From Policy to Practice: How East Africa is Transforming Markets for Nutrition

There is an urgent need to improve food environments in the East Africa region. Rates of non-communicable diseases (NCDs) are increasing rapidly while undernutrition and micronutrient deficiencies remain unsolved challenges.  ATNi (Access to Nutrition initiative), the African Population Health Research Center (APHRC), and the Kenyan Ministry of Health (MoH) recently joined efforts hosting a two-day policy workshop ‘The East Africa Regional Dialogue‘ to discuss opportunities to transform markets for nutrition, including a comprehensive set of policy approaches to support markets to deliver healthier diets for all.  

Setting the scene: policy makers from Kenya, Tanzania and Uganda set the scene by reflecting on rapid increase in NCD burden and the change in diets in the region.  Rapid urbanization is leading to changing lifestyles and a growing preference for convenience, often in the form of process and packaged foods.  People are also increasingly exposed to advertising for “fast foods” which are often easy to prepare but lacking in key nutrients. Children and adolescents in particular are exposed to marketing of unhealthy foods, especially through online channels and by influencers. These changes hinder access to healthy, micronutrient dense foods, and are increasing burdens of NCDs, leading to high costs, for both individuals and society. In Kenya, households spend close to a third of their incomes on treating NCDs. These conditions are also placing a strain on already burdened health systems.   

East Africa is standing at a pivotal moment, with the opportunity to lead the way on the African continent, and globally, by developing progressive nutrition policies.  

What policies are effective at improving the healthiness of food environments in Africa?

Several policies show promise in improving the healthiness of the food environment:  

Limits on marking unhealthy foods and non-alcoholic beverages to children: Yolanda Radu, from Priceless, a research to policy unit of Wits University in South Africa, shared their experience advocating for strong regulation around the marketing of unhealthy foods to children. Building on the legal framework provided by the Consumer Protection Act, they brough together strong evidence of the negative impacts of child directed marketing, both on food preference and consumption. High level advocacy and public awareness campaigns raised awareness among key constituencies.   

However, industry pushback presented a critical roadblock. Industry reframed the issue with policy makers, focus on potential job loss, despite evidence to the contrary. Currently, industry has agreed to voluntary regulations that apply to advertising aimed at children under 12, with compliance monitored through a self-regulatory framework. Priceless and allies are still pushing for strong enforcement mechanisms and a higher age threshold.  

Taxation of less healthy foods:  Annabel Yeboah-Nkrumah from the University of Ghana shared their experience passing a sugar sweetened beverage tax (SSB) in Ghana, which passed by only one vote in parliament! The SSB tax was introduced and took effect on the 15th of April 2023, as a 20% levy on both sugar content and product volume, using the 2022 Ghana National NCD Policy to justify the new tax. (cont…)

The initiative was formally endorsed by the Government of Ghana and was championed by academia, civil society organizations, and development partners demonstrating a successful model of multi-stakeholder collaboration. One of the most notable outcomes of monitoring of the tax was a reported 50% reduction in the production of ultra-processed foods (UPFs) following the implementation of the tax. While the law is currently still in effect, there are ongoing discussions to repeal the tax, led by the new government, showing that just because a policy is passed does not mean that it will remain.  

Kenya’s Nutrient Profile Model: Mr. Zachary Ndegwa from the Division of Nutrition and Dietetics, Ministry of Health, Kenya presented Kenya’s pioneering work on the Kenyan Nutrition Profile Model (KNPM), supported by the Global RECAP project and funded by the International Development Research Centre (IDRC) and later by the Food Environment Policy Action Initiative (FEP-ACTION). The KNPM was developed specifically for the Kenyan context, to take into account excessive consumption of nutrients of concern including total fat, saturated fats, sodium, and total sugars. The plan is to use the KNPM as a basis for other policies, including in determining which products need to display the newly developed front-of-package nutrition warning labels (FOPNLs), or in guiding regulations around the marketing of unhealthy foods and non-alcoholic beverages to children.  When the KNPM is launched and rolled out, there are questions about backlash from industry, especially given the relatively strict nutrient thresholds around which products will need to carry a warning label.  

Regional Collaboration for effective food environment policies: Food systems transcend national boundaries, necessitating cross-border solutions to shared challenges. Many of the initiatives discussed, including agreement on a nutrient profile model (NPM) for the region, and FOPNLs, are more effective if they are introduced at the regional level, for example by a body like the East African Community (EAC). While countries are at various stages of developing NPM and FOPNLs, the EAC has the institutional foundation to support policy convergence through its four integration pillars: customs union, common market, monetary union, and political federation, and could choose to push forward a regional NPM and FOPNL. There are ongoing discussions on the best approach way forward in terms of a EAC regional approach, and what additional data would be needed to develop a regional NPM and FOPNL. Improving regional collaboration can be supported through cross-country learning and evidence sharing. Engaging stakeholders–including civil society and the private sector– are also vital to building momentum. While harmonization is complex, sustained collaboration, capacity-building, and coordinated advocacy will be key to establishing coherent, enforceable food environment policies across the region. 

Regional Collaboration for effective food environment policies: Food systems transcend national boundaries, necessitating cross-border solutions to shared challenges. Many of the initiatives discussed, including agreement on a nutrient profile model (NPM) for the region, and FOPNLs, are more effective if they are introduced at the regional level, for example by a body like the East African Community (EAC). While countries are at various stages of developing NPM and FOPNLs, the EAC has the institutional foundation to support policy convergence through its four integration pillars: customs union, common market, monetary union, and political federation, and could choose to push forward a regional NPM and FOPNL. There are ongoing discussions on the best approach way forward in terms of a EAC regional approach, and what additional data would be needed to develop a regional NPM and FOPNL. Improving regional collaboration can be supported through cross-country learning and evidence sharing. Engaging stakeholders–including civil society and the private sector– are also vital to building momentum. While harmonization is complex, sustained collaboration, capacity-building, and coordinated advocacy will be key to establishing coherent, enforceable food environment policies across the region. 

Key Questions Moving Forward:

• Industry engagement is critical, because they are ultimately the ones who need to implement policies, but we saw in all the case studies that they also were the ones fighting against proposed policies. How can we effectively engage industry to implement policies that are in the best interest for public health? 

• Regional harmonization presents a chicken and egg problem: should countries all develop their own NPMs and then try to reach consensus at the regional level? Or can a regional body lead, and engage with countries to all use the same NPM and labelling? Both options have pros and cons, but the ultimate goal of improving public health throughout the region should remain paramount to finding the best solution.  

Transforming markets for nutrition is a multifaceted challenge that demands comprehensive, evidence-based policy approaches, regional collaboration, and multi-stakeholder engagement. The APHRC-MoH-ATNi Regional Policy Workshop highlighted the critical steps needed to create healthier food environments in Eastern Africa. By prioritizing these key messages, we can pave the way for a healthier future, where nutritious food is accessible to all.