https://www.worldobesity.org/resources/resource-library/world-obesity-atlas-2023. Accessed October 11, 2024.
Tiseo I. Statista: Global GHG Emission Shares by Sector. Statista; 2023. https://www.statista.com/statistics/241756/proportion-of-energy-in-global-greenhouse-gas-emissions/. Accessed October 11, 2024.
Candel JJ, Biesbroek R. Policy integration in the EU governance of global food security. Food Secur. 2018;10(1):195-209. doi:1007/s12571-017-0752-5
Lang T, Mason P. Sustainable diet policy development: implications of multi-criteria and other approaches, 2008-2017. Proc Nutr Soc. 2018;77(3):331-346. doi:1017/s0029665117004074
FAO, IFAD, UNICEF, WFP, WHO. The State of Food Security and Nutrition in the World 2020: Transforming Food Systems for Affordable Healthy Diets. 2020. https://www.fao.org/3/ca9692en/online/ca9692en.html. Accessed January 26, 2024.
Swinburn B, Kraak V, Rutter H, et al. Strengthening of accountability systems to create healthy food environments and reduce global obesity. Lancet. 2015;385(9986):2534-2545. doi:1016/s0140-6736(14)61747-5
Burgaz C, Gorasso V, Achten WMJ, et al. The effectiveness of food system policies to improve nutrition, nutrition-related inequalities and environmental sustainability: a scoping review. Food Secur. 2023;15(5):1313-1344. doi:1007/s12571-023-01385-1
Aborode AT, Favour Obianuju A, Onyeaka H, et al. Editorial: Obesity and nutrition in the most remote parts of Africa. Front Public Health. 2023;11:1197367. doi:3389/fpubh.2023.1197367
FAO, AUC, ECA, WFP. Africa - Regional Overview of Food Security and Nutrition 2023: Statistics and Trends. Accra, Ghana: FAO, AUC, ECA, WFP; 2023. doi:4060/cc8743en
Global Network Against Food Crises (GNAFC). Global Report on Food Crises 2022 Mid-Year Update. GNAFC; 2022. https://reliefweb.int/report/world/global-report-food-crises-2022-mid-year-update. Accessed January 26, 2024.
Food and Agriculture Organization (FAO). Transforming the World through Food and Agriculture: FAO and the 2030 Agenda for Sustainable Development. FAO; 2019. https://www.fao.org/documents/card/en/c/CA5299EN/. Accessed January 26, 2024.
United Nations Statistics Division (UNSD). The Sustainable Development Goals Report 2024. UNSD; 2024. https://unstats.un.org/sdgs/report/2024/. Accessed October 7, 2024.
Laar A, Barnes A, Aryeetey R, et al. Implementation of healthy food environment policies to prevent nutrition-related non-communicable diseases in Ghana: national experts' assessment of government action. Food Policy. 2020;93:101907. doi:1016/j.foodpol.2020.101907
Holdsworth M, Kimenju S, Hallen G, Laar A, Oti SO. Review of policy action for healthy environmentally sustainable food systems in sub-Saharan Africa. Curr Opin Environ Sustain. 2023;65:101376. doi:1016/j.cosust.2023.101376
Burgaz C, Van-Dam I, Garton K, et al. Which government policies to create sustainable food systems have the potential to simultaneously address undernutrition, obesity and environmental sustainability? Global Health. 2024;20(1):56. doi:1186/s12992-024-01060-w
International Development Research Centre (IDRC). Harmonized Indicators for Measuring Progress Toward More Sustainable, Healthier Food Systems. https://idrc-crdi.ca/en/project/harmonized-indicators-measuring-progress-toward-more-sustainable-healthier-food-systems. Accessed April 2, 2024.
Dokua SasuD. Africa: Prevalence of Undernourishment by Country. Statista; 2024. https://www.statista.com/statistics/1305636/prevalence-of-undernourishment-in-africa-by-country/. Accessed October 11, 2024.
World Bank Group. World Bank Open Data. https://data.worldbank.org. Accessed August 26, 2024.
Mialon M. An overview of the commercial determinants of health. Global Health. 2020;16(1):74. doi:1186/s12992-020-00607-x
Miller D, Harkins C. Corporate strategy, corporate capture: food and alcohol industry lobbying and public health. Crit Soc Policy. 2010;30(4):564-589. doi:1177/0261018310376805
Brownell KD, Warner KE. The perils of ignoring history: Big Tobacco played dirty and millions died. How similar is Big Food? Milbank Q. 2009;87(1):259-294. doi:1111/j.1468-0009.2009.00555.x
Plested BA, Edwards RW, Jumper-Thurman P. Community Readiness: A Handbook for Successful Change. Fort Collins, CO: Tri-Ethnic Center for Prevention Research; 2006.
