Q&A: Africa's new nutrition strategy

NAIROBI — Africa is struggling with not only a rise in undernutrition but also in obesity, leading to escalating rates of diet-related noncommunicable diseases.

From 2010 to 2016, the number of undernourished people on the continent increased by 23% to 222 million people, according to the World Health Organization. Obesity rates for children aged 9 through 15 doubled during that same time frame.

In 2012, a global plan for maternal, infant, and young child nutrition was adopted by the World Health Assembly, to achieve six global targets by 2025 and ultimately end all forms of malnutrition by 2030. However, WHO acknowledged that “progress in the African Region is hampered by a policy environment that is under-equipped to control the consumption of poor-quality diets, as well as inadequate resources and capacity for effective programmes.”

In August, at the WHO Regional Committee Meeting for Africa in Brazzaville, Republic of Congo, health ministers from across the continent adopted a new strategic plan to tackle these issues.

Devex spoke with Dr. Adelheid Onyango, regional adviser for nutrition at the WHO Regional Office for Africa about the new strategy’s focus on strengthening policies and regulatory frameworks around nutrition, as well as sensitizing the population on healthy diets.

This conversation has been edited for length and clarity.

What are specific policy initiatives governments can take on?

We are looking at policies that protect healthy diets. The food environment has changed a lot, combined with lifestyle choices that are reducing activity levels. We are looking to policies that regulate the quality of foods that are sold and advertised.

When you look, for example, at the choices of food we are eating — we are leaning towards processed foods with a high content of sugar, fats, and trans fats. That’s what we are concerned about, in terms of public health. It’s high caloric content, with low nutritional value. Minimally processed cereals, millets, and grains that used to be part of the African diet, have been replaced with milled rice and pasta. We have many markets that are saturated with frozen chicken and sometimes the vendors don’t know where it comes from. We are importing meats and we don’t know the quality.

The policies that governments would put in place would work to create the capacity to test the food that is sold. What is the content and the composition of the food? What are the safety standards we need to establish? We need a way of testing and ensuring they meet defined standards of food safety and quality.

We would also look into food fortification. In order to address micronutrient deficiencies, there are standards for fortification. How do you ensure that when a product goes out to the market saying it is fortified with Vitamin A or zinc — how do we know? Do we have a system that helps us to monitor this?

Would you say the new strategy is primarily focused on quality control?

That’s just one arm of it. There is also the sensitization of the public on what is a healthy diet and why it’s important to live an active life. If people understand why eating minimally-processed food is an advantage over eating processed foods that might be more convenient, then they may invest more time in preparing fresh foods and paying a bit more.

Some countries have realized they have a huge problem with overweight and obesity, even in the young population. We can use schools as an entry point, not only to control what is given to children, because they are more easily manipulated, but also to promote positive values about food with children. They can be important change agents in adopting healthier food consumption practices.

We also want people to understand why, for example, when a government passes a taxation, a law, or a regulation on sugar-sweetened beverages, what does that mean for them? What is the good in it for them?

What are some of the tactics that can be implemented across the continent to reach people with this messaging?

We will look at each country’s identification of their priority interventions and then together with partners and government counterparts, we would look to see how to begin to address this. It needs to be adapted to the needs of each country.

Algeria, for example, has introduced taxation on sugar-sweetened beverages and fruit juices. That tax money is going directly into a fund to address the management of cancer. Those are innovative ways of getting money from within countries and investing it, especially if it’s going directly to address the problems linked with the unhealthy foods that are taxed.

What are some of the challenges in rolling out this strategy?

One of the big challenges is that it takes a long time to put in place policies that control marketing because commercial interests are very strong. The policy-making space is of keen interest for people who do not want too much control on the quality of what they are producing. It becomes too expensive for them.

Also, when you talk about educating and sensitizing the population to adopt positive food habits, it takes a long time. If someone is addicted to sugar and puts four spoons of sugar into their cup of tea, it takes a lot of will and perseverance for them to reduce the sugar to an amount where they might even eliminate it. If we are going to be effective just through education, we would have to be doing that across a population of about 20 million people. To achieve that change is a lot of work and its persistent work.

We cannot just have a television program that runs for three weeks and say we have sensitized the public. Yes, they may be sensitized but if they are not consistently and sustainably changing their practices, we are not getting where we need to go.

Sometimes, it’s a question of access. People may know it’s good to consume minimally processed foods, fresh foods, but if they are in a place where it is hard to get those products or there are controls in who can access those markets. Then, we may have the desire, but we are not able to meet the demands for healthier foods.

What sort of financial resources are needed to roll this out?

To be effective, you need to reach 90% coverage with high-impact nutrition interventions. For example, breastfeeding and micronutrient supplementation. If we were to do that, we would need something like $3.4 billion for the region. This looks like a really huge figure, but when you think that needs to be invested in 47 member states of the African region, it is actually not very much. Also, when you think about what can be supplied for in-kind, we don’t have to actually raise $3.4 billion.

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