Nutrition policy reforms to address the double burden of malnutrition in Zambia: a prospective policy analysis

Author:

Mukanu Mulenga Mary1ORCID,Mchiza Zandile June-Rose12,Delobelle Peter34ORCID,Thow Anne Marie5

Affiliation:

1. School of Public Health, University of the Western Cape , Bellville, Cape Town 7535, South Africa

2. Non-Communicable Diseases Research Unit, South African Medical Research Council , Cape Town 7505, South Africa

3. Chronic Disease Initiative for Africa, University of Cape Town , Cape Town 7700, South Africa

4. Department of Public Health, Vrije Universiteit Brussel , Brussels, Belgium

5. Menzies Centre for Health Policy and Economics, University of Sydney , Camperdown, NSW 2006, Australia

Abstract

Abstract The evolution of nutrition patterns in Zambia has resulted in the coexistence of undernutrition and overnutrition in the same population, the double burden of malnutrition. While Zambia has strong policies addressing undernutrition and stunting, these do not adequately address food environment drivers of the double burden of malnutrition and the adolescent age group and hence the need for nutrition policy reforms. We conducted a theory-based qualitative prospective policy analysis involving in-depth interviews with nutrition policy stakeholders and policy document review to examine the feasibility of introducing nutrition policy options that address the double burden of malnutrition among adolescents to identify barriers and facilitators to such policy reforms. Using the multiple streams theory, we categorized the barriers and facilitators to prospective policy reforms into those related to the problem, policy solutions and politics stream. The use of a life-course approach in nutrition programming could facilitate policy reforms, as adolescence is one of the critical invention points in a person’s lifecycle. Another key facilitator of policy reform was the availability of institutional infrastructure that could be leveraged to deliver adolescent-focused policies. However, the lack of evidence on the burden and long-term impacts of adolescent nutrition problems, the food industry’s strong influence over governments’ policy agenda setting and the lack of public awareness to demand better nutrition were perceived as critical barriers to policy reforms. In addition, the use of the individual responsibility framing for nutrition problems was dominant among stakeholders. As a result, stakeholders did not perceive legislative nutrition policy options that effectively address food environment drivers of the double burden of malnutrition to be feasible for the Zambian context. Policy entrepreneurs are required to broker policy reforms that will get legislative policy options on the government’s agenda as they can help raise public support and re-engineer the framing of nutrition problems and their solutions in Zambia.

Funder

Alliance for Health Policy and Systems Research

Publisher

Oxford University Press (OUP)

Subject

Health Policy

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