Rose N, Reeve B, Charlton K. Barriers and enablers for healthy food systems and environments: the role of local governments. Curr Nutr Rep. 2022;11(1):82-93. doi:1007/s13668-022-00393-5
Phulkerd S, Sacks G, Vandevijvere S, Worsley A, Lawrence M. Barriers and potential facilitators to the implementation of government policies on front-of-pack food labeling and restriction of unhealthy food advertising in Thailand. Food Policy. 2017;71:101-110. doi:1016/j.foodpol.2017.07.014
Mohamed SF, Juma P, Asiki G, Kyobutungi C. Facilitators and barriers in the formulation and implementation of tobacco control policies in Kenya: a qualitative study. BMC Public Health. 2018;18(Suppl 1):960. doi:1186/s12889-018-5830-x
Clarke B, Kwon J, Swinburn B, Sacks G. Understanding the dynamics of obesity prevention policy decision-making using a systems perspective: a case study of Healthy Together Victoria. PLoS One. 2021;16(1):e0245535. doi:1371/journal.pone.0245535
Gittell R, Magnusson M, Merenda M. The Sustainable Business Case Book. Saylor Foundation; 2012. https://open.umn.edu/opentextbooks/textbooks/142. Accessed March 21, 2024.
Meiksin R, Er V, Thompson C, et al. Restricting the advertising of high fat, salt and sugar foods on the transport for London estate: process and implementation study. Soc Sci Med. 2022;292:114548. doi:1016/j.socscimed.2021.114548
Kallio H, Pietilä AM, Johnson M, Kangasniemi M. Systematic methodological review: developing a framework for a qualitative semi-structured interview guide. J Adv Nurs. 2016;72(12):2954-2965. doi:1111/jan.13031
Zahidie A, Asif S, Iqbal M. Building on the health policy analysis triangle: elucidation of the elements. Pak J Med Sci. 2023;39(6):1865-1868. doi:12669/pjms.39.6.7056
O'Brien GL, Sinnott SJ, Walshe V, Mulcahy M, Byrne S. Health policy triangle framework: narrative review of the recent literature. Health Policy Open. 2020;1:100016. doi:1016/j.hpopen.2020.100016
Boyatzis RE. Transforming Qualitative Information: Thematic Analysis and Code Development. SAGE Publications; 1998.
Sing F, Carriedo A, Mackay S, Tenbensel T, Swinburn B. Barriers and enablers in designing regulations to restrict the exposure of children to unhealthy food and beverage marketing. Front Polit Sci. 2023;5:945742. doi:3389/fpos.2023.945742
Saito J, Keosada N, Tomokawa S, et al. Factors influencing the National School Health Policy implementation in Lao PDR: a multi-level case study. Health Promot Int. 2015;30(4):843-854. doi:1093/heapro/dau016
Reeve E, Thow AM, Bell C, et al. Implementation lessons for school food policies and marketing restrictions in the Philippines: a qualitative policy analysis. Global Health. 2018;14(1):8. doi:1186/s12992-017-0320-y
Fagbemi F, Oke DF, Fajingbesi A. Climate-resilient development: an approach to sustainable food production in sub-Saharan Africa. Future Foods. 2023;7:100216. doi:1016/j.fufo.2023.100216
Crippa M, Solazzo E, Guizzardi D, Monforti-Ferrario F, Tubiello FN, Leip A. Food systems are responsible for a third of global anthropogenic GHG emissions. Nat Food. 2021;2(3):198-209. doi:1038/s43016-021-00225-9
Rivera-Ferre MG. From agriculture to food systems in the IPCC. Glob Chang Biol. 2020;26(5):2731-2733. doi:1111/gcb.15022
Resnick D, Swinnen J. The Political Economy of Food System Transformation: Pathways to Progress in a Polarized World. Oxford, UK: Oxford University Press; 2023. doi:1093/oso/9780198882121.001.0001
Mozaffarian D, Angell SY, Lang T, Rivera JA. Role of government policy in nutrition-barriers to and opportunities for healthier eating. BMJ. 2018;361:k2426. doi:1136/bmj.k2426
Fanzo J, Hunter D, Borelli T, Mattei F. Diversifying Food and Diets: Using Agricultural Biodiversity to Improve Nutrition and Health. Routledge; 2013.
Herens M, ten Hove H, Bakker S, et al. Addressing Overweight and Obesity in LMICs in the Realm of Rural Development and Food Systems: Global Evidence Base versus Practice in Five Country Examples. International Fund for Agricultural Development; 2023.
Rose N, Reeve B, Charlton K. Barriers and enablers for healthy food systems and environments: the role of local governments. Curr Nutr Rep. 2022;11(1):82-93. doi:1007/s13668-022-00393-5
Brouwer H, Hiemstra W, van Vugt S, Walters H. Analysing stakeholder power dynamics in multi-stakeholder processes: insights of practice from Africa and Asia. Knowl Manag Dev J. 2013;9(3):11-31.
Milsom P, Tomoaia-Cotisel A, Smith R, Modisenyane SM, Walls H. Using system dynamics to understand transnational corporate power in diet-related non-communicable disease prevention policy-making: a case study of South Africa. Int J Health Policy Manag. 2023;12:7641. doi:34172/ijhpm.2023.7641
Mui Y, Ballard E, Lopatin E, Thornton RLJ, Pollack Porter KM, Gittelsohn J. A community-based system dynamics approach suggests solutions for improving healthy food access in a low-income urban environment. PLoS One. 2019;14(5):e0216985. doi:1371/journal.pone.0216985
Quinteros-Reyes C, Seferidi P, Guzman-Abello L, Millett C, Bernabé-Ortiz A, Ballard E. Mapping food system drivers of the double burden of malnutrition using community-based system dynamics: a case study in Peru. BMC Glob Public Health. 2024;2(1):15. doi:1186/s44263-024-00045-